1. Consultation Process Benny Chung

2. 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.

3. 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 ???

4. NO!!! But what else should be in a consultation?

5. Purposes of a Consultation Inflow / Backflow of information Communication Diseases / Diagnosis Illness / Cure Doctors role / Patients Role

6. 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

7. Task No. 2 Physical examination -Selective -Relevant -Sensitive -Competent

8. Task No. 3 Managing the Chronic Problems (other problems) -E.g. co-existing DM, HT, Epilepsy

9. Task No.4 Identify other at-risk problems Anticipatory care e.g. smoking, alcohol, obesity, occupational hazard, Pap smear, etc…

10. Task No.5 To achieve a shared understanding of the problems with the patient.

11. Task No. 6 Choose the appropriate action for each problem (with the patient) Involve the patient in the management, enhance patients responsibility.

12. Task No. 7 Modification of patients help-seeking behavior

13. Task No. 8 To use TIME and RESOURCES appropriately

14. Task No. 9 Maintain an effective Doctor-Patient relationship.

15. Task No. 10 Record-keeping

16. The diagnostic process Inductive method of problem-solving Hypothetico-deductive method

17. Inductive method Presenting complaint System review Previous medical Hx Drugs (current/allergy) Social family Complete physical examination Investigations (Then consider) = Daignosis

18. 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