THE CONSULTATION

OBJECTIVES:  Use different ways of communication skills which encourage patients’ participations in consultation by mastering the following skills: Establish eye contact Start with open-ended question and move to closed questions appropriately. Encourage patients with appropriate questioning Use "active listening" Use of silence appropriately

OBJECTIVES: Explore patient's idea, concern and expectation. Summarize information & check understanding Properly, inform patients about treatment options by discussing possible implication and checking if they want to be involved in decisions. Emphasize on the importance of following the agreed decisions about treatment and lifestyles. Use sympathy & empathy in appropriate ways. Know & Apply Stott & Davis/Pendleton & Roger Neighbour models of consultation. Know & apply Performance Criteria

A) - DEFINE A CONSULTATION?

DEFINITION The occasion when, a person who is ill, or believes himself to be ill, seeks the advice of a doctor whom he trust. (Wright & Macadam)

- WHAT IS A CONSULTATION MODEL?  A structure or a framework within which doctor & patient interact during the consultation;  Consultations have been studied by a variety of people over the years.  Although these demonstrate some similar conclusions, they also reflect great variety.

- WHAT IS A CONSULTATION MODEL?  Just as there is no one right way of consulting, there is no one right model.  Different models choose to emphasize different aspects.  Which model will be useful will depend very much on the consultation being considered.

B) EXPLAIN THE 14 PERFORMANCE CRITERIA? A- DISCOVER THE REASONS FOR THE PATIENT'S ATTENDANCE 1- Encourage Respond to signals (Cues) Psych-social4- ICE

B- DEFINE THE CLINICAL PROBLEM(S) 5- Red Flags 6- Examination 7- Working Diagnosis

C- EXPLAIN THE PROBLEM(S) TO THE PATIENT 8- Explain 9- Explanation incorporate Pt.’ ICE 10- Confirm Pt.’ understanding

D- ADDRESS THE PATIENT’S PROBLEM(S) 11- Management Plan 12- INVOLVE Pt. in management plan

E- MAKE EFFECTIVE USE OF THE CONSULTATION 13- Enhance Concordance 14- Follow-Up

C) - APPLY PENDLETON MODEL + MODIFICATION OF HELP-SEEKING BEHAVIOURS & OPPORTUNISTIC HEALTH PROMOTION + 'SAFETY-NETTING' & 'HOUSEKEEPING' TO: - The headache Scenario.

D) APPLY THE 14 PERFORMANCE CRITERIA TO: - Depression Scenario.

CONSULTATION IN PHC Vs. CONSULTATION IN HOSPITAL

CHARACTERISTICS OF HOSPITAL MODEL  It is doctor centred 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 )

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 concerns???  Her expectations???  The effect of the problem in her life??? What is most likely the diagnosis???

CHARACTERISTICS OF PHC CONSULTATION MODEL Patient – centred Holistic approach (Bio-psycho – social) Prevention & Health education Treatment by reassurance Appropriate use of time & resources

CONSULTATION SKILLS *Interviewing skills *History taking skills *Physical examination skills *Problem-solving skills

IMPROVING CONSULTATION SKILLS

*Constant Learning and Practice * Feed Back: -Self monitoring/Peer review -Audio-visual technique -Role play

DYSFUNCTIONAL CONSULTATION

SIGNS OF DYSFUNCTIONAL CONSULTATION  Poor reputation among patients  Upset patients or doctors  Increasing complaints  Increasing critical events  Reduced job satisfaction

DONE BAD VIDEO

PATIENT FACTORS Hearing or linguistic difficulties Upset patients Psychiatric illness Loss of faith in the doctor (poor reputation, adverse incident etc) Patients that ‘violate’ the doctors values e.g. drug misusers or alcoholics Problem Patients

DOCTOR FACTORS:  Attitudes – a doctor centred consulter, burnt out depersonalisation, angry, defensive, ‘over caring’- always wanting to be liked or hard-line doctors.  Poor emotional housekeeping.  Skills – poor consultation or clinical skills resulting in an inappropriate management plan.  Knowledge – lack of knowledge leading to an inappropriate or suboptimal management plan.  Bored –lack of personal or professional development

PATIENT–DOCTOR FACTORS  Cultural issues  Failure to identify hidden agendas.  Failure to identify the patients fears, beliefs or expectations.  Failure to generate a management plan appropriate to the patient’s circumstances.

PRACTICE FACTORS:  Pressure of time – running late.  Poor systems (e.g. telephone access, appointments, admin).  Poor staffing, inappropriate skill mix etc which unnecessarily increase workload.  Unnecessary interruptions – telephone, staff, patients.  Physical factors - lay out of the room, lighting, extraneous noise.

THE CONCLUSION:  Consultation skills are learnt behavior.  For beginner a model to be kept in mind.  The consultation should be a discussion and sharing of ideas between two experts.  Each consultation should be tailored to fit the different needs of each patient.  Patient-centered consultation. Vs. Doctor-centered consultation.

CONSULTATION DONE WELL VIDEO

ROLE PLAY