How can ICE help us communicate with patients?

Ice is something historically and traditionally associated with the Physiotherapy profession, however this blog isn’t about the brittle transparent crystalline solid, nor is it a post outlinig the benefits, role and indications for cryotherapy. No, this blog is about communication!

It has been shown that on average, it only takes a patient 92 seconds to explain their problem to you however, the average time a patient is given to speak prior to interruption by the clinician is only 23 seconds.

It is becoming increasingly recognised how the way that we communicate is highly important for our therapeutic relationship with patients, clinical outcomes, guidance of expectations and so as to not induce iatrogenic disability. ‘ICE’ is a model of communication that historically has been used by GP’s to help structure their consultations to provide maximum effect within often limited time, whilst providing clarity to the clinical encounter (Matthys et al. 2009).

Ice, Ice, Baby..

Ice, Ice, Baby..

I was introduced to ‘ICE’ on the Clinical Maze course delivered by Steve Nawoor . Since attending this course, I’ve been utilising ‘ICE’ in my practice to guide my consultations with the aim of improving the outcomes of my patients.

ICE stands for:

– Ideas

– Concerns

– Expectations

Traditionally, the model proposes exploring these three constructs in that order however, I’ve personally adopted a more ‘laissez faire’ model (or maybe I should pioneer a new term, the ‘Modified ICE Model’ a.k.a Water!!) whereby I let the patient speak and guide the consultation in the way they feel appropriate whilst ensuring that I have the ‘ICE’ model in my mind. In doing so, during the conversation I can entice out what the patient may think is going on, any concerns they have, why they think this, where these concerns may have come from and what they expect from both the consultation and by the way of future management. Our qualitative work that is currently under review demonstrates that patient expectation of treatment matches their understanding of the problem and ultimately this will determine satisfaction and potentially outcome; the ‘ICE’ model therefore may help provide those of us at the clinical coalface with a method or framework to be able to influence patient understanding and expectations.

The purist ‘ICE’ model also suggests that you should consider that if a third party is present (i.e. a friend or family member) or the patient brings a third party into the conversation (e.g. my partner thinks I’ve torn a muscle and therefore shouldn’t be going to the gym), that it may be beneficial to consider ‘ICE’ with them also due to the influence that they may exert on your patient’s beliefs, compliance and ultimately outcome.

There are some fantastic resources on communication during the clinical encounter from the GP literature. As we move more into First Contact Practitioner roles and taking on tasks historically undertaken by GPs, we find ourselves consulting in less time than we may normally be used to; interacting and learning from these resources is invaluable.

Some questions that may help you apply ‘ICE’ to your practice are below; these were developed for GP Training but are equally applicable to Physiotherapy practice:

Ideas (beliefs)

  • ‘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?’
  • ‘You’ve obviously given this some thought, it would help me to know what you were thinking 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?’
  • ‘In your darkest moments …‘


  • ‘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?’
  • ‘You’ve obviously given this some thought, what were you thinking would be the best way of tackling this?’

Increasingly, people are presenting with more complex problems, a greater amount of co-morbidity and often persistent pain. Don’t just assume that the person is presenting to you because they expect 100% pain resolution; understand their expectations, work with them to achieve this and ultimately we may see higher satisfaction and improved outcomes.