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Consultation Analysis. VTS 3/10/07. Analysis of consultations. How could consultations be analysed? How could we derive any models? Byrne & Long (1976), “Doctors talking to patients”. 5 models of the consultation. Stott & Davis Pendleton et al Roger Neighbour Cambridge-Calgary

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analysis of consultations

Analysis of consultations

How could consultations be analysed?

How could we derive any models?

Byrne & Long (1976), “Doctors talking to patients”.

5 models of the consultation

5 models of the consultation

Stott & Davis

Pendleton et al

Roger Neighbour


John Heron

RCGP curriculum COT

Consultation models.doc

stott davis the unique potential of each primary care consultation
Stott & Davis - The unique potential of each primary care consultation
  • Dealing with the acute problem
  • Dealing with chronic problems
  • Opportunistic health promotion
  • Modification of help-seeking behaviour
  • Stott NC, Davis RH, “The Exceptional Potential in each Primary Care Consultation”, Journal of the Royal College of General Practitioners 1979; 29: 201–5
stott davis the unique potential
Stott & Davis - The unique potential..
  • What is the meaning of “Modification of help-seeking behaviour”?
    • Not wasting resources – making better use
    • Empowering patients – encouraging self- reliance and reducing dependency
    • Controlling demands on NHS
    • An example might be to suggest that someone who repeatedly presents within 24 hours of the onset of a sore throat might consider self medication for future episodes
stott davis the unique potential6
Stott & Davis - The unique potential..
  • What is the meaning of “Opportunistic health promotion?”
    • Timely advice
    • Relevant to the presentation
    • Directs attention to aetiological factors
    • Evidence that it is more effective then
pendleton et al 7 tasks of the consultation
Pendleton et al – 7 tasks of the consultation
  • Why did the patient attend?
  • Consider other problems
  • Choose appropriate action(s)
  • Share understanding
  • Involve patient – management and


  • Effective use of time & resources
  • Establish/ maintain relationship with patient
  • Pendleton et al, “The Consultation: an approach to learning and teaching”, Oxford Medical GP Series
roger neighbour the inner consultation
Roger Neighbour - The Inner Consultation
  • Connecting
  • Summarizing
  • Handing Over
  • Safety-netting
  • House-keeping
  • Neighbour, R (1987), “The Inner Consultation”, Kluwer Academic
cambridge calgary
  • Initiating the session
  • Gathering information
  • Explanation and planning
  • Closing the session
  • Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press ( Oxford)
  • Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford)
john heron interventions
John Heron - interventions
  • Six types of intervention:
  • Authoritative
      • Prescriptive – directing patient’s behaviour
      • Informative – imparting information
      • Confronting – raising patient’s awareness
  • Facilitative
      • Cathartic – enabling abreaction of painful emotion
      • Catalytic – eliciting
      • Supportive – affirming patient’s worth
heron interventions 2
Heron – interventions 2
  • Prescriptive - Directs the behaviour of the patient - treatment and follow up
  • Informative – Imparts knowledge, information and meaning to patient
  • Confronting - Raises the patient’s consciousness about some limiting factor
  • Cathartic - Enables patient to abreact painful emotion
  • Catalytic - Seeks to elicit self discovery
  • Supportive - Affirms worth & value of patient
heron interventions 3
Heron – interventions 3
  • Degenerate Intervention
    • Fails in one or more of these aspects
    • Practitioner lacks personal development, training, experience, awareness or combination of these
    • Unsolicited
      • Insensitive blundering into territory - intrusive
    • Manipulative
      • Motivated by self interest regardless of needs of patient
      • From stress, lack of control, lack of awareness
      • Facipulation - using facilitation to manipulate a desired outcome
    • Compulsive
    • Unskilled
  • Heron J, “Helping the Client: A Creative Practical Guide”, 2001 (First published 1975)
rcgp curriculum statement 2 the general practice consultation
RCGP Curriculum Statement 2: The General Practice Consultation
  • Six core competencies:
  • Primary Care Management
  • Person-Centred Care
  • Specific Problem-Solving Skills
  • A Comprehensive Approach
  • Community Orientation
  • A Holistic Approach
  • Being a GP.pdf
competencies following on from the rcgp curriculum statement
Competencies following on from the RCGP curriculum statement:
  • Communication and consultation skills
  • Practising holistically
  • Data gathering and interpretation
  • Making a diagnosis / decisions
  • Clinical management
what is the aim
What is the aim…..
  • A doctor who is competent to

practise independently as an

unsupervised GP

assessing the consultation for the cot
Assessing the consultation for the COT
  • Insufficient evidence
  • Needs further development
  • Competent
  • Excellent
units of competence and performance criteria
Units of Competence and Performance Criteria
  • Discover the reason for the patient’s


  • Define the clinical problem(s)
  • Explain the problem(s) to the patient
  • Address the patient’s problem(s)
  • Make effective use of the consultation
performance criteria
Performance Criteria
  • PC1: The doctor is seen to encourage the patient’s contribution at appropriate points in the consultation
  • PC2: The doctor is seen to respond to signals (cues) that lead to a deeper understanding of the problem
  • PC3: The doctor uses appropriate psychological and

social information to place the complaint(s) in context

  • PC4: The doctor explores the patient’s health understanding
performance criteria22
Performance Criteria
  • PC5: The doctor obtains sufficient information to include or exclude likely relevant significant conditions
  • PC6: The physical /mental examination chosen is likely to confirm or disprove reasonable hypotheses
  • PC7: The doctor appears to make a clinically appropriate working diagnosis
  • PC8: The doctor explains the problem or diagnosis in appropriate language
performance criteria23
Performance Criteria
  • PC9: The doctor specifically seeks to confirm the

patient’s understanding of the diagnosis

  • PC10: The management plan (including any

prescription) is appropriate for the working diagnosis

  • PC11: The patient is given the opportunity to be

involved in significant management decisions

  • PC12: The doctor makes effective use of resources
  • PC13: The doctor specifies the conditions and interval

for follow up or review