1. Consultation Models

2. Overview
Different models lend different perspectives to the consultation. This allows you to concentrate of different individual training needs. They are commonly asked about inn the MRCGP exam.

3. RCGP Model
Asks the doctor to look beyond the organic and include other elements of the presentation of ill health:
Physical
Psychological
Social

4. McWhinney 1972

5. Byrne and Long 1976 Establish a relationship
Discover the reason for attending
Perform verbal and physical examination
The doctor, patient or both then consider the problem
Discuss management

6. Berne 1977 Transactional Analysis Model of human behaviour
Ego states Parent / Child / Adult
May help in interpreting some situations

7. Stott and Davis 1979 Management of presenting problem
Modification of help-seeking behaviour
Management of continuing problems
Opportunistic health promotion
may be helpful in extending your outlook into the potential of each consultation

8. Pendleton et al 1984 Define the reason for the attendance
nature and history
aetiology
ideas, concerns and expectations
effects of the problem

9. Pendleton et al 1984 (cont) Consider the other problems
Choose an appropriate action for each
Achieve an understanding with patient
Involve them in management plan
Use time and resources appropriately
Establish / maintain relationship

10. Helman 1984 Anthropological model What has happened
Why has it happened? Why me? Why now?
What would happen if I did nothing?
What should I do about it?
What can you do about it?
How can I stop it happening again?

11. Heron 1986 Six-category intervention analysis:
Prescriptive - advising / telling
Informative - instructive / interpreting
Confronting - challenging / feeding back
Cathartic - releasing emotions
Catalytic - encouraging exploration
Supportive - comforting / affirming

12. Neighbour 1987 The Inner Consultation Connecting Summarising
Handing over
Safety netting
Housekeeping

13. Murtagh 1998 What is the probability diagnosis?
What serious diagnosis should not be missed?
What conditions are often missed?
Is this a masquerade?
Is the patient trying to tell me something that I have missed?

14. Cambridge-Calgary Initiating the consultation Gathering information
Building the relationship / facilitating the patient’s involvement
Explanation and planning
Closing

15. Neurolinguistic Planning
Based on models of how the brain handles information. Identify the predominant system the patient is using and modify your communication accordingly.
Kinaesthetic (feeling)
Visual (seeing)
Auditory (hearing)

16. Match problem to model Doctor Centred Expand outlook
Difficult patients
Difficult situations
Anxious
Body language
Hospital based
Practical teaching
Helman
Stott and Davis
Heron
Berne (TA)
Murtagh
Neighbour
McWhinney
Cambridge-Calgary

17. Constructive Feedback
Pendleton’s Rules
SETGO

18. Pendleton’s Rules What do you think you did well?
What do I think you did well?
What could have done differently?
What do I think you could have done differently?
How do you feel about this
Finish on a positive reinforcement

19. SETGO What did you See? What Else did I see?
What do you Think about this?
What Goals can we now set?
What Offers have we got to achieve these goals? (Role Play)