Add “ICE” to history – Patient’s perspective

In medical history taking, “ICE” is an acronym for trilogy of “Ideas”, “Concerns” and “Expectations” which is a doctor’s tool to assess the patient’s perspective of the presenting problem. There has been a shift towards patient centered approach and many patients tend to prefer a shared decision-making model which includes their perspective. This integration of patient’s perspective has some benefits:

1. Increased patient’s satisfaction
2. Better adherence to medications
3. Fewer new medication presciribing
4. Lower likelihood of mistakes

All the patients will possess some ideas, concerns or expectations regarding their problem(s) but they may not be able to share them straight away because this is a sensitive area and a good rapport and some form of guidance is necessary for patient’s to speak out their “ICE”. It is a good idea to incorporate “ICE” tool towards the end of history taking. This tool has been used by General Practitioners (GPs) for decades, however, these may be handy for any medical/surgical specialities.

Let us briefly talk about the components of “ICE”. The definitions 1(PDF) Patients’ ideas, concerns, and expectations (ICE) in general practice: Impact on prescribing. Available from: https://www.researchgate.net/publication/23687592_Patients’_ideas_concerns_and_expectations_ICE_in_general_practice_Impact_on_prescribing [accessed Apr 10 2020]. are:

1. ‘Ideas’ – every opinion of the patient about a possible diagnosis, treatment, or prognosis
2. ‘Concern’ – expressed fear/worry of the patient about a possible diagnosis or treatment
3. ‘Expectation’ – expressed or reported expectation about a treatment , a diagnosis, or a certificate

Some of the phrases that can be used to elicit “ICE” are listed below.

Ideas (What they think it might be)

• ‘Tell me about what you think is causing it.’
• ‘What do you think might be happening?’
• ‘Have you any ideas about it yourself?’
• ‘Do you have any clues; any theories about what might be going on?’

Concerns (What they fear it might be)

• ‘What are you concerned that it might be’.
• ‘Is there anything particular or specific that you were concerned about?’
• ‘What was the worst thing you were thinking it might be?’

Expectations (What they hope or want next to happen)

• ‘What were you hoping we might be able to do for this?’
• ‘What do you think might be the best plan of action?’
• ‘How might I best help you with this?’
• ‘What were you thinking would be the best way of tackling this?’

You might as well use “ICEIE” which is derived from “ICE” with addition of “impact of the problem” and “emotions“.