7Task Orientated Traditional medical interview Pendleton Helman folk model
8Pendleton 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
9Helman 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?
10Process Orientated Balint - the dr, his patient and the illness Byrne & Long's 6-stage modelNeighbourTransactional analysisCalgary-Cambridge
11Balint "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