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Consultation Skills 3. 6.10.11. Programme. Neighbour consultation model Difficult aspects Practice part 2 consultation Video and role plays. Neighbour’s Consultation Model 1987. 4. Safety netting. 3. Handing Over. 5. House keeping. 2. Summarising. 1. Connecting. 1. Connecting.

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Presentation Transcript

Programme
Programme

  • Neighbour consultation model

  • Difficult aspects

  • Practice part 2 consultation

  • Video and role plays.


Neighbour s consultation model 1987
Neighbour’s Consultation Model1987

4. Safety

netting

3. Handing Over

5. House

keeping

2. Summarising

1. Connecting


1 connecting
1. Connecting

  • Rapport

  • Gambits & Curtain Raisers

  • Minimal cues

  • What is said & not said

  • Eye movements

  • 3 cardinal mental thought processes

  • Speech censoring

  • Internal Search

  • Acceptance Set


2 summarising
2. Summarising

  • What information do we need?

  • I, C, E.

  • Feelings

  • Effects of symptoms, treatment etc

  • When should you elicit that information?

  • What signals can the patient give to suggest that

  • more information could be elicited?

  • How should we elicit the information?


3 handing over
3.Handing Over

  • Negotiating

  • Give the patient options

  • Influencing

  • in my opinion…

  • Use questions instead of statements

  • Reframing

  • Shepherding

  • Pre-empting

  • My friend John…

  • Gift Wrapping

  • Chunk & Check

  • How to give instructions – rule of 3.


4 safety netting
4. Safety Netting

  • “General Practice is the Art of Managing Uncertainty”

  • If I am right, what do I expect to happen?

  • Worst case scenario

  • Instructions to patient

  • F/U - What if patient doesn’t come back?

  • How will I know if I am wrong?

  • What will I do then?

  • What to say to the patient


5 house keeping
5. House Keeping

  • Long term

  • In between Patients-clear the mind of the psychological remains of one’s consultation

  • During Consultations

  • Am I in good enough shape for the nextpatient?"


Simple model

Data Gathering-Establish reasons for consultation-Pt centred then Dr centred

Explanation and planning

Simple Model

Rapport Building


Rapport
Rapport then Dr centred

  • Ongoing in consultation

  • Starts at greeting

  • What else is involved

  • Sometimes omitted as concentrate on other aspects


Difficulties explanation
DIFFICULTIES –EXPLANATION then Dr centred

  • EXPLANATIONS-KEEP SIMPLE 30SEC LANGUAGE

  • WHAT DO YOU KNOW?

  • WHAT DO YOU WANT TO KNOW?

  • WHAT DO YOU NEED TO KNOW?

  • EXPLANATION GAME


Difficulties explanation2
DIFFICULTIES –EXPLANATION2 then Dr centred

  • SUMMARISE PRE

  • CHUNK AND CHECK

  • AVOID JARGON AND STANDARDISED

  • KEEP SIMPLE

  • VIDEO-http://youtu.be/A_iWmX28R7c


Explanation game
EXPLANATION GAME then Dr centred

  • IN PAIRS PRACTICE EXPLANATIONS

  • 30-60secs.pre management plans

  • Swap over.

    How to assess

  • Ease of understanding

  • Avoidance of medical jargon

  • Use of analogies

  • Timing

  • Alternative resources-diagrams/PILS( quality control)


Explanation game ideas
EXPLANATION GAME IDEAS then Dr centred

  • CKD

  • HYPO/HYPERTHYROIDISM

  • ASTHMA

  • COPD

  • DIABETES

  • ANGINA

  • ATRIAL FIBRILLATION


Sharing options
SHARING OPTIONS then Dr centred

  • WHAT IS DIFFICULT?

  • IS THERE ALWAYS AN OPTION?

  • USE ICE

  • KITES IN THE AIR-NEIGHBOUR

  • Relative risks and benefits

  • LEAVE PAUSES

  • KEEP SIMPLE NO JARGON

  • LOOK AT NON VERBAL CUES

  • CHECK UNDERSTANDING –How?


Concordance the end
CONCORDANCE-THE END then Dr centred

  • WHAT IS IT ?

  • HOW ACHIEVED

  • PATIENT AND DOCTOR AGENDA MET

  • PT SUMMARISE TO CHECK UNDERSTANDING

  • SAFETY NET

  • http://youtu.be/MQFuLLX-KCY 314 - 3:35


Video
VIDEO then Dr centred

  • How effective was the GP?

  • Informed controller-how to deal with?

  • A shared understanding?

  • How to communicate risk?

  • What was good?

  • What could be improved?


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