How to Counsel a Patient on Medication?
Medication counselling is a common OSCE communication station.
The aim is to help the patient understand why a medication has been started, how to take it safely, what side effects to watch for, and what monitoring or follow-up is needed.
Good medication counselling is not about listing every possible side effect. It is about giving clear, practical advice that helps the patient feel informed and safe.
Why this Matters?
OSCE Talk Tip
Explain the medication to the patient, not the examiner.
Focus on what they actually need to know:
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Why they are taking it
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When and how to take it
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How long they may need it
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The main benefits and side effects
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Important interactions or cautions
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What monitoring is needed
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When to seek help
Use ATHLETICS in your head to keep the explanation organised.
Check Understanding and Concerns
Before explaining, check what the patient already knows.
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“What have you been told about this medication so far?”
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“Have you taken it before?”
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“Is there anything in particular you’re worried about?”
Patients may be worried about side effects, interactions, alcohol, driving, pregnancy, addiction, long-term tablets or previous bad experiences.
This helps you focus the explanation.
Brief Focused History if Appropriate
The amount of history depends on the station.
If appropriate, ask briefly about medication safety:
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“Do you take any regular medication?”
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“Do you take anything over the counter, including herbal or recreational substances?”
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“Do you have any allergies?”
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“Have you ever had a bad reaction to a medication?”
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“Is there any chance you could be pregnant, or are you breastfeeding?”
The aim is not to take a full history unless the station asks for it. Focus on safety.
The Structure: ATHLETICS
A useful structure for medication counselling is:
ATHLETICS
This stands for:
A — Action
T — Timing
H — How to take it
L — Length of treatment
E — Effects and side effects
T — Tests and monitoring
I — Interactions
C — Contraindications and cautions
S — Summary and safety-net
You do not need to say “ATHLETICS” to the patient.
Use it in your head to keep the explanation organised.
A — Action
Start by explaining what the medication does and why the patient is taking it.
Keep this simple and link it to the patient’s condition.
For example:
“This medication helps lower your blood pressure. Over time, that reduces strain on the heart, brain, kidneys and blood vessels.”
Or:
“This inhaler helps reduce inflammation in the airways, which should help with wheeze and breathlessness.”
Or:
“This medication reduces the chance of blood clots forming, which lowers your risk of stroke.”
The patient should understand not just what the medication does, but why it matters.
T — Timing
Explain when and how often to take it.
For example:
“You take this once a day, ideally at the same time each day.”
Or:
“You take this twice a day, usually morning and evening.”
If timing matters, say so. Some medications are taken with food, before food, once weekly, or only when symptoms start.
Do not assume the patient will work this out from the prescription label.
H — How to take it
Explain how the medication is taken.
Is it a tablet, inhaler, injection, patch, cream, liquid or drops?
You could ask:
“Are you usually okay swallowing tablets?”
“Have you used an inhaler before?”
If technique matters, mention it. Inhalers, insulin, eye drops and patches all need practical explanation.
L — Length of Treatment
Explain how long the patient may need the medication.
Some treatments are short courses. Others are longer term. Some are started and then reviewed.
For example:
“This is a short course for one week.”
Or:
“This is likely to be a longer-term medication, but we will review how you are getting on.”
If the medication is long term, explain why:
“This is not just to treat symptoms today. It also helps reduce your risk of future complications.”
Avoid saying “you’ll be on this forever” unless that is definitely true and explained sensitively.
E — Effects and Side Effects
This section has two parts:
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What benefit you expect from the medication
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What side effects the patient should know about
Expected Benefit
Start with the positive effect.
For example:
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“This should help reduce your breathlessness.”
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“This should help bring your blood pressure down and reduce strain on the heart and blood vessels.”
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“This medication reduces the chance of blood clots forming, which lowers your risk of stroke.”
Common or Expected Side Effects
Then explain the main side effects.
You do not need to list every rare side effect. Focus on side effects that are common, important or relevant to the patient.
A useful phrase is:
“Most people tolerate this medication well, but there are some side effects it is useful to know about.”
For example:
“Some people feel dizzy when they first start it, especially when standing up.”
“This can sometimes upset the stomach.”
Serious Side Effects and Safety-Net
Mention any serious side effects the patient must act on.
For example:
“This medication can increase bleeding risk, so you should seek help if you develop black stools, vomiting blood, unusual bruising or bleeding that will not stop.”
Or:
“If you developed swelling of the lips or tongue, difficulty breathing, or felt severely unwell, you should seek urgent medical help.”
You can finish with:
“You’ll also get an information leaflet with the medication, which lists side effects in more detail. The main ones I want you to be aware of today are…”
The skill is to be honest without overwhelming or frightening the patient.
T — Tests and Monitoring
Explain whether the patient needs monitoring.
This may include blood tests, blood pressure checks, drug levels, symptom review or follow-up appointments.
For example:
“We will check your blood pressure and repeat your blood tests after starting this.”
Or:
“We need to monitor your kidney function and salt levels to make sure the medication is safe for you.”
Monitoring reassures the patient that there is a plan and shows the examiner you are thinking about safe prescribing.
I — Interactions
Mention important interactions.
You do not need to give a long list unless there is a specific interaction for that medication.
The main thing is to check what else the patient takes and warn them about anything important.
You could say:
“This medication can interact with some other tablets, so it is important we know about any prescription medication, over-the-counter tablets or herbal supplements you take.”
A useful general phrase is:
“Before starting any new medication, even something bought over the counter, it is worth checking with a pharmacist or doctor.”
If there is a major interaction, be specific.
For example:
“You should avoid alcohol with this medication because it can make you very unwell.”
C — Contraindications and Cautions
This means checking whether there is any reason the medication may not be safe or suitable.
Important areas may include:
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Allergies
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Pregnancy or breastfeeding
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Kidney disease
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Liver disease
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Asthma
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Heart conditions
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Bleeding risk
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Previous medication reactions
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Other medications
You do not need to list every contraindication to the patient. Mention the important ones for that drug.
For example:
“We would usually avoid this medication in pregnancy.”
Or:
“We need to be careful with this if kidney function is reduced.”
S — Summary and Safety-Net
At the end, summarise the main points.
Keep it short.
For example:
“So just to summarise, this is a tablet to help lower your blood pressure and protect your kidneys. You will take it once a day. We will check your blood tests after starting it. Some people feel dizzy at first, but if you feel very unwell or develop any worrying symptoms, please seek medical advice.”
Then check understanding:
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“Does that all make sense?”
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“Is there anything you would like me to go over again?”
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“Do you have any concerns about starting it?”
Always explain what to do if they develop worrying symptoms or have concerns after leaving.
Ensure you offer patients leaflets or online resources about their medication!
Chunk and Check
Do not explain the whole medication in one long speech.
Give a few points, then check the patient is following.
For example:
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“Does that make sense so far?”
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“Would you like me to go over that again?”
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“How does that sound to you?”
This is especially important when discussing side effects, because patients can easily become overwhelmed.
Example: Medication Counselling using ATHLETICS
This is an example for a blood pressure medication.
“Before I explain the medication, can I check what you’ve already been told about it?”
“Is there anything in particular you’re worried about with starting a new tablet?”
“This medication is used to lower your blood pressure. The reason that matters is that high blood pressure can put strain on the heart, brain, kidneys and blood vessels over time. Lowering it reduces the risk of problems later on.”
“You would usually take it once a day, ideally at the same time each day. ”
“It comes as a tablet. Are you usually okay swallowing tablets?”
“This is likely to be a longer-term medication, but we will review how you are getting on.”
“Most people tolerate it well. Some people can feel dizzy when they first start, especially when standing up, so take your time getting up from sitting or lying. If you feel very faint, collapse, or feel seriously unwell, you should seek medical advice.”
“We will check your blood pressure and arrange blood tests after starting it, including kidney function and salt levels, to make sure it is working safely.”
“It is important to let us know about any other medications you take, including over-the-counter tablets or supplements. If you are starting anything new, check with a pharmacist or doctor.”
“We would also check there is no reason this medication would be unsafe for you, such as previous allergy, pregnancy or significant kidney problems, depending on the specific tablet.”
“So just to summarise, this is a once-daily tablet to lower your blood pressure and reduce your risk of future problems. We will monitor your blood pressure and blood tests after starting it. The main thing to watch for is feeling very dizzy or unwell. Does that all make sense, or is there anything you would like me to go over again?”
Key Message
Medication counselling is not about naming every possible side effect.
It is about helping the patient understand why they are taking the medication and how to take it safely.
Use ATHLETICS to keep your explanation organised:
Action — Timing — How to take it — Length — Effects — Tests — Interactions — Contraindications — Summary
The best medication counselling is clear, practical and patient-centred.
Quick Structure to Remember
A focused medication counselling station can be structured around:
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Check understanding and concerns
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Take a brief safety history if appropriate
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Explain the action
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Explain timing and how to take it
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Explain length of treatment
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Discuss benefits and key side effects
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Explain monitoring
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Mention interactions and cautions
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Summarise, safety-net and check understanding
