consultation

1. consultation Dr. JAWAHER AL-AHMADI MB. ABFM. SBFM

2. what do you understand by consultation ?

3. For relief of symptoms & diagnosis For normal medical service For reassurance For support For playing games As habitual response to anxieties For certification For follow-up For referral For prescription What are the reasons for pt consulting ?

4. What are the doctor’s objectives from the consultation ? • Establishing and maintaining relationship • Obtaining information relating to the pt problem • Conveying appropriate information to the pt • Terminating the consultation in the shortest possible time

5. Some early truths to remember • The patient is as frightened as you are • The patient think is more serious than you • Illness is frightening but understanding what is going on helps

6. The health belief model Health motivation Perceived vulnerability Perceived seriousness Perceived costs and benefits

7. Locus of control • The internal controller • The external controller • The powerful other

8. Diagnostic process Cues Clinical,behvioral Hypothesis revise Unexpected cues Search History.exam,invest managment Follow-up

9. Psychological & Social Component of Physical Problem • Illness behavior • Interaction between psyho-social and physical problems

10. Pt centered Use of pt’s knowledge & experience PHC Doctor centered Use of doctor’s skills & knowledge Hospital Models of consultation

11. Pandleton seven tasks • To establish & maintain Dr-pt relationship • To define the real reasons for pt attendance • To consider other problems • To choose with the pt appropriate action for each problem • To achieve a share understanding • To involve pt in the management • To use time & resources effectively

12. To establish & maintain Dr-pt relationship • Why ? • What ? • How ?

13. Dr – Pt Relationship

15. To establish & maintain Dr-pt relationship • Welcoming the pt • Showing sympathy & empathy • Showing respect • confidentiality

16. Communication appearance • Pt response to questions about items of Dr’s dress • Believe male doctor should wear: • white coat 15% • Suit 44% • Tie 64% • Jeans(object) 59%

17. Communication appearance • Believe female doctor should wear: • White coat 34% • Skirt 57% • Jeans&jewelry(object) 63%

18. Communications environment dr pt couch

19. Communications environment

20. Communication • Verbal communication • Nonverbal communication • Paralanguage • Touch • Body languabge body position head position face eye leg arms

21. To define the real reasons for pt attendance • Nature of the problem • Etiology • Pt ideas • Pt concern • Pt expectation • Pt fears • Pt effect of the problem

22. To define the real reasons for pt attendance • Pt ideas

23. To define the real reasons for pt attendance • Pt concern

24. To define the real reasons for pt attendance • Pt expectation

25. Sabah is 38 years old lady, divorced 2week ago,running small business, looking after 5 children by herself, complaining of 2 week history of headache. Speculates how she may think about her illness

26. To consider other problems • Continuous problem • At risk factors

27. To choose with the pt appropriate action for each problem • Pt responsibility • Pt compliance

28. doctor patient To achieve a share understanding Knowledge Questions Doubts Theories experience Knowledge Questions Doubts Theories experience

29. To involve pt in the management

30. To use time & resources effectively

31. The expanded model of consultation • Management of presenting problem • Management of continuous problem • Modification of help seeking behavior • Opportunistic health promotion

32. Modification of help seeking behavior • Denial • Sick role • Hidden agenda • By the way doctor

33. Inner consultation • Connect • Summarize • Hand over • Safety netting • House keeping

34. PRACTICAL • Prior to the consultation • Relationship • Anxieties • Common language • Translation • Interaction • Converting insight into action • Agreement check, safety netting • Leave from consultation, time for reflection

35. THANK YOU