consultation Dr. JAWAHER AL-AHMADI MB. ABFM. SBFM

What are the reasons for pt consulting ? For relief of symptoms & diagnosis For relief of symptoms & diagnosis For normal medical service For normal medical service For reassurance For reassurance For support For support For playing games For playing games As habitual response to anxieties As habitual response to anxieties For certification For certification For follow-up For follow-up For referral For referral For prescription For prescription

What are the doctor’s objectives from the consultation ? Establishing and maintaining relationship Establishing and maintaining relationship Obtaining information relating to the pt problem Obtaining information relating to the pt problem Conveying appropriate information to the pt Conveying appropriate information to the pt Terminating the consultation in the shortest possible time Terminating the consultation in the shortest possible time

Some early truths to remember The patient is as frightened as you are The patient is as frightened as you are The patient think is more serious than you The patient think is more serious than you Illness is frightening but understanding what is going on helps Illness is frightening but understanding what is going on helps

The health belief model Health motivation Perceived vulnerability Perceived seriousness Perceived costs and benefits

Locus of control The internal controller The internal controller The external controller The external controller The powerful other The powerful other

Diagnostic process Cues Clinical,behvioral Hypothesis Search History.exam,invest managment Follow-up Unexpected cues revise

Psychological & Social Component of Physical Problem Illness behavior Illness behavior Interaction between psyho- social and physical problems Interaction between psyho- social and physical problems

Models of consultation Pt centered Pt centered Use of pt’s knowledge & experience Use of pt’s knowledge & experience PHC PHC Doctor centered Doctor centered Use of doctor’s skills & knowledge Use of doctor’s skills & knowledge Hospital Hospital

Pandleton seven tasks To establish & maintain Dr-pt relationship To establish & maintain Dr-pt relationship To define the real reasons for pt attendance To define the real reasons for pt attendance To consider other problems To consider other problems To choose with the pt appropriate action for each problem To choose with the pt appropriate action for each problem To achieve a share understanding To achieve a share understanding To involve pt in the management To involve pt in the management To use time & resources effectively To use time & resources effectively

To establish & maintain Dr-pt relationship Why ? Why ? What ? What ? How ? How ?

Dr – Pt Relationship

To establish & maintain Dr-pt relationship Welcoming the pt Welcoming the pt Showing sympathy & empathy Showing sympathy & empathy Showing respect Showing respect confidentiality confidentiality

Communication appearance Pt response to questions about items of Dr’s dress Pt response to questions about items of Dr’s dress Believe male doctor should wear: Believe male doctor should wear: 1. white coat 15% 2. Suit 44% 3. Tie 64% 4. Jeans(object) 59%

Communication appearance Believe female doctor should wear: Believe female doctor should wear: 1. White coat 34% 2. Skirt 57% 3. Jeans&jewelry (object) 63%

Communications environment

Communications environment

Communication Verbal communication Verbal communication Nonverbal communication Nonverbal communication  Paralanguage  Touch  Body languabge body position body position head position head position face face eye eye leg leg arms arms

To define the real reasons for pt attendance Nature of the problem Nature of the problem Etiology Etiology Pt ideas Pt ideas Pt concern Pt concern Pt expectation Pt expectation Pt fears Pt fears Pt effect of the problem Pt effect of the problem

To define the real reasons for pt attendance Pt ideas Pt ideas

To define the real reasons for pt attendance Pt concern Pt concern

To define the real reasons for pt attendance Pt expectation Pt expectation

Sabah is 38 years old lady, divorced 2week ago,running small business, looking after 5 children by herself, complaining of 2 week history of headache. Speculates how she may think about her illness Sabah is 38 years old lady, divorced 2week ago,running small business, looking after 5 children by herself, complaining of 2 week history of headache. Speculates how she may think about her illness

To consider other problems Continuous problem Continuous problem At risk factors At risk factors

To choose with the pt appropriate action for each problem Pt responsibility Pt responsibility Pt compliance Pt compliance

To achieve a share understanding doctor doctor patient patient Knowledge Questions Doubts Theories experience Knowledge Questions Doubts Theories experience

To involve pt in the management

To use time & resources effectively

The expanded model of consultation Management of presenting problem Management of presenting problem Management of continuous problem Management of continuous problem Modification of help seeking behavior Modification of help seeking behavior Opportunistic health promotion Opportunistic health promotion

Modification of help seeking behavior Denial Denial Sick role Sick role Hidden agenda Hidden agenda By the way doctor By the way doctor

Inner consultation Connect Connect Summarize Summarize Hand over Hand over Safety netting Safety netting House keeping House keeping

PRACTICAL Prior to the consultation Prior to the consultation Relationship Relationship Anxieties Anxieties Common language Common language Translation Translation Interaction Interaction Converting insight into action Converting insight into action Agreement check, safety netting Agreement check, safety netting Leave from consultation, time for reflection Leave from consultation, time for reflection