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The Rough Guide to consultation skills 2

The Rough Guide to consultation skills 2. Consultation tasks. Establish rapport Get the patient to tell you what is wrong Explore what the patient hasn’t told you What does the patient think is wrong and what do they want? Examine the patient Explain the problem Share management options

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The Rough Guide to consultation skills 2

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  1. The Rough Guide to consultation skills 2

  2. Consultation tasks • Establish rapport • Get the patient to tell you what is wrong • Explore what the patient hasn’t told you • What does the patient think is wrong and what do they want? • Examine the patient • Explain the problem • Share management options • Safety net

  3. ‘Eliciting’ micro-skills • Nudging • Echoing • Feedback-eg ‘I noticed’ • Checking (mini summary) • Explain why you are asking • Statement as a question • ‘My friend John’ • The ‘square search’

  4. Recognising and responding to cues verbal emotional Non-verbal

  5. What a cue is and what it is not

  6. Summarising: why? • Shortens the consultation but improves the quality • Prevents the doctor taking a wrong turning • Confirms the doctor is interested and listening • May give the patient new insights • Provides a node in the consultation and a signpost

  7. Summarising: how? • Finish eliciting and listening before you start • Use some of the patients own words • Watch and listen to the patient whilst summarising • Leave a gap at the end • Look for the ‘yes set’ • If ‘yes’ not clear then go back to listening and eliciting

  8. An exercise in eliciting and summarising

  9. Passing on information effectively • Consider the pace that the patient can cope with “I’m wondering if I am going too fast, You look puzzled, let me just check you are clear so far” etc • Break the information in to bite-sized chunks

  10. Phrases to confirm understanding • I have given you a lot of information in a short space of time, just run through what I have said so I know you have got it • I might not always explain things well. Could you just tell me what you understand I have said so I can go over any bits again? • Can you go over that for me so I know I have been clear enough? • Could you tell me what you might say about this to your partner when you go home tonight?

  11. An exercise in giving information and checking understanding

  12. Offering choices to the patient • Do nothing • Home/OTC remedies • Continue what the patient is already doing • Come back • Investigations • Prescription • Referral • admission

  13. An exercise in thinking of choices

  14. Negotiating the management plan • Start with the patient’s own ideas, concerns and expectations • It may be OK to be very directive • Try “thinking out loud” • State your position • Phrasing information as questions • Explain what will happen if no action is taken • What are the advantages and disadvantages of any course of action • What a hospital consultant would do • ‘My friend John’

  15. An exercise involving a result, offering options and negotiating

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