Initiation 23/02/2019 B Davies

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. 23/02/2019 B Davies

First Task How can you do worse? Positive alternatives 23/02/2019 PATIENT: You are a 28 year old who has had a very sore throat for 4 days. You have tried normal analgesia. You feel awful, hot shivery and ache all over. You want treated! After getting started we will stop – probably. DOCTOR You are tired and fed up. Try to do this consultation as badly as possible. Do all the things that you hope never to do in reality. 23/02/2019 B Davies

Preparation Records and computers before the consultation? Focussed attention and preparation. So many consults get off to a bad start – uncertainties at the start. ? Right patient, ? Right notes, met before?, no results, no letters, Open discussion of how doctors use Records and computers before the consultation. 23/02/2019 B Davies

Initial Rapport Effect of looking at records on non-verbal communication. Non-verbal messages override verbal cues. Role play: Opening a consultation flicking through records versus sitting there with good eye contact. Trios: patients perspective for observer 23/02/2019 B Davies

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. 23/02/2019 B Davies

Opening Question Do I know why this patient wants to see me? Brainstorm favourite openers. Main aim: Do I know why this patient wants to see me? How can these subtly change the patients response? 23/02/2019 B Davies

Listening Not “doing nothing” Components of listening? Effect of interruptions. Brainstorming Verbal facilitation: um, yes, go on, ah ha. Non-verbal facilitation: position, posture, eye contact, facial expression, animation, tone of voice. Wait-time: length of pause before asking follow-up questions ? Waiting feels unnatural: Roles play – sit behind – squeeze on shoulder etc. 23/02/2019 B Davies

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! What other problems are there? Listening more important Time management skills – my surgery always runs late Patinets have more than one thing to discuss on at least 33% of consults. “Apart from this small pimple – I’ve been getting pains in my chest all week” “By the way my left foot turned blue last week” Exact words 23/02/2019 B Davies

Agenda Setting How will we structure this time. Explicit and hidden ways of chunking. Aide memoires. Mutually understood common ground – leads to rapport, good communication and better outcomes for all. Exact words – how we do things 23/02/2019 B Davies