DR. ABDULLAH ALSHAHRANI CONSULTATION MODELS DR. ABDULLAH ALSHAHRANI (MBBS/CABFM/ POST GRADUATE TRAINER) Joint Program of Family Medicine, Aseer

Objectives What is the consultation What are the benefits of consultation What are the types of consultation How to change from traditional biological model to a more comprehensive model

Introduction Introduction Consultation Definition: The essential unit of medical practice is the occasion when in the intimacy of the consultation room, the person who is ill or believes himself to be ill, seeks the advice of a doctor who he trust. ( Sir James Spence 1949 )

Consultation Models Hospital Model( Biological Model): PHC Model( Bio-psycho-social Model). Stott &Davis (The Expanded Model) Pendleton Model( 7 Tasks). Neighbour Model( Anticipatory care) (difficult consultation).

Sara is 38 years old lady, complaining of 2 weeks history of headache. How are you going to conduct this consultation

Hospital Model of Consultation (Bio – Medical Model) HISTORY PRESENTING COMPLAIN SYSTEMATIC REVIEW EXAMINATION INVESTIGATION DIAGNOSIS TREATMENT FOLLOW-UP Computerized Checklist of history Taking. A case of 2 weeks headache

Characteristics of Hospital Model It is doctor centered and disease oriented. A diagnosis must be arrived at "objectively" before treatment. It takes long time No consideration of the psychosocial dimensions explanation, health education, health promotion and treatment by reassurance

PHC Model of Consultation (Bio-psychological Model)

What is most likely the diagnosis??? Sara is 38 years old lady, divorced 2 weeks ago, looking after 5 children by herself, complaining of 2 weeks history of headache Speculate how Sara think about her illness? Her ideas??? Her concern??? Her fears??? The effect of the problem in her life??? What is most likely the diagnosis???

Characteristics of PHC Consultation Model Patient – centered Holistic approach (Bio-psycho – social) Prevention & Health education Treatment by reassurance Appropriate use of time & resources

The Expanded Model of Consultation (Stott & Davis 1979) Management of Modification of Help Presenting Problem Seeking Behaviour Management of Opportunistic health Continuous Problem Promotion

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

Pendleton First Task To Explore the real reasons for pt. Attendance History Nature of the problem Causes Effect of the problem

Patient’s Ideas: Neurological problem. Becoming disable or crazy Patient’s Ideas: Neurological problem. Becoming disable or crazy. Cannot work as a teacher anymore ?

Patient’s Concern: Financial insecurity ! ! ! Patient’s Concern: Financial insecurity

Sick leave Investigation Treatment Patient’s Expectation: Sick leave Investigation Treatment explanation

To consider other problems Pendleton Second Task To consider other problems

With the patient to choose an appropriate action for each problem Pendleton Third Task With the patient to choose an appropriate action for each problem Why? Patient responsibility Patient compliance

Pendleton Fourth Task With the patient to reach Shared Understanding of the Problem Doctor Patient Knowledge Questions Doubts Theories Experience Knowledge Questions Doubts Theories Experience

To involve patient in the management Pendleton Fifth Task To involve patient in the management

To use Time and Resources appropriately Pendleton Sixth Task To use Time and Resources appropriately

Pendleton Seventh Task To Establish & Maintain Doctor – Patient Relationship

Neighbor ModelThe Inner Consultation Connecting (establishing relationship) Summarizing (physical, social & psychosocial diagnosis) Handing-over (management of presenting symptom) Safety netting (Red flags) House-keeping (Taking care or yourself)

Approach to Sara Problem Safety-netting: Is there any possibility of serious differential diagnoses or complications from her headache?

Approach to Sara Problem House Keeping This consultation may result in some negative feelings, examples: Sad feeling because of Sara's divorce. Helpless feeling because of her financial problem.

Approach to Sara Problem House Keeping Sad feeling for her children. Feeling of being under pressure of time, because of this long consultation. Feeling anxious about the reaction of the next patient for being waiting for so long. How to deal with these feelings?

Conclusion Hospital Model of Consultation is not suitable for Family Medicine Family Medicine Model of Consultation is characterized by: Holistic Approach Deep understanding of human behaviour

THANK YOU Home Messages A lot of practice is needed to be able to adopt the proper consultation model Consultation is a communication with a human being with feelings & thoughts…it is not just clinical skills THANK YOU