The “why” of consulting?. Exercise. Why are good consultation skills important? In small groups: What consultation skills were learnt & how: (a) As a GP trainee (b) Since qualifying as a GP Share thoughts and feedback key findings. Friday 25, January 2013
Man, 60, who was in debt was found drowned in Avon
‘She said in the 12 months leading up to his death he had visited the doctor “quite frequently” and was coming home and telling her he was “quite poorly”, although the doctor said they had struggled to find anything wrong with him.’
History of unprofessional behaviour medical school
Narrative about a doctor
Not working in country of primary medical qualification
Volume of practice / work load
1% doctors cause 25% of claims
Risk of 2nd claim 20%, 3rd 25%. 4th 40%
Managing difficult patients
Mastering shared decision making
“The risk of a complaint starts before the patient enters the room.”
GP behaviour related to ability to detect psychological illness
Making eye contact early in consultation
Clarifying presenting complaints
Sensitive to verbal and non-verbal cues
Poor evidence base in primary care especially at lower thresholds
Poor fit of guidelines to primary care
Continuum of normal to illness, and threshold for diagnosis varies
GPs doubt effectiveness of guidelines in face of social problems and co-morbidity.
EBM treatment not always meets patients needs or unavailable or in state of flux.
MH issues often treated “simply” with usual GP care
Grown out of psychotherapy
Evidence base weak for improved outcome but…
Lack of agreement on outcome & method.
Reduce risk of complaint -> satisfied patients
Current teaching possiblyselects“psychotherapy friendly” doctors.
We can teach behavioural change (how to pass CSA)
Need understanding and meaning (why)
Probably the best training to detect psychological issues
Listen (Active listen)
(Do the clinical bit)
Mental illness Mental health Mental healthy Flourishing
issue: stress, worry Well Being
B - Background: What is going on in your life?
A - Affect: How do you feel about that?
T - Trouble: What troubles you about that?
H - Handling: How are you handling that?
E - Empathy: That must be very difficult for you
“Allows the practitioner to hand the problem back to the patient, while still showing them understanding, all in a standard consultation”
Sickness brought me this Thought, in that scale of his: Why should I be dismayed Though flame had burned the whole World, as it were a coal, Now I have seen it weighed Against a soul?
Dr Martin Wilkinson
Director GP Education
Health Education West Midlands