1. Bradford GPST Programme
Consultation Models
Hasna Begum
Bradford GPST Programme

2. What is a model? A certain way of doing something
We all have models for tasks that we have done more than once
eg Tying shoelaces

3. Why learn about consultation models?
Toolbox
Framework for learning to consult
Easier to pinpoint where difficulties occur
Offers 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-Illness
Heron's (Six Category Intervention Analysis)
Calgary-Cambridge
BARD
Helman's Folk Model
Balint
Transactional Analysis
Narrative-based
Pendleton, Schofield, Tate & Havelock

6. Task vs Process
Doctor-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 problems
TASK 3: Choose (with patient) an appropriate action for each problem
TASK 4: Achieve a shared understanding of the problem
TASK 5: Involve the patient in management, encourage acceptance of responsibility
TASK 6: Use time and resources appropriately
TASK 7: Establish or maintain a relationship with the patient that helps to achieve other tasks

9. Helman Folk Model
Every 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 model
Neighbour
Transactional analysis
Calgary-Cambridge

11. Balint "The Doctor, his Patient and the Illness"
Emotional relationship between dr and patient - collusion
Clinician may feel what patient feels - counter transference
Attentive listening helps patients feel better
Doctor as a therapeutic agent in the consultation - "doctor as the drug"
Consultations extending over years - mutual investment company
Listening as a skill that needs to be learned

12. Neighbour 1. Connectt 2. Summarise 5. Housekeepingxt 3. Handover
4. Safety net

13. Calgary-Cambridge Initiating the session Gathering information
Building the relationship
Providing structure
Explanation and planning
Closing the session

14. Think about a recent consultation
Try going through the same scenario using one of the models mentioned today

15. References
Moulton, L. (2007). 'The Naked Consultation'. Abingdon: Radcliffe Publishing.
Usherwood, T. (1999). 'Understanding the Consultation'. Maidenhead: Open University Press.