THE CONSULTATION

OUTCOMEPROCESSBAD CONSULTATIONSPRESCRIBINGTELEPHONE CONSULTATIONS

OUTCOME

SATISFACTION

ENABLEMENT

AGENDAS

COMPLIANCE

PROCESS

TRADITIONAL MEDICAL MODEL HOLISTIC AND SOCIOLOGICAL ANTHROPOLOGICAL SIX CATEGORY INTERVENTION

ANALYSIS TRANSACTIONAL ANALYSIS TASK ORIENTATED MODELS

STOTT AND DAVIS (1979)

1. Management of presenting problems

2. Modification of health seeking behaviour

3. Management of continuing problems

4. Opportunistic health promotion

BYRNE AND LONG (1976) 1. The doctor establishes a relationship with

the patient 2. The doctor attempts to discover the reason

for the patient’s attendance 3. The doctor conducts a verbal or physical

examination or both 4. The doctor and/or the patient consider the

condition 5. The doctor and/or the patient detail further

treatment or investigation 6. The consultation is terminated usually by

the doctor

PENDLETON ET AL (1984) 1. Define the reason for the patient’s

attendance including ideas, concerns and expectations

2. Consider other problems (continuing problems, at-risk factors)

3. Choose an appropriate action with the patient 4. Achieve a shared understanding of the

problem with the patient 5. Involve the patient in management. Share

responsibility 6. Use time and resources appropriately 7. Establish a relationship which helps to

achieve other tasks

ROGER NEIGHBOUR (1987) 1. Connecting-forming a rapport, learning about

the patient and their problems 2. Summarising-making a diagnosis in physical,

psychological and social terms. Checking back with the patient that they agree with the summary

3. Handover-a management plan is negotiated, agreed upon and responsibility is handed back to patient to see the plan through

4. Safety net-the patient is given advice on what to do if the problem doesn’t resolve as predicted

5. Housekeeping-looking after yourself

BAD CONSULTATIONS

THE PATIENT’S AGENDA

PSYCHODYNAMICS- Balint 1957

PRESCRIBING

EXTERNAL FACTORS

TELEPHONE CONSULTATIONS ADVANTAGES Majority of diagnoses made on history alone Convenience for patients Rapid access if well organised Can be delegated e.g. NHS Direct Protocols available to guide decisions Triage by telephone- fewer home visits,

fewer extras in surgery, reduction in stress

TELEPHONE CONSULTATIONS DISADVANTAGES An essentially new consultation skill which

requires further training Loss of visual and behavioural clues Sub-optimal communication can lead to

misunderstanding Easy to bring pre-conceptions to the

consultation Problems with nurse-led triage: time required

to develop safe guidelines; need for quality control and audit

The Telephone Consultation Introduce oneself Record details of patient, time etc. Gather information Consider the likely diagnosis Giving advice- home management plan

if appropriate, assess caller’s satisfaction with approach

Safety netting with explicit plan of when to call back

Record-keeping