Find the IMP: Resources for GP Trainees and Educators

Conceptual Framework

Find the IMP builds on and integrates into establish consultation models

  
      Model
      How IMP fits
    
      Calgary-Cambridge (Kurtz et al., 2005)
      IMP maps to gathering information: exploring patient’s lived experience (Impact), beliefs (Meaning), and expectations/goals (Priorities). It informs the explanation and shared decision-making stages.
    
      Pendleton et al. (2003)
      IMP aligns with: find out why the patient has come and identify and negotiate the patient’s agenda, supporting collaborative planning.
    
      Helman’s Folk Model (2007)
      IMP operationalizes understanding of patient beliefs about illness, incorporating personal, cultural, and psychosocial meaning into care planning.
    
      ICE (Ideas, Concerns, Expectations)
      
        IMP complements ICE by systematically eliciting:
        Impact: practical and emotional effect on life
Meaning: patient’s explanatory model
Priorities: what matters most to the patient, enabling negotiation of care

Rationale:

Enhances patient-centered communication (Mead & Bower, 2000).
Supports safe, effective, and negotiated management planning.
Demonstrates competence in all RCGP communication domains: data gathering, relationship building, and management planning.

The IMP Framework

  
      Element
      Purpose
      High-level Question Stems
      Notes
    
      Impact
      Understand practical, emotional, and social consequences
      
        “How has this affected your daily life/work?”

        “What has been most challenging for you?”
      
      Explore functional limitations, family/work impact, social isolation, emotional burden
    
      Meaning
      Explore patient beliefs, understanding, and explanatory models
      
        “What do you think is causing these symptoms?”

        “What worries you most about it?”
      
      Include biomedical, cultural, or personal explanatory models
    
      Priorities
      Identify what the patient wants to achieve from consultation or treatment
      
        “What matters most to you right now?”

        “If we could do one thing today, what would help most?”
      
      Priorities may differ from clinician’s agenda; negotiation and shared decision-making are key

Stepwise Application in Consultation

Step 1 – Establish ICE

Identify patient’s Ideas, Concerns, Expectations.
Sets the stage for deeper exploration of IMP.

Step 2 – Explore IMP

Impact → Meaning → Priorities.
Use open questions, reflective listening, and summarisation.
Capture explicit and implicit cues.

Step 3 – Integrate IMP with Clinical Assessment

Align patient priorities with biomedical needs.
Identify potential conflicts or negotiation points.

Step 4 – Shared Decision-Making & Negotiation

Present options aligned with patient priorities.
Address safety, chronic disease targets, and psychosocial concerns.
Document rationale and negotiated plan.

Step 5 – Reflective Practice

Reflect on consultation: Did eliciting IMP change your understanding?
How did it inform management and patient engagement?
What communication techniques were most effective?

Scenarios where Find the IMP is especially useful

Multi-problem consultations/Consultations with lists:
Use IMP to prioritise which issues to address first.
Hidden agendas:
IMP exploration can uncover fears, misconceptions, or social concerns not revealed in ICE.
Chronic or complex illness:
Use IMP to guide personalised care plans. Finding the IMP can give clarity as to issues with perceived noncompliance and taken into management it can ensure that the patient’s and the clinicians agenda and outcomes align.
Negotiation skills:
Explicitly summarise and confirm priorities with patient: “It seems your main goal is X; medically, we also need to address Y. Let’s agree how to manage both.”
Documentation:
Clearly record patient’s IMP alongside ICE to demonstrate patient-centered care.

Example Scenario’s

Case 1 – Adult Woman with Chronic Pain

Patient: 46-year-old teacher, chronic back pain, frustrated at inability to exercise.

ICE: “I think my posture is causing the pain; I worry about long-term damage; I want painkillers.”
IMP:
- Impact: Reduced ability to work and care for children.
- Meaning: Fear of permanent disability.
- Priorities: Wants functional improvement more than medication alone.

Case 2 – Older Man with Multiple Comorbidities

Patient: 72-year-old man, diabetes, heart failure, depression.

ICE: “I want my blood pressure checked; I’m worried about side effects.”
IMP:
- Impact: Fatigue limiting social engagement.
- Meaning: Believes illness is punishment for lifestyle choices.
- Priorities: Wants to maintain independence and avoid hospital admission.

Case 3 – Young Adult with Mental Health and Work Stress

Patient: 28-year-old woman, anxiety, intermittent insomnia.

ICE: “I feel stressed; I think therapy might help; I hope this will get better.”
IMP:
- Impact: Missed workdays, disrupted relationships.
- Meaning: Fear that anxiety will prevent career progression.
- Priorities: Wants practical strategies to manage anxiety at work and sleep better.

Reflection & Training Prompts

How did eliciting IMP help your understanding of the patient?

Were patient priorities aligned with your priorities?
How did you negotiate any differences?
Which communication strategies help you to elicit patient priorities and discover the disease impact?
How could IMP exploration improve safety and adherence?

References

Helman C. Culture, Health and Illness. 5th edition. London: Hodder Arnold; 2007.
https://www.waterstones.com/book/culture-health-and-illness-fifth-edition/cecil-g-helman/cecil-helman/9780340914502
Kurtz S, Silverman J, Draper J. Teaching and Learning Communication Skills in Medicine. 2nd edition. Abingdon: Radcliffe Medical Press; 2005.
https://www.waterstones.com/book/teaching-and-learning-communication-skills-in-medicine/suzanne-kurtz/juliet-draper/9781857756586
Pendleton D, Schofield T, Tate P, Havelock P. The New Consultation: Developing doctor-patient communication. 2nd Edition. 2003
https://www.waterstones.com/book/the-new-consultation/david-pendleton/theo-schofield/9780192632883
Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7):1087–1110.
https://www.sciencedirect.com/science/article/abs/pii/S0277953600000988?via%3Dihub
RCGP Curriculum for Specialty Training, 2025.
https://www.rcgp.org.uk/mrcgp-exams/gp-curriculum

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