Consultation ModelsHasna Begum

Bradford GPST Programme

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

Why learn about consultation models?

Toolbox

Framework for learning to consult

Easier to pinpoint where difficulties occur

Offers alternatives

Think about the way you consult and try to map your own consultation

model

Consultation Models

Task vs Process

Doctor-Centred vs Patient-Centred

Task Orientated

Traditional medical interview

Pendleton

Helman folk model

PendletonTASK 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

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.

1. What has happened?

2. Why has it happened?

3. Why to me?

4. Why now?

5. What would happen if nothing was done about it?

6. What should I do about it / who should I ask?

Process Orientated

Balint - the dr, his patient and the illness

Byrne & Long's 6-stage model

Neighbour

Transactional analysis

Calgary-Cambridge

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

Neighbour

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3. Handover

4. Safety net

Calgary-Cambridge

Initiating the session

Gathering information

Building the relationship

Providing structure

Explanation and planning

Closing the session

Think about a recent consultation

Try going through the same scenario using one of the models mentioned today

References

Moulton, L. (2007). 'The Naked Consultation'. Abingdon: Radcliffe Publishing.

Usherwood, T. (1999). 'Understanding the Consultation'. Maidenhead: Open University Press.