1. Sources of information in the consultation
DATA GATHERING
Sources of information in the consultation
Dr Ramesh Mehay,

2. Consultation Models Byrne & Long Doctor – Patient Relationship
Pendleton
Define reason for attendance (patient’s ideas/concerns/expectations)
Consider other problems
Choose appropriate action for each problem
Achieve shared understanding
Involve patient/accept responsibility
Use time/resources appropriately
Establish/maintain relationship with patient
Neighbour
Connecting
Summarising
Handing Over
Safety Netting
Housekeeping
Byrne & Long
Doctor – Patient Relationship
Discover reason for attendance
Verbal/Physical Examination
Doctor/Patient consider condition
Doctor/Patient consider Treatment/Investigation
Close consultation
Stott & Davis
Management of presenting problems
Management of continuing problems
Modification of help-seeking behaviour
Opportunistic health promotion

3. The Clinical Method “HEIMR” “HEIRS” SOAP Hx (History) Ex (Examination)
Ix (Investigation)
Mx (Management)
Rx (Prescribe)
“HEIRS”
History
Examination
Investigation
Referral
See again?
SOAP
Subjective
Objective
Assessment
Plan

4. Considering Health & Disease
Normal Range
Patterns of Illness
Natural History
Prevention
Early Diagnosis
Diagnostic skills/techniques
Management/Treatment

5. For Child Development: PIE
Physical
Intellectual
Emotional
What is the normal range?

6. Considering the Illness: PP-SOF
Always answer in terms of:
Physical
Psychological
Social
Occupational
Family/Community
Note:
Disease = the specific medical condition a person has e.g. Osteoarthritis
Illness = the impact of the disease on the person’s life eg not able to work, do stairs, go out, family has to help mobilise, husband is carer now, not working hence money problems, now also depressed, and so on.

7. Considering Human Behaviour
Behaviour presenting to Doctor
Behaviour in Relationships
Behaviour in Family
Behaviour in Doctor-Patient Relationship

8. The Doctor’s & Patient’s feelings
Awareness
Have your awareness levels just been raised?
Has the patient’s awareness levels just been raised?
Have either of you just had a moment of enlightenment? (Balint’s ‘flash’ moment)
Power
Are you feeling intimidated by the patient?
Is the patient feeling intimidated by you?
Anger
Are you feeling angry with the patient – something they’ve said, done or doing?
Is the patient feeling angry with something you have said, done or doing?
Guilt
Are you feeling guilty about something you wish you had done for the patient?
Has the patient got guilt issues that need exploring?
Stressed/Overwhelmed
Do you feel stressed or overwhelmed by all the problems and woes the patient is telling you?
Are they emotionally vomiting all over you?
Is the patient feeling stressed, coerced or overwhelmed with what you are saying to them?
Conflicts
Is there a conflict between your agenda and the patient’s agenda?
How do you resolve that conflict?
Consider what both you and the patient are feeling in the consultation.
It helps you step back a little and decide whether your approach is being affected by your feelings or the patient’s feelings.
Consider sharing how the patient or consultation discussion is making you feel with the patient. Raising the patient’s awareness of how they make people feel might be therapeutic in itself.