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MRCP PACES • Communication Skills

Explaining an Abnormal CT Brain Scan

Following a First Focal Seizure

Learn how to explain an abnormal brain scan after a first seizure, communicate diagnostic uncertainty with confidence, manage patient anxiety empathetically, and discuss investigations, treatment and safety advice in a structured, patient-centred consultation.

Station Type Explaining Test Results
Setting Acute Medical Unit
Duration 10 Minutes
Difficulty ★★★★★
Clinical Context

Clinical Scenario

A 51-year-old secondary school teacher was admitted to the Acute Medical Unit after experiencing her first seizure at home. According to her husband, the episode began with rhythmic twitching of her left hand before spreading up the arm. She became briefly unresponsive and remained confused for several minutes afterwards.

She has recovered fully and feels well. Routine blood tests, electrocardiogram and chest X-ray are normal. However, her CT brain scan has shown an abnormal lesion in the right frontal lobe that is suspicious for a possible growth. The radiologist has recommended an urgent contrast MRI scan for further evaluation.

The patient has not yet been informed of the CT findings. She knows only that investigations were arranged after her seizure and is anxious to understand what happened and what the results mean.

PACES Task

Candidate Task

You are the Medical Registrar reviewing the patient on the Acute Medical Unit.

Your task is to explain the likely cause of her seizure, discuss the CT brain scan findings, communicate the uncertainty surrounding the diagnosis, outline the next steps in investigation and management, and answer any questions or concerns she may have.

Your consultation should:
  • Explain the diagnosis of a first focal seizure in clear, everyday language.
  • Communicate the abnormal CT findings honestly without prematurely diagnosing a brain tumour.
  • Respond appropriately to the patient's emotional reaction.
  • Explain why an MRI scan is needed.
  • Discuss specialist referral, possible treatment and follow-up.
  • Provide practical advice regarding driving and seizure safety.
  • Address concerns about cancer, surgery and previous headaches.
Examiner Insight

What the Examiner Is Looking For

This station is designed to assess your ability to communicate abnormal investigation results while diagnostic uncertainty remains. Examiners are not looking for a detailed neurology discussion—they want to see whether you can explain complex information clearly, respond compassionately to emotions and develop a safe, shared management plan.

High-scoring candidates avoid making unsupported conclusions, explain the purpose of further investigations, provide realistic reassurance without false certainty, and ensure that the patient leaves the consultation understanding both the current situation and the next steps.

Communication Principles

Learning Hub

Master these five communication principles to confidently explain abnormal investigation results while maintaining empathy, honesty and patient trust.

1. Explain What You Know — And What You Don't Know

Why it matters

Patients value honesty. Explain the confirmed findings clearly while acknowledging uncertainty. Avoid making a diagnosis that has not yet been established.

Say this
"The scan has shown an abnormal area in the brain. At the moment, we can't be certain exactly what it is, so we'll arrange a more detailed MRI scan to help us understand it better."
Avoid this
"The scan shows you have a brain tumour."
Examiner Pearl: Communicating uncertainty honestly is safer and scores higher than making premature conclusions.

2. Respond to Emotions Before Giving More Information

Why it matters

Unexpected investigation results often trigger fear or shock. Patients absorb information better once their emotions have been acknowledged.

Say this
"I can see this has come as a real shock. Take your time. I'm here to answer any questions and we'll go through everything together."
Avoid this
"Let's move on to what happens next."
Examiner Pearl: Pause after difficult news. A few seconds of silence often speaks louder than more words.

3. Use Plain Language

Why it matters

Medical terminology can increase anxiety and confusion. Explain seizures, scans and investigations in everyday language before introducing technical terms.

Say this
"A seizure happens because of a temporary burst of abnormal electrical activity in the brain. In your case, it appears to have started in one small area."
Avoid this
"You experienced a focal impaired-awareness seizure with a Jacksonian march."
Examiner Pearl: Patients remember explanations, not medical terminology.

4. Explain the Next Steps Clearly

Why it matters

Anxiety reduces when patients understand what will happen next and why each investigation or referral is necessary.

Say this
"The next step is an MRI scan, which gives much more detailed images than the CT scan. After that, a neurologist will review the results with you and discuss the best treatment plan."
Avoid this
"We'll just wait and see."
Examiner Pearl: Patients should leave the consultation knowing exactly what happens next.

5. Finish With Safety and Support

Why it matters

The consultation should end with practical advice, reassurance of ongoing support and a clear opportunity for further questions.

Say this
"Although we still need more information, there are some important things you can do to stay safe. We'll also make sure you have specialist support throughout this process."
Avoid this
"You'll hear from someone once the MRI is done."
Examiner Pearl: Strong candidates always combine practical advice with ongoing support and a clear safety-net.
Consultation Guide

Stage-by-Stage Consultation

Stage 1

Introduction & Setting the Agenda

Objective

Introduce yourself, establish rapport and explain that you are reviewing the results of today's investigations.

Example Dialogue

"Hello Mrs Smith, I'm Dr Ahmed, one of the Medical Registrars looking after you today."

"I'd like to talk through the results of the tests you've had and discuss what we think happened this morning. We'll also talk about what happens next, and I'll answer any questions you have."

Avoid

"I've come to tell you about your scan."
Examiner Thinking

Candidates should prepare the patient for an important conversation before delivering potentially distressing information.

Stage 2

Explore Understanding & Concerns

Objective

Establish what the patient remembers about the event, what she has already been told, and what she is most concerned about before providing new information.

Example Dialogue

"Before I explain the results, could you tell me what you remember about what happened today?"

"What have the doctors told you so far?"

"Is there anything in particular that's worrying you at the moment?"

Avoid

Launching straight into the CT findings without first exploring the patient's understanding.
Examiner Thinking

Good communication starts with understanding the patient's perspective. This also allows you to correct misconceptions and tailor your explanation.

Stage 3

Explain the First Seizure

Objective

Explain that the episode was most likely a focal seizure using simple, reassuring language. Ensure the patient understands this before discussing the scan findings.

Example Dialogue

"From everything you've told us, together with your husband's description, we think you experienced a seizure."

"A seizure happens because of a temporary burst of abnormal electrical activity in the brain. In your case, the abnormal activity appears to have started in one small area before affecting your awareness. That's why only your left arm was shaking at first, rather than your whole body."

"Does that explanation make sense so far?"

Key Teaching Points

  • Explain the seizure before discussing its underlying cause.
  • Use everyday language rather than neurological terminology.
  • Pause frequently to check understanding.
  • Signpost that you are now going to explain why the investigations were performed.
Examiner Thinking

Strong candidates explain the event in clear language and ensure the patient understands the diagnosis of a first focal seizure before introducing the abnormal CT findings.

Stage 4

Explain the CT Brain Scan Findings

Objective

Explain the abnormal CT scan honestly and compassionately while avoiding premature conclusions. Make it clear that the scan has identified an abnormal area, but further investigations are needed before a definite diagnosis can be made.

Example Dialogue

"To help us understand why the seizure happened, we arranged several investigations, including blood tests and a CT scan of your brain."

"The reassuring news is that your blood tests were all normal."

"However, the CT scan has shown an abnormal area in the right front part of your brain."

(Pause)

"At this stage, we can't say exactly what that abnormal area represents. One possibility is that it could be a growth, but the CT scan isn't detailed enough to tell us for certain."

Key Teaching Points

  • Start with the normal investigation results before discussing the abnormal findings.
  • Use the phrase "abnormal area" before introducing the possibility of a growth.
  • Avoid saying the patient has a brain tumour or cancer.
  • Pause after delivering the abnormal result to allow the patient time to process the information.
Examiner Thinking

This stage assesses your ability to communicate uncertainty. Candidates should explain what is known, acknowledge what remains uncertain and avoid making unsupported diagnoses.

Stage 5

Respond to Emotions

Objective

Recognise the patient's emotional response before providing further explanations. Allow silence, acknowledge the impact of the news and demonstrate empathy.

Example Dialogue

"I can see this wasn't the news you were expecting."

"I'm sorry you're having to deal with this uncertainty."

"Please take your time. I know this is a lot to take in."

(Allow silence)

"What is going through your mind at the moment?"

If the Patient Asks, "Does this mean I have brain cancer?"

"I understand why that would be your first concern."

"At the moment, we simply don't know exactly what the abnormal area represents."

"Some brain growths are non-cancerous, while others are cancerous. The CT scan alone cannot tell us which it is. That's why the MRI scan is so important."
Examiner Thinking

Empathy should always come before further explanation. Candidates who immediately continue talking without recognising emotion often lose valuable communication marks.

Stage 6

Explain the MRI Scan & Next Steps

Objective

Explain why an MRI scan is required, what additional information it provides and how it will guide further management.

Example Dialogue

"The next step is to arrange an MRI scan."

"An MRI provides much more detailed pictures of the brain than a CT scan, helping us understand exactly what this abnormal area is."

"During the scan you'll receive a contrast injection into a vein, which helps produce clearer images."

"Once we have the MRI results, we'll ask our Neurology team to review you. They'll discuss the findings with you and recommend the most appropriate treatment."

Key Teaching Points

  • Explain the purpose of the MRI rather than simply stating it has been requested.
  • Link each investigation to the clinical question it aims to answer.
  • Explain that specialist review depends on the MRI findings.
  • Reassure the patient that she will not face the next steps alone.
Examiner Thinking

Patients should leave this stage understanding why further investigations are necessary and what will happen after the MRI. A clear management plan helps reduce uncertainty and anxiety.

Stage 7

Discuss Management & Specialist Review

Objective

Explain how the MRI findings will guide further management and introduce the role of the Neurology and Neurosurgical teams.

Example Dialogue

"Once the MRI scan has been completed, one of our Neurology specialists will review you."

"They may arrange additional investigations, such as an electrical recording of the brain (an EEG), and they'll discuss whether you would benefit from medication to reduce the risk of further seizures."

"If the MRI suggests that the abnormal area needs further assessment or treatment, we'll also involve our Neurosurgical team, who will discuss all available treatment options with you."

Key Teaching Points

  • Introduce specialists as part of the patient's support network.
  • Avoid discussing treatments that have not yet been indicated.
  • Explain that management depends on the MRI findings.
  • Reassure the patient that decisions will be made together.
Examiner Thinking

Strong candidates avoid speculating about surgery or long-term treatment before the diagnosis has been established.

Stage 8

Provide Safety Advice

Objective

Discuss practical measures to reduce the risk of harm should another seizure occur, including driving restrictions and general safety advice.

Example Dialogue

"Because you've had a seizure, there is a possibility that another one could occur."

"For your own safety and the safety of others, you must stop driving until you've been assessed by the specialist team and it is safe for you to drive again."

"We'll also advise you about informing the driving authority and explain when driving can be resumed."

"Until we know more, it's sensible to avoid activities where a sudden loss of awareness could put you or others at risk, such as swimming alone, climbing ladders or working at heights."
Examiner Thinking

Safety advice is an essential component of this consultation. Candidates should explain the reason for the restrictions rather than simply issuing instructions.

Stage 9

Address Additional Concerns

Objective

Answer questions honestly, acknowledge uncertainty and avoid criticising previous healthcare professionals.

Example Dialogue

If asked, "Can this abnormality be removed?"

"That depends entirely on what the MRI shows. If treatment is needed, our Neurosurgical team will explain the available options and help you decide what is best."

If asked, "Did my GP miss this?"

"I understand why you're asking that question."

"Based on what you've described, your headaches didn't have the warning features that would normally prompt an urgent brain scan."

"Now that you've experienced a seizure, we have new information, which is why these investigations are appropriate."

Key Teaching Points

  • Never criticise another healthcare professional.
  • Base your explanation on the information available at the time.
  • Acknowledge the patient's concerns before providing reassurance.
  • Remain honest if the answer is not yet known.
Examiner Thinking

Candidates are expected to maintain professionalism, avoid hindsight bias and answer challenging questions without making speculative or defensive statements.

Stage 10

Summarise, Safety-Net & Close

Objective

Summarise the consultation, reinforce the key messages, check understanding and ensure the patient knows how to access further support.

Example Dialogue

"To summarise, we believe today's episode was most likely a focal seizure."

"The CT scan has shown an abnormal area in your brain, but we don't yet know exactly what it is."

"The MRI scan will help us understand this in much more detail, and you'll then be reviewed by our Neurology team to discuss the results and the next steps."

"In the meantime, it's important that you don't drive and that you follow the safety advice we've discussed."

"I appreciate this has been a lot of information to take in. What questions do you have before we finish today?"
Examiner Thinking

Finish with a clear summary, reinforce diagnostic uncertainty, provide practical safety-netting and invite further questions. Patients should leave feeling informed, supported and aware of the next steps.

Assessment Guide

Examiner's Checklist

These are the communication behaviours examiners expect from high-performing PACES candidates during this station.

Build Rapport

Introduces themselves, establishes rapport, sets the agenda and explores the patient's understanding before discussing the results.

Explain Clearly

Explains the seizure and CT findings using simple, patient-friendly language without unnecessary medical jargon.

Communicate Uncertainty

Explains that the CT scan has identified an abnormal area while making it clear that further imaging is required before a diagnosis can be confirmed.

Demonstrate Empathy

Recognises emotional responses, allows time for reflection and responds with empathy before providing further information.

Explain the Next Steps

Clearly explains the purpose of the MRI scan, specialist review, possible investigations and future management.

Ensure Safety

Provides appropriate driving advice, discusses seizure safety, summarises the consultation and checks the patient's understanding.

Avoid These Mistakes

Common Pitfalls

Avoid these common communication errors to maximise your PACES score and maintain patient confidence.

Diagnosing a Brain Tumour Too Early

A CT scan showing an abnormal area does not confirm a brain tumour or cancer. Avoid making a definitive diagnosis before further investigations have been completed.

Ignoring the Patient's Emotions

Delivering unexpected news without pausing to acknowledge the patient's emotional response can make the consultation feel rushed and impersonal.

Using Excessive Medical Jargon

Terms such as Jacksonian march, focal impaired-awareness seizure or space-occupying lesion are rarely helpful for patients. Explain concepts in plain language instead.

Forgetting Safety Advice

Driving restrictions and seizure precautions are essential parts of the consultation. Failure to discuss them is a common reason for losing marks.

Criticising Previous Healthcare Professionals

If asked whether the GP should have diagnosed the problem earlier, avoid assigning blame. Explain that decisions are based on the information available at the time.

Rushing Into Management

Before discussing MRI scans, medications or specialist referrals, ensure the patient understands the seizure and CT findings and has had an opportunity to ask questions.

Communication in Practice

Handling Challenging Questions

Patients often ask difficult questions immediately after hearing about an abnormal scan. These responses demonstrate empathy, honesty and effective communication of uncertainty.

"Does this mean I have a brain tumour?"

"The CT scan has shown an abnormal area, but it doesn't tell us exactly what it is. One possibility is a growth, but there are several possible causes. The MRI scan will provide much more detailed information before we can make a diagnosis."

"Is it cancer?"

"I understand why you're worried about that. At this stage we simply don't know. Some brain growths are non-cancerous, while others are cancerous. The MRI scan is needed to determine what this abnormal area represents."

"Will I need an operation?"

"That will depend entirely on what the MRI shows. Some conditions require surgery, while others are managed without an operation. If treatment is needed, our specialist team will explain all the options and involve you in every decision."

"Did my GP miss this?"

"I understand why you're asking that. Based on the information available at the time, your symptoms may not have suggested the need for an urgent brain scan. Today's seizure has given us new information, which is why these investigations have now been arranged."

"Can I still drive?"

"Because you've had a seizure, you shouldn't drive for now. This is to protect both you and other road users. We'll explain the driving regulations and let you know when it is safe to drive again after specialist assessment."

"What happens next?"

"The next step is an MRI scan, which gives much more detailed images of the brain. Once we have those results, you'll meet with the Neurology team to discuss the findings, answer your questions and agree on the most appropriate treatment plan."

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