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Consultation Models

Consultation Models. Aims & Objectives. Aims to introduce GPTs to several types of consultation models and how to integrate them into practice Objectives What’s the point of making models of the consultation What types of model there are Having a go at putting them into practice.

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Consultation Models

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  1. Consultation Models

  2. Aims & Objectives Aims • to introduce GPTs to several types of consultation models and how to integrate them into practice Objectives • What’s the point of making models of the consultation • What types of model there are • Having a go at putting them into practice

  3. What are consultation skills? • Spend 2 minutes in pairs discussing this.

  4. What are consultation skills? Behaviours that result in desired outcomes culminating in a consultation which achieves a satisfactory outcome

  5. The Medical Model Patient Patient accepts, respects and leaves Enters sick role Dr advises (often in high class English) Enters surgery Ticket of admission Dr rations his skill & attention Temporarily hands over care to the Doctor CLOTHED DOCTOR, NAKED PATIENT ACTIVE DOCTOR, PASSIVE PATIENT

  6. So Why are Models so Important? • Patients don’t function simply as machines • They have feelings too • Doctors don’t function simply as machines • They have feelings too • Every presenting complaint has psycho-social implications

  7. THE MODELS • 1957 M Balint - The Doctor, His Patient and The Illness • 1964 E Berne - Games People Play • 1975 J Heron - Six Category Intervention Analysis • 1976 Byrne & Long - Doctors Talking to Patients • 1979 Stott & Davis - The Exceptional Potential in Each Primary Care Consultation • 1981 C Helman - Disease vs Illness in Gen Practice • 1984 Pendleton et al - The Consultation • 1987 R Neighbour - The Inner Consultation • 1996 Kurtz & Silverman The Calgary-Cambridge Observation Guide to The Consultation

  8. Michael Balint (1957) “The Doctor, the patient and their illness” • Physical, Psychological, Social Aspects • Doctor’s apostolic function • Entry ticket • Hidden agenda • The mutual investment fund • Doctors have feelings • Collusion of anonymity • The “drug doctor” Focuses on the doctor / patient relationship

  9. John Heron (1975) Six Category Intervention analysis Interventions can be: 1 Prescriptive 2 Informative 3 Confronting 4 Cathartic 5 Catalytic 6 Supportive Authoritative Facilitative

  10. Health Belief Model – Becker & Maiman (1975) • Ideas • Concerns • Expectations • “ICE”

  11. Eric Berne (1976) Games People Play • Transactional analysis • Parent, Adult, Child roles • The Adult / Adult goal

  12. Byrne and Long (1976) Doctors Talking to Patients • Sequence of events in a consultation: • Establishing a relationship • Why has the patient come • Verbal and/or physical examination • Considering the condition • Further investigation or treatment • Termination

  13. Stott & Davies (1979) The potential of each primary care consultation • The management of the presenting problem • Modification of help seeking behaviour • Management of continuing problems • Opportunistic health promotion/QOF

  14. Helman’s ‘folk’ model (1981) Disease vs Illness in General Practice A Patient comes to the Dr. seeking answers to 6 questions • What has happened? • Why has it happened? • Why to me? • Why now? • What would happen if nothing were done about it? • What should I do about it or whom should I consult for further help?

  15. Pendleton (1984) The consultation, an approach to learning and teaching • Define the reasons for the patient’s attendance (exploring ICE, Implications, aetiology etc) • Consider other problems 3 Identifying an appropriate solution to each problem 4 Achieve a shared understanding of the problems 5 Involve the patient in the management and encourage the patient to take responsibility • Use time and resources appropriately 7 Establish or maintain the doctor patient relationship

  16. Roger Neighbour (1987) The Inner Consultation • A journey with five checkpoints 1 Connecting 2 Summarising 3 Handing over 4 Safety Netting 5 House Keeping Housekeeping and safety netting are his original contributions

  17. Calgary Cambridge - Silverman et al (1988) • 5 Check Points • A. Initiating the session • B. Gathering information • C. Building the relationship • D. Giving information - explaining and planning • E. Closing the session

  18. Flanagan’s CSA model 2010 Welcome Golden minute Exploration of ICE Medical data gathering including red flags Summarising Examination Summarising Explanation Option sharing Shared management plan and safety netting

  19. Summary • Consultation models help us to decide what to do and how to do it • The aim is to develop your own style and have a flexible approach to the consultation, using different models & skills according to the nature of the patient and their problem. • You may wish to use different models for different situations eg Kayes Model for Breaking Bad News

  20. Highly Recommended • The Inner Consultation – Roger Neighbour • The New Consultation: Developing doctor-patient communication – Pendleton & Tate • The Naked Consultation – Liz Moulton

  21. Coffee Break

  22. Role Play • GPSTs & Simulators will role play consultations while other GPSTs assess the consultation using the different consultation models; Heron, Flanagan’s and Stott & Davies

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