1. consultation MODELS & Performance criteria
Dr. Yousif E. El Gizouli
MRCGP (UK), JMHPE (MAASTRICHT)

2. ROAD MAP What is Consultation What is consultation model
Why consultation models
Types of consultation models
Barriers to effective consultation
What are the Performance Criteria
Application of Performance criteria &
Take home message.

3. The consultation
The central act of medicine which deserves to be understood.
The occasion when, a person who is ill, or believes himself to be ill, seeks the advice of a doctor whom he trust.
(Wright & Macadam)

4. WHAT is a Consultation MODEL?

5. A structure or a framework
Similar conclusions, but also reflect great variety;
Many shapes, sizes, and styles,
Not the real world.
There is no one right model.

6. Why learn consultation models?
For anything we do regularly;
To make our own model;
To understand the patient’s perspective.
Help teachers teach on the consultation.

7. TYPES of the consultation models

8. Stott and Davis (1979)

9. Q4 Strength Weakness Simple Doctor –centred
Modification of Help Seeking Behavior
in a way which does not damage the doctor patient relationship.
Opportunistic Health Promotion
Difficult to apply to some problems

10. Schofield, Tate and Havelock (1984)
PENDLETON’S MODEL
Schofield, Tate and Havelock (1984)

11. Seven Tasks:
1. To define the reasons for the Patient’s attendance 2. To consider other problems
3. To choose with the Patient. An appropriate action for each problem. 4. To achieve a shared understanding of the problems with the patient.

12. 5. To involve the Patient in the management.
6. To use time and resources appropriately.
7. To establish a relationship with the Patient.

13. Strength Weakness Patient’s-centred. Considered Patient’s ICE
Although set out in logical sequence, not all consultations will follow this order.
Encourages patient responsibility
Not appropriate for acute
settings like emergencies.
Used in the MRCGP Consultation Observation Tool

14. Roger Neighbor

15. Pros. Cons. Empowers the patient Is a bit doctor centred at times
(safetynetting) & (housekeeping)
Difficult to understand
Easy to remember

16. Pros. Cons. Comprehensive The 71 micro-skills puts people off
applicable to all
medical interviews with patients.
Probably best read after having read one
of the other more introductory ones first
Evidence-based
Two separate books are available

18. Performance Criteria?

19. Your name is Ahmad a 35-Ys- old, working as a bus driver in near school, 3 days ago after you hold a heavy tire, you felt a LBP
 The pain is down the back and not goes down, it is stabbing in nature, aggravated by leaning forward and stiff in the morning, it is ease by lying in a bed
  Your concern today is that, it could be a disc prolapse because you have an elder brother who had a prolapse last Year, you hope your doctor to ask for MRI to be reassured and also to give you a sick leave.

20. A- DISCOVER THE REASONS FOR THE PATIENT'S ATTENDANCE1-
Encourage
2-Respond to signals (Cues)
3-Psych-social
4- ICE

21. B- DEFINE THE CLINICAL PROBLEM(S)
5- Red Flags
6- Examination
7- Working Diagnosis

22. C- EXPLAIN THE PROBLEM(S) TO THE PATIENT
9- Explanation incorporate Pt.’ ICE
10- Confirm Pt.’ understanding

23. D- ADDRESS THE PATIENT’S PROBLEM(S)
11- Management Plan
12- INVOLVE Pt. in management plan

24. E- MAKE EFFECTIVE USE OF THE CONSULTATION
13- Enhance Concordance
14- Follow-Up

25. Barriers to effective consultation

26. Patient factors
Hearing or linguistic difficulties
Upset patients
Psychiatric illness
Loss of faith in the doctor (poor reputation, adverse incident etc)
Patients that ‘violate’ the doctors values e.g. drug misusers or alcoholics
Problem Patients

27. Doctor factors:
Attitudes – a doctor centred consulter, burnt out depersonalisation, angry.
Poor emotional housekeeping.
Skills – poor consultation or clinical skills.
Knowledge – lack of knowledge .
Bored –lack of personal or professional development

28. Practice factors: Pressure of time – running late.
Poor systems (e.g. telephone access, appointments, admin).
Poor staffing, inappropriate skill mix etc which unnecessarily increase workload.
Unnecessary interruptions – telephone, staff, patients.
Physical factors - lay out of the room, lighting, extraneous noise.

29. Take home message
There have been a number of helpful consultation models
Models give a framework for learning & teaching the consultation
For beginner a model to be kept in mind.
The idea is not to produce clones who consult in the same way.

30. Take home message
The consultation remains the main & basic tool for family medicine
Consultation skills are learnt behavior.
The consultation should be a discussion and sharing of ideas between two experts.
Each consultation should be tailored to fit the different needs of each patient.

31. شكــــــراً
THANKS