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Initiation

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Common Problems

• Preparation before the patient comes in.

• Listening attentively without interrupting at the beginning of the interview.

• Discovering all the issues or problems the patient wishes to discuss.

• Setting the agenda for the rest of the session.

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First Task

• How can you do worse?

• Positive alternatives

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Preparation

• Records and computers before the consultation?

• Focussed attention and preparation.

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Initial Rapport

• Effect of looking at records on non-verbal communication.

• Non-verbal messages override verbal cues.

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Identifying the Issues – the Patient Wants to Discuss

• Most doctors and nurses end up discussing not quite knowing or having an incomplete understanding of why the patient has really come.

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Opening Question

• Brainstorm favourite openers.

• Main aim:

– Do I know why this patient wants to see me?

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Listening

• Not “doing nothing”

• Components of listening?

• Effect of interruptions.

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Screening

• Order of presentation not related to either medical importance or importance to patient.

• Doctors like doing things – mustn’t leap into screening before listening.

• Remember its importance when you think you know what they are here for!

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Agenda Setting

• How will we structure this time.

• Explicit and hidden ways of chunking.

• Aide memoires.