1. DR. ABDULLAH ALSHAHRANI
CONSULTATION MODELS
DR. ABDULLAH ALSHAHRANI
(MBBS/CABFM/ POST GRADUATE TRAINER)
Joint Program of Family Medicine, Aseer

2. Objectives What is the consultation
What are the benefits of consultation
What are the types of consultation
How to change from traditional biological model to a more comprehensive model

3. Introduction Introduction
Consultation Definition:
The essential unit of medical practice is the occasion when in the intimacy of the consultation room, the person who is ill or believes himself to be ill, seeks the advice of a doctor who he trust.
( Sir James Spence 1949 )

4. Consultation Models Hospital Model( Biological Model):
PHC Model( Bio-psycho-social Model).
Stott &Davis (The Expanded Model)
Pendleton Model( 7 Tasks).
Neighbour Model( Anticipatory care) (difficult consultation).

5. Sara is 38 years old lady, complaining of 2 weeks history of headache.
How are you going to conduct this consultation

6. Hospital Model of Consultation (Bio – Medical Model)
HISTORY
PRESENTING COMPLAIN
SYSTEMATIC REVIEW
EXAMINATION
INVESTIGATION
DIAGNOSIS
TREATMENT
FOLLOW-UP
Computerized
Checklist of history
Taking.
A case of
2 weeks headache

7. Characteristics of Hospital Model
It is doctor centered and disease oriented.
A diagnosis must be arrived at "objectively" before treatment.
It takes long time
No consideration of the psychosocial dimensions explanation, health education, health promotion and treatment by reassurance

8. PHC Model of Consultation (Bio-psychological Model)

9. What is most likely the diagnosis???
Sara is 38 years old lady, divorced 2 weeks ago, looking after 5 children by herself, complaining of 2 weeks history of headache
Speculate how Sara think about her illness?
Her ideas???
Her concern???
Her fears???
The effect of the problem in her life???
What is most likely the diagnosis???

10. Characteristics of PHC Consultation Model
Patient – centered
Holistic approach (Bio-psycho – social)
Prevention & Health education
Treatment by reassurance
Appropriate use of time & resources

11. The Expanded Model of Consultation (Stott & Davis 1979)
Management of Modification of Help
Presenting Problem Seeking Behaviour
Management of Opportunistic health
Continuous Problem Promotion

12. Pendleton Model To define the real reasons for pt attendance
To consider other problems
To choose with the pt. appropriate action for each problem
To achieve a share understanding
To involve pt. in the management
To use time & resources effectively
To establish & maintain Dr – pt relationship

13. Pendleton First Task To Explore the real reasons for pt. Attendance
History
Nature of the problem
Causes
Effect of the problem

14. Patient’s Ideas: Neurological problem. Becoming disable or crazy
Patient’s Ideas: Neurological problem. Becoming disable or crazy. Cannot work as a teacher anymore ?

15. Patient’s Concern: Financial insecurity! ! !
Patient’s Concern: Financial insecurity

16. Sick leave Investigation Treatment
Patient’s Expectation:
Sick leave Investigation Treatment
explanation

17. To consider other problems
Pendleton Second Task
To consider other problems

18. With the patient to choose an appropriate action for each problem
Pendleton Third Task
With the patient to choose an appropriate action for each problem
Why?
Patient responsibility
Patient compliance

19. Pendleton Fourth Task With the patient to reach Shared Understanding of the Problem
Doctor
Patient
Knowledge
Questions
Doubts
Theories
Experience
Knowledge
Questions
Doubts
Theories
Experience

20. To involve patient in the management
Pendleton Fifth Task
To involve patient in the management

21. To use Time and Resources appropriately
Pendleton Sixth Task
To use Time and Resources appropriately

22. Pendleton Seventh Task
To Establish & Maintain
Doctor – Patient Relationship

23. Neighbor ModelThe Inner Consultation
Connecting
(establishing relationship)
Summarizing
(physical, social & psychosocial diagnosis)
Handing-over
(management of presenting symptom)
Safety netting
(Red flags)
House-keeping
(Taking care or yourself)

24. Approach to Sara Problem
Safety-netting:
Is there any possibility of serious differential diagnoses or complications from her headache?

25. Approach to Sara Problem
House Keeping
This consultation may result in some negative feelings, examples:
Sad feeling because of Sara's divorce.
Helpless feeling because of her financial problem.

26. Approach to Sara Problem
House Keeping
Sad feeling for her children.
Feeling of being under pressure of time, because of this long consultation.
Feeling anxious about the reaction of the next patient for being waiting for so long.
How to deal with these feelings?

27. Conclusion
Hospital Model of Consultation is not suitable for Family Medicine
Family Medicine Model of Consultation is characterized by:
Holistic Approach
Deep understanding of human behaviour

28. THANK YOU Home Messages
A lot of practice is needed to be able to adopt the proper consultation model
Consultation is a communication with a human being with feelings & thoughts…it is not just clinical skills
THANK YOU