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Consultation Skills 3

Consultation Skills 3. 6.10.11. Programme. Neighbour consultation model Difficult aspects Practice part 2 consultation Video and role plays. Neighbour’s Consultation Model 1987. 4. Safety netting. 3. Handing Over. 5. House keeping. 2. Summarising. 1. Connecting. 1. Connecting.

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Consultation Skills 3

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  1. Consultation Skills 3 6.10.11

  2. Programme • Neighbour consultation model • Difficult aspects • Practice part 2 consultation • Video and role plays.

  3. Neighbour’s Consultation Model1987 4. Safety netting 3. Handing Over 5. House keeping 2. Summarising 1. Connecting

  4. 1. Connecting • Rapport • Gambits & Curtain Raisers • Minimal cues • What is said & not said • Eye movements • 3 cardinal mental thought processes • Speech censoring • Internal Search • Acceptance Set

  5. 2. Summarising • What information do we need? • I, C, E. • Feelings • Effects of symptoms, treatment etc • When should you elicit that information? • What signals can the patient give to suggest that • more information could be elicited? • How should we elicit the information?

  6. 3.Handing Over • Negotiating • Give the patient options • Influencing • in my opinion… • Use questions instead of statements • Reframing • Shepherding • Pre-empting • My friend John… • Gift Wrapping • Chunk & Check • How to give instructions – rule of 3.

  7. 4. Safety Netting • “General Practice is the Art of Managing Uncertainty” • If I am right, what do I expect to happen? • Worst case scenario • Instructions to patient • F/U - What if patient doesn’t come back? • How will I know if I am wrong? • What will I do then? • What to say to the patient

  8. 5. House Keeping • Long term • In between Patients-clear the mind of the psychological remains of one’s consultation • During Consultations • Am I in good enough shape for the nextpatient?"

  9. Data Gathering-Establish reasons for consultation-Pt centred then Dr centred Explanation and planning Simple Model Rapport Building

  10. Rapport • Ongoing in consultation • Starts at greeting • What else is involved • Sometimes omitted as concentrate on other aspects

  11. DIFFICULTIES –EXPLANATION • EXPLANATIONS-KEEP SIMPLE 30SEC LANGUAGE • WHAT DO YOU KNOW? • WHAT DO YOU WANT TO KNOW? • WHAT DO YOU NEED TO KNOW? • EXPLANATION GAME

  12. DIFFICULTIES –EXPLANATION2 • SUMMARISE PRE • CHUNK AND CHECK • AVOID JARGON AND STANDARDISED • KEEP SIMPLE • VIDEO-http://youtu.be/A_iWmX28R7c

  13. EXPLANATION GAME • IN PAIRS PRACTICE EXPLANATIONS • 30-60secs.pre management plans • Swap over. How to assess • Ease of understanding • Avoidance of medical jargon • Use of analogies • Timing • Alternative resources-diagrams/PILS( quality control)

  14. EXPLANATION GAME IDEAS • CKD • HYPO/HYPERTHYROIDISM • ASTHMA • COPD • DIABETES • ANGINA • ATRIAL FIBRILLATION

  15. SHARING OPTIONS • WHAT IS DIFFICULT? • IS THERE ALWAYS AN OPTION? • USE ICE • KITES IN THE AIR-NEIGHBOUR • Relative risks and benefits • LEAVE PAUSES • KEEP SIMPLE NO JARGON • LOOK AT NON VERBAL CUES • CHECK UNDERSTANDING –How?

  16. CONCORDANCE-THE END • WHAT IS IT ? • HOW ACHIEVED • PATIENT AND DOCTOR AGENDA MET • PT SUMMARISE TO CHECK UNDERSTANDING • SAFETY NET • http://youtu.be/MQFuLLX-KCY 314 - 3:35

  17. VIDEO • How effective was the GP? • Informed controller-how to deal with? • A shared understanding? • How to communicate risk? • What was good? • What could be improved?

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