consultation models
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Consultation Models. The Second Termers. Why the consultation?. Pivotal to everything we do as GPs Gives insight into doctor-patient relationship Likely to feature in every module of the exam Leads to better patient understanding, better concordance, fewer complaints. - PowerPoint PPT PresentationTRANSCRIPT
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Consultation Models
The Second Termers
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Why the consultation?• Pivotal to everything we do as GPs• Gives insight into doctor-patient
relationship• Likely to feature in every module of the
exam• Leads to better patient understanding,
better concordance, fewer complaints
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“Poor communication about illness causes more suffering than any other problem except unrelieved pain”.
Avril Stedeford - Facing Death 1984
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Consulting in UK General Practice
• Average length of 7.5 minutes• Fastest in Europe• We will each do 200,000 during
out careers
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Why model the consultation?
• We subconsciously make models for anything we do regularly
• By studying other peoples models we can develop our own
• Helps us understand patient’s perspective
• Make us safer and more thorough
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Hospital Model• History• Examination• Investigations• Diagnosis• Management plan• Follow-up
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What if we cannot make a diagnosis?What if a patient doesn’t like the
management plan?What if the patient has hidden agenda?What if the patient’s concerns are not
addressed?
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Dr. Roger “Karl” Neighbour
• President of RCGP• The Inner
Consultation 1984• 5 checkpoints
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• Connecting• Summarising• Safety netting• Handing over• Housekeeping
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Connecting• Building rapport• Identify patients
views, beliefs and experiences
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Summarising• Explaining back to the
patient what they have told you.
• Allows for correction, development of ideas/understanding
• Useful tool if things are not going well
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Handing over• Agreeing on a
management plan• Giving ownership and
responsibility of that management plan to the patient
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Safety-netting• Considering “what if?”• Can take form of follow-
up, what to do if problem continues, referral.
• For benefit of patient and the Dr.
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Housekeeping• The Dr recognising
the importance of looking after oneself.
• Coffee, going for a walk, check score in the cricket.
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Neighbour’s model Pros:• Good for acute
problems• Recognises
importance of Dr looking after himself
• Empowers patient
Cons:
•Dr centred
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Helman’s “Folk Model”• 1981• Medical Anthropologist• Patients form a theory based on their
– Experience– Imagination– Peer group views
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Helman’s “Folk Model”• WHAT has happened?• WHY has it happened?• Why to ME?• Why NOW?• What would happen if NOTHING DONE
about it?• What should I DO ABOUT IT or whom
should I consult?
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Helman’s “Folk Model”Pros:• Very patient
centred• Patient
satisfaction
Cons:• Time• Hard to apply to
certain situations e.g. severe mental health, elderly, emergencies.
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Transactional Analysis• 1964 Eric Berne• Parent
– Critical or caring
• Adult– Logical
• Child– dependent
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Transactional AnalysisPros:• Important to be
aware of role• Attempt to break
patterns of behaviour
Cons:• Not always
relevant
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Stott & Davis• 1979• 4 areas can be
systematically explored each time a patient consults
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Stott & Davis• Management of the PRESENTING
PROBLEM• Modification of HEALTH SEEKING
BEHAVIOURS• Management of CONTINUING
PROBLEMS• Opportunistic HEALTH PROMOTION
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Stott & DavisPros:• QOF• Long term
benefits of modifying behaviour
Cons:• May miss
psychological problems
• No account of patient’s health beliefs
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Pendleton et al• 1984, 2003• 7 tasks
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Pendleton et al• DEFINE the reason for attendance
• Consider OTHER PROBLEMS
• With the patient chose an APPROPRIATE ACTION for each problem
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Pendleton et al• Achieve a SHARED UNDERSTANDING of the
problems with the pt
• INVOLVE the pt in management decisions & encourage to TAKE RESPONSIBILITY
• Use TIME & RESOURCES appropriately
• ESTABLISH or maintain a RELATIONSHIP with the pt
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PENDLETON1. Define the reason for the patient’s attendance,
including:• Nature and history of problem• Their aetiology• Ideas concerns and expectations• Effects of the problem
2. Consider other problems:• Continuing problems• At risk problems
3. With the patient, to choose an appropriate action for each problem.
4. To achieve a shared understanding of the problems with the patient.
5. To involve the patient in the management and encourage him to accept appropriate responsibility
6. To use time and resources appropriately:• In the consultation• In the long term
7. To establish or maintain a relationship with the patient which helps to achieve the other tasks
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Pendleton et alPros:• Pt centred• Ideas, concerns,
expectations• Encourages pt
responsibility• Basis for
summative assessment videos
Cons:• Emergencies
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In summary• Numerous models• Apply to different consultations• Important to know NEIGHBOUR &
PENDLETON plus one other