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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 l.jpg

Analysis of consultations

How could consultations be analysed?

How could we derive any models?

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

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5 models of the consultation

Stott & Davis

Pendleton et al

Roger Neighbour


John Heron

RCGP curriculum COT

Consultation models.doc

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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

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Stott & Davis - The unique potential.. consultation

  • 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

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Stott & Davis - The unique potential.. consultation

  • 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

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Pendleton et al – 7 tasks of the consultation 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

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Roger Neighbour - The Inner Consultation consultation

  • Connecting

  • Summarizing

  • Handing Over

  • Safety-netting

  • House-keeping

  • Neighbour, R (1987), “The Inner Consultation”, Kluwer Academic

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Cambridge-Calgary consultation

  • 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)

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John Heron - interventions consultation

  • 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

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    Heron – interventions 2 consultation

    • 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

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    Heron – interventions 3 consultation

    • 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)

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    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

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    Competencies following on from the RCGP curriculum statement:

    • Communication and consultation skills

    • Practising holistically

    • Data gathering and interpretation

    • Making a diagnosis / decisions

    • Clinical management

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    What is the aim….. statement:

    • A doctor who is competent to

      practise independently as an

      unsupervised GP

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    Assessed by….. statement:

    • COT

    • CSA

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    Assessing the consultation for the COT statement:

    • Insufficient evidence

    • Needs further development

    • Competent

    • Excellent

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    Units of Competence and Performance Criteria statement:

    • 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

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    Performance Criteria statement:

    • 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

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    Performance Criteria statement:

    • 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

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    Performance Criteria statement:

    • 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