2 What is a model? A certain way of doing something We all have models for tasks that we have done more than onceeg Tying shoelaces
3 Why learn about consultation models? ToolboxFramework for learning to consultEasier to pinpoint where difficulties occurOffers alternatives
4 Think about the way you consult and try to map your own consultation model
5 Consultation Models Stott & Davis Neighbour Byrne & Long Disease-IllnessHeron's (Six Category Intervention Analysis)Calgary-CambridgeBARDHelman's Folk ModelBalintTransactional AnalysisNarrative-basedPendleton, Schofield, Tate & Havelock
6 Task vs ProcessDoctor-Centred vs Patient-Centred
7 Task Orientated Traditional medical interview Pendleton Helman folk model
8 Pendleton TASK 1: Find out why the patient is here TASK 2: Consider other problemsTASK 3: Choose (with patient) an appropriate action for each problemTASK 4: Achieve a shared understanding of the problemTASK 5: Involve the patient in management, encourage acceptance of responsibilityTASK 6: Use time and resources appropriatelyTASK 7: Establish or maintain a relationship with the patient that helps to achieve other tasks
9 Helman Folk ModelEvery patient comes to a doctor seeking the answers to SIX questions. To be effective, the doctor needs to help the patient verbalise the questions so they can be addressed.What has happened?Why has it happened?Why to me?Why now?What would happen if nothing was done about it?What should I do about it / who should I ask?
10 Process Orientated Balint - the dr, his patient and the illness Byrne & Long's 6-stage modelNeighbourTransactional analysisCalgary-Cambridge
11 Balint "The Doctor, his Patient and the Illness" Emotional relationship between dr and patient - collusionClinician may feel what patient feels - counter transferenceAttentive listening helps patients feel betterDoctor as a therapeutic agent in the consultation - "doctor as the drug"Consultations extending over years - mutual investment companyListening as a skill that needs to be learned
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