Consultation skills

1. Consultation skills COT

2. Patient-centred consultingcalgary-cambridge • Process skills • Biomedical perspective (disease) • Patient’s perspective (illness) • Essential background information • Integration and weaving of the 2 frameworks • Explanation and planning • Shared understanding and decision-making

3. Neighbour • Connecting • Summarising • Handover • Safety-netting • housekeeping

4. Discover the reason for the patient’s attendance 1 • The doctor is seen toencourage the patient’s contribution at appropriate points in the consultation.

5. Active listening facilitation • Verbal • Non verbal • Looking for evidence that the doctor can encourage contribution from a patient when encouragement is needed

6. Discover the reason for the patient’s attendance 2 (Merit) • The doctor is seen to respond to signals (cues) that lead to a deeper understanding of the problem.

7. Responding to cues • “You look upset…..” • “You said earlier…..” • “I noticed that….” • Non verbal cues • Pacing as a response • Empathy Did responding to the cue contribute to the consultation- how did it alter what emerged?

8. Discover the reason for the patient’s attendance 3 • The Dr uses appropriate psychological and social information to place the complaints in context and to explore the problem. • 25% of those who failed, did it here!

9. “How does your backache affect you at work?” • Case selection

10. Discover the reason for the patient’s attendance 4 • The Dr. explores the patient’s health understanding • 24% of those who failed, did it here!

11. What did you think was going on? • Were you concerned that this was something serious? • What would be your worst fear? • What were you hoping I would be able to do?

12. Defines the clinical problem 5 • The Dr obtains sufficient information to include or exclude likely relevant significant conditions. • 28% of those who failed, did it here! This is avoidable with good case selection.

13. 6 Defines the clinical problem • The physical/mental examination chosen is likely to confirm or disprove hypotheses that could reasonably have been formed OR is designed to address a patient’s concern. • Use of closed questioning. • Taking into account the epidemiological realities of general practice.

14. Defines the clinical problem 7 • The Dr appears to make a clinically appropriate working diagnosis.

15. Explains the problem to the patient 8 The Dr explains the problem or diagnosis in appropriate language. • What was the quality of the explanation? • Excellent consultations will incorporate some of the patient’s health beliefs.

16. Addresses the patient’s problem9 • The Dr specifically seeks to confirm the patient’s understanding of the diagnosis.

17. “I don’t know whether that makes sense, is there anything you want to ask me? • “How will you explain this to….” • What do you understand by that? • What does high blood pressure mean to you?

18. Addresses the patient’s problem 10 • The management plan (including any prescription) is appropriate for the working diagnosis, reflecting a good understanding of modern accepted medical practice. • It must represent good current medical practice.

19. Addresses the patient’s problem 11 • The patient is given the opportunity to be involved in significant management decisions. • 65% of those who failed, did it here!- because they weren’t “patient-centred” right at the beginning.

20. Explained sufficiently for the patient to be able to make a choice. • It’s the real opportunity of a real choice that matters • Still OK if the patient doesn’t want to choose.

21. Makes effective use of the consultation 12Makes effective use of the resources • Includes effective use of time.

22. Makes effective use of the consultation 13 • The Dr specifies the conditions and interval for follow-up or review. Should be straightforward- interpretation is broad.

23. Communication and consultation skills- Needs further development • The problem, rather than the patient is the focus. • Management plans are appropriate. • Explanations are relevant and understandable. • Achieves the tasks of the consultations, but uses a rigid approach.

24. Communication and consultation skills- Competent • Explores patient’s agenda and health beliefs & elicits pyschosocial information. • Works in partnership with the patient. • Explores understanding. • Responds to the consultation preferences of the patient.

25. Communication and consultation skills- Excellent • Incorporates the patients perspective into the management plan. • Plans respect the patient’s autonomy. • Uses a variety of communication techniques to adapt explanations to the patient. • Uses advanced consultation skills such as catharsis or confrontation to achieve better patient outcomes.

26. Agenda led outcome based analysis •   ask what problems the learner experienced and what help he would like from the rest of the group. •    encourage the group to work together to generate solutions not only to help the learner but also to help themselves in similar situations.