Bradford GPST Programme Consultation Models Hasna Begum Bradford GPST Programme

What is a model? A certain way of doing something We all have models for tasks that we have done more than once eg Tying shoelaces

Why learn about consultation models? Toolbox Framework for learning to consult Easier to pinpoint where difficulties occur Offers alternatives

Think about the way you consult and try to map your own consultation model

Consultation Models Stott & Davis Neighbour Byrne & Long Disease-Illness Heron's (Six Category Intervention Analysis) Calgary-Cambridge BARD Helman's Folk Model Balint Transactional Analysis Narrative-based Pendleton, Schofield, Tate & Havelock

Task vs Process Doctor-Centred vs Patient-Centred

Task Orientated Traditional medical interview Pendleton Helman folk model

Pendleton TASK 1: Find out why the patient is here TASK 2: Consider other problems TASK 3: Choose (with patient) an appropriate action for each problem TASK 4: Achieve a shared understanding of the problem TASK 5: Involve the patient in management, encourage acceptance of responsibility TASK 6: Use time and resources appropriately TASK 7: Establish or maintain a relationship with the patient that helps to achieve other tasks

Helman Folk Model Every patient comes to a doctor seeking the answers to SIX questions. To be effective, the doctor needs to help the patient verbalise the questions so they can be addressed. What has happened? Why has it happened? Why to me? Why now? What would happen if nothing was done about it? What should I do about it / who should I ask?

Process Orientated Balint - the dr, his patient and the illness Byrne & Long's 6-stage model Neighbour Transactional analysis Calgary-Cambridge

Balint "The Doctor, his Patient and the Illness" Emotional relationship between dr and patient - collusion Clinician may feel what patient feels - counter transference Attentive listening helps patients feel better Doctor as a therapeutic agent in the consultation - "doctor as the drug" Consultations extending over years - mutual investment company Listening as a skill that needs to be learned

Neighbour 1. Connectt 2. Summarise 5. Housekeepingxt 3. Handover 4. Safety net

Calgary-Cambridge Initiating the session Gathering information Building the relationship Providing structure Explanation and planning Closing the session

Think about a recent consultation Try going through the same scenario using one of the models mentioned today

References Moulton, L. (2007). 'The Naked Consultation'. Abingdon: Radcliffe Publishing. Usherwood, T. (1999). 'Understanding the Consultation'. Maidenhead: Open University Press.