Consultation Models

Dr. Sameer H. AlGhamdi MBBS, ABFM, SBFM

Assistant Professor, Family Medicine, College of Medicine

Salman Bin Abdulaziz University

Outline

• Why look at consultation models?

• Aims of the consultation

• Different approaches to the consultation

• The traditional medical model

• Examples of specific consultation models

Why look at consultation models?

Neighbour Berne

Balint

Helman Stott & Davis

Pendelton

Fraser

Heron Stewart

Why look at consultation models?

• Cornerstone of GP’s

• Framework within which doctor & patient interact

• By studying other’s models, we can develop our own style

• Gives us an insight into doctor-patient relationship & patient’s perspective

• If done well, leads to better patient understanding & concordance and fewer complaints

Consultation models & styles

• No correct way to perform a consultation

• Approach varies according to situation & participants

• Different consultation styles will be effective in different circumstances/ for different doctors

Aims of the consultation

• Establish constructive relationship with patient – Enable effective communication

• Determine whether patient has any health problems/health promotion needs

• Find out (if possible) what caused them

• Assess patient & family’s emotions & attitudes towards the problem

• Establish how problems might be managed

• Good communication essential in achieving these aims

Potential barriers to effective communication

• Lack of time

• Language problems

• Differing gender/age/ethnic or social backgrounds

• ‘Sensitive’ issues to address

• ‘Hidden’ or differing agendas

• Prior difficult meetings

• Lack of trust

The traditional medical model

• History

• Examination

• Investigation

• Diagnosis

• Treatment

• Follow-up

• But….it has it’s limitations…

Examples of specific consultation models

Stott and Davis

• Management of presenting problems.

• Management of continuing problems.

• Modification of health-seeking behaviors.

• Opportunistic health promotion.

Helman Folk Model, 1981

• Suggested that patients form theory based on their experience, imagination & peer group views

• Consult doctors in order to obtain answers to 6 questions…

Helman Folk Model, 1981

1) What has happened?

2) Why has it happened?

3) Why to me?

4) Why now?

5) What would happen if nothing were done about it?

6) What should I do about it or whom should I consult for further help?

Helman Folk Model, 1981

Pro’s

• Very patient-centred

• Patient satisfied

Con’s

• Time

• Hard to apply to certain situations eg. Severe mental health

Pendleton et al – 1984

• Pendleton, Schofield, Tate and Havelock (1984) “The Consultation - An Approach to Learning and Teaching” describe seven

tasks which taken together form comprehensive and coherent aims for any consultation.

1) To define the reason for the patient’s attendance, including: i) the nature and history of the problems iii) the patient’s ideas, concerns and expectations iv) the effects of the problems 2) To consider other problems: i) continuing problems ii) at-risk factors 3) With the patient, to choose an appropriate action for each problem

:

Pendleton et al – 1984

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:

i) in the consultation

ii) in the long term

7) To establish or maintain a relationship with the patient which helps to achieve the other tasks.

:

Pendleton et al

• Pros: – Pt centred

– Ideas, concerns and expectations

– Encourages pt responsibility

• Cons: – Emergencies

Roger Neighbour – The Inner Consultation, 1987

1) Connecting – Building rapport

– Identifying patient’s views, beliefs & expectations

2) Summarising – Explaining back to patient what they have told you

– Allows for correction/development of ideas & understanding

– Useful tool if not going well!

3) Handing over – Agreeing on doctor’s and patient’s agendas

– Negotiating, influencing & gift-wrapping

– Giving ownership & responsibility of management plan to patient

Roger Neighbour – The Inner Consultation, 1987

4) Safety netting – Considering “What if?”

– Could be follow-up, advice or referral

– For benefit of both doctor & patient

5) Housekeeping – Doctor recognises importance of looking after oneself, eg.

Coffee/going for a walk etc.

– “Am I in good enough shape for the next patient?”

Roger Neighbour – The Inner

Consultation, 1987

Pro’s

• Good for acute problems

• Recognises importance of doctor looking after themselves

• Empowers patient

Con’s

• Doctor-centred

Calgary-Cambridge model-2002

• The structure (5 tasks): • Initiating the session • Gathering information • Building the relationship • Explanation and Planning • Closing the session

Calgary-Cambridge model

• The Framework: • Initiating the session

– Establishing initial rapport – Identifying the reason(s) for the consultation

• Gathering information – Exploration of problems – Understanding the patient’s perspective – Providing structure to the consultation

• Building the Relationship – Developing rapport – Involving the patient

• Explanation and Planning – Providing correct amount and type of information – Aiding accurate recall and understanding – Achieving a shared understanding: incorporation the patient’s perspective – Planning: shared decision making

• Closing the session

Summary

• The consultation is the cornerstone of general practice

• There are many models which can be used to analyse and shape consultations – Try & read more about some of them

– Aim is to develop your own style

– Different models can be used in different situations

Thank you