Presentation on theme: "Consultation Models Dr Darren Tymens, 2003. Consultation Models "Bad consultations result from having insufficient clinical knowledge, from failing to."— Presentation transcript:
Consultation Models Dr Darren Tymens, 2003
Consultation Models "Bad consultations result from having insufficient clinical knowledge, from failing to relate to patients or from failing to understand the patient's behaviour, his perception of his illness or its context - JGR Howie (1985)
The Biomedical Model Take an accurate and relevant history (OBSERVATION). Perform an accurate and relevant examination (OBSERVATION). Make a provisional diagnosis (HYPOTHESIS). Order and interpret the results of appropriate investigations (HYPOTHESIS TESTING). Make a definitive diagnosis (DEDUCTION).
M Balint (1957) The Doctor, His Patient and The Illness The Apostolic Function The Drug Doctor The Sick Role The Long Consultation
Berne (1964) Games People Play / Transactional Analysis Games Parent / Adult / Child
RCGP Model (1972) Physical, Psychological and Social The Triaxial Model Extend thinking beyond organic Consider Emotional, Family, Social and Environmental factors
Becker & Maiman (1975) Health Belief Model Ideas Concerns Expectations
Byrne & Long (1976) 6 Phases of the Consultation 1. The doctor establishes a relationship with the patient 2. The doctor discovers or attempts to discover the reason for the attendance 3. The doctor conducts a verbal and/or physical examination 4. The doctor, the doctor and patient, or the patient (in that order of probability) consider the condition 5. The doctor and occasionally the patient detail further treatment or investigation 6. The consultation is terminated, usually by the doctor
Byrne & Long (1976) Consultation Styles doctor-centred –dominates the consultation –asks direct, closed questions –rejects the patient's ideas –evades the patient's questions patient-centred –asks open questions –actively listens –challenges and reflects the patients' words and behaviour to allow them to express themselves in their own way
Stott & Davis (1979) Areas to Explore The identification & management of the presenting problem Modification of the patient's help-seeking behaviour The management of continuing problems Opportunistic health promotion
Helman (1981) Folk Model - Questions to be Answered What has happened? Why has it happened? Why me? Why now? What would happen if nothing were done about it? What should I do about it and who should I consult for further help?
Pendleton (1984) the Doctor's Tasks Define the reason for the patient's attendance Consider other problems Together choose an appropriate action for each problem Achieve a shared understanding of problems Involve the patient in the management of problems and encourage acceptance of appropriate responsibility Use time and resources appropriately Establish and maintain a relationship with the patient which helps to achieve the other tasks
Levenstein (1984) Patient-Centred Model 1. Exploring both the disease and the illness experience 2. Understanding the whole person 3. Finding common round regarding management 4. Incorporating prevention and health promotion 5. Enhancing the Doctor-Patient relationship 6. Being realistic
Disease-Illness Model (1984)
Neighbour (1987) Checkpoints 1.Connecting: have we got rapport? 2.Summarising: could I demonstrate to the patient that I've sufficiently understood why he's come? 3.Handing over: has the patient accepted the management plan we have agreed? 4.Safety-netting: What if...? 5.Housekeeping
Fraser (1987) Areas of Competence 1. Interviewing and history-taking 2. Physical examination 3. Diagnosis and problem-solving 4. Patient management 5. Relating to patients 6. Anticipatory care 7. Record-keeping
Kurtz and Silverman (1996) Calgary-Cambridge Observation Guide A. Initiating the session B. Gathering information C. Building the relationship D. Giving information - explaining and planning E. Closing the session
MRCGP Video Criteria Doctor encourages patients contribution. Dr. responds to cues Dr. elicits appropriate details to place complaint in social & psycho- logical context Dr. explores patients health understanding Merit Dr. obtains sufficient information for no serious condition to be missed. Dr. chooses an appropriate examination. Dr. makes clinically appropriate working diagnosis. Dr. explains diagnosis. Dr. uses appropriate language. Dr. takes account of patients belief Merit. Dr. confirms patients understanding Merit. Dr. uses appropriate management plan. Dr. shares management options. Dr. uses appropriate prescribing behaviour. Dr. and patient appear to have established a rapport.