1. THE CONSULTATION

2. OUTCOME PROCESS BAD CONSULTATIONS PRESCRIBING TELEPHONE CONSULTATIONS

3. OUTCOME SATISFACTION ENABLEMENT AGENDAS COMPLIANCE

4. PROCESS TRADITIONAL MEDICAL MODEL HOLISTIC AND SOCIOLOGICAL ANTHROPOLOGICAL SIX CATEGORY INTERVENTION ANALYSIS TRANSACTIONAL ANALYSIS TASK ORIENTATED MODELS

5. STOTT AND DAVIS (1979) 1. Management of presenting problems 2. Modification of health seeking behaviour 3. Management of continuing problems 4. Opportunistic health promotion

6. BYRNE AND LONG (1976) 1. The doctor establishes a relationship with the patient 2. The doctor attempts to discover the reason for the patient’s attendance 3. The doctor conducts a verbal or physical examination or both 4. The doctor and/or the patient consider the condition 5. The doctor and/or the patient detail further treatment or investigation 6. The consultation is terminated usually by the doctor

7. PENDLETON ET AL (1984) 1. Define the reason for the patient’s attendance including ideas, concerns and expectations 2. Consider other problems (continuing problems, at- risk factors) 3. Choose an appropriate action with the patient 4. Achieve a shared understanding of the problem with the patient 5. Involve the patient in management. Share responsibility 6. Use time and resources appropriately 7. Establish a relationship which helps to achieve other tasks

8. ROGER NEIGHBOUR (1987) 1. Connecting-forming a rapport, learning about the patient and their problems 2. Summarising-making a diagnosis in physical, psychological and social terms. Checking back with the patient that they agree with the summary 3. Handover-a management plan is negotiated, agreed upon and responsibility is handed back to patient to see the plan through 4. Safety net-the patient is given advice on what to do if the problem doesn’t resolve as predicted 5. Housekeeping-looking after yourself

9. BAD CONSULTATIONS THE PATIENT’S AGENDA PSYCHODYNAMICS- Balint 1957 PRESCRIBING EXTERNAL FACTORS

10. TELEPHONE CONSULTATIONS ADVANTAGES Majority of diagnoses made on history alone Convenience for patients Rapid access if well organised Can be delegated e.g. NHS Direct Protocols available to guide decisions Triage by telephone- fewer home visits, fewer extras in surgery, reduction in stress

11. TELEPHONE CONSULTATIONS DISADVANTAGES An essentially new consultation skill which requires further training Loss of visual and behavioural clues Sub-optimal communication can lead to misunderstanding Easy to bring pre-conceptions to the consultation Problems with nurse-led triage: time required to develop safe guidelines; need for quality control and audit

12. The Telephone Consultation Introduce oneself Record details of patient, time etc. Gather information Consider the likely diagnosis Giving advice- home management plan if appropriate, assess caller’s satisfaction with approach Safety netting with explicit plan of when to call back Record-keeping