Consultation Models

Overview Different models lend different perspectives to the consultation. This allows you to concentrate of different individual training needs. They are commonly asked about inn the MRCGP exam.

RCGP Model Asks the doctor to look beyond the organic and include other elements of the presentation of ill health: Physical Psychological Social

McWhinney 1972

Byrne and Long 1976 Establish a relationship Discover the reason for attending Perform verbal and physical examination The doctor, patient or both then consider the problem Discuss management

Berne 1977 Transactional Analysis Model of human behaviour Ego states Parent / Child / Adult May help in interpreting some situations

Stott and Davis 1979 Management of presenting problem Modification of help-seeking behaviour Management of continuing problems Opportunistic health promotion may be helpful in extending your outlook into the potential of each consultation

Pendleton et al 1984 Define the reason for the attendance nature and history aetiology ideas, concerns and expectations effects of the problem

Pendleton et al 1984 (cont) Consider the other problems Choose an appropriate action for each Achieve an understanding with patient Involve them in management plan Use time and resources appropriately Establish / maintain relationship

Helman 1984 Anthropological model What has happened Why has it happened? Why me? Why now? What would happen if I did nothing? What should I do about it? What can you do about it? How can I stop it happening again?

Heron 1986 Six-category intervention analysis: Prescriptive - advising / telling Informative - instructive / interpreting Confronting - challenging / feeding back Cathartic - releasing emotions Catalytic - encouraging exploration Supportive - comforting / affirming

Neighbour 1987 The Inner Consultation Connecting Summarising Handing over Safety netting Housekeeping

Murtagh 1998 What is the probability diagnosis? What serious diagnosis should not be missed? What conditions are often missed? Is this a masquerade? Is the patient trying to tell me something that I have missed?

Cambridge-Calgary Initiating the consultation Gathering information Building the relationship / facilitating the patient’s involvement Explanation and planning Closing

Neurolinguistic Planning Based on models of how the brain handles information. Identify the predominant system the patient is using and modify your communication accordingly. Kinaesthetic (feeling) Visual (seeing) Auditory (hearing)

Match problem to model Doctor Centred Expand outlook Difficult patients Difficult situations Anxious Body language Hospital based Practical teaching Helman Stott and Davis Heron Berne (TA) Murtagh Neighbour McWhinney Cambridge-Calgary

Constructive Feedback Pendleton’s Rules SETGO

Pendleton’s Rules What do you think you did well? What do I think you did well? What could have done differently? What do I think you could have done differently? How do you feel about this Finish on a positive reinforcement

SETGO What did you See? What Else did I see? What do you Think about this? What Goals can we now set? What Offers have we got to achieve these goals? (Role Play)