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Published byAngel McDaniel Modified over 11 years ago
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Consultation Process Benny Chung
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What is a consultation? Described as the essential unit of medical practice (by Spencer, 1960.) If a clinician is incompetent in consultation, other skills will become irrelevant.
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A common consultation: 45 yo housewife C/O cough, sputum, ST, RN, headache – for 3 days P/E Throat and chest clear, no LN, afebrile, others unremarkable Dx: URI Rx: Piriton, Panadol, MES. IS THAT ALL ABOUT GP CONSULTATIONS ???
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NO!!! But what else should be in a consultation?
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Purposes of a Consultation Inflow / Backflow of information Communication Diseases / Diagnosis Illness / Cure Doctors role / Patients Role
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Task No.1 Identification of presenting problem(s). The nature and history of the problems. Their etiology The patients idea, concern, expectation The effects of the problem
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Task No. 2 Physical examination -Selective -Relevant -Sensitive -Competent
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Task No. 3 Managing the Chronic Problems (other problems) -E.g. co-existing DM, HT, Epilepsy
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Task No.4 Identify other at-risk problems Anticipatory care e.g. smoking, alcohol, obesity, occupational hazard, Pap smear, etc…
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Task No.5 To achieve a shared understanding of the problems with the patient.
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Task No. 6 Choose the appropriate action for each problem (with the patient) Involve the patient in the management, enhance patients responsibility.
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Task No. 7 Modification of patients help-seeking behavior
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Task No. 8 To use TIME and RESOURCES appropriately
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Task No. 9 Maintain an effective Doctor-Patient relationship.
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Task No. 10 Record-keeping
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The diagnostic process Inductive method of problem-solving Hypothetico-deductive method
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Inductive method Presenting complaint System review Previous medical Hx Drugs (current/allergy) Social family Complete physical examination Investigations (Then consider) = Daignosis
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Hypothetico-deductive method Cues + Presenting info. + info. already a/v Hypothesis(es) Search for further information- support or not support Revise Management plan & follow up
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