The Rough Guide to consultation skills
Consultation tasks Establish rapport Get the patient to tell you what is wrong Explore what the patient hasn’t told you What does the patient think is wrong and what do they want? Summarise (frequently!) Examine the patient Explain the problem Share management options Safety net
Five checkpoints (Roger Neighbour) Connect Summarise Hand over Safety net Housekeeping
Consultation tasks Establish rapport Get the patient to tell you what is wrong Explore what the patient hasn’t told you What does the patient think is wrong and what do they want? Summarise (frequently!) Examine the patient Explain the problem Share management options Safety net
An exercise in establishing rapport
‘Eliciting’ micro-skills Nudging Echoing Feedback-eg ‘I noticed’ Checking (mini summary) Explain why you are asking Statement as a question ‘My friend John’ The ‘square search’
Group work to practice micro-skills 1. haematuria 2. several episodes of severe abdominal pain 3. a cough for 6 weeks
Recognising and responding to cues verbal emotional Non-verbal
What a cue is and what it is not
Verbal cues to hidden agenda What is said What is not said Speech censoring Turbulence Imprecise language Emotive language Opening gambits and curtain raisers
Non-verbal cues The ‘set-up’ Body language Eye contact, internal search
Emotional cues Micro emotions Unexpected emotions Mismatched emotions
What to do with cues? Ignore them Notice them and store for later Comment Act, change the consultation plan