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GP ST2 session

GP ST2 session. The GP consultation. General format. 1-intros 2-gp rags 3-problems 4-questions 5-allocated topic of the day Coffee 6-ethical topic. Consultation Models. "Words are, of course, the most powerful drug used by mankind" Rudyard Kipling.

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GP ST2 session

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  1. GP ST2 session The GP consultation

  2. General format • 1-intros • 2-gp rags • 3-problems • 4-questions • 5-allocated topic of the day • Coffee • 6-ethical topic

  3. Consultation Models "Words are, of course, the most powerful drug used by mankind" Rudyard Kipling

  4. Demonstrate understanding of the context in which the consultation happens.With patients this means: • 􀁺 Recognising that patients are diverse: that their behaviour and attitudes vary, for example, by age, gender… • 􀁺 Responding flexibly to the needs and expectations of different individuals • 􀁺 Understanding the process by which patients decide to consult, and how this can affect consulting outcomes • 􀁺 Recognising the GP’s roles and responsibilities towards the patient • 􀁺 Negotiating a shared understanding of the problem and its management with the patient, so that he or she • is empowered to look after his or her own health • 􀁺 Demonstrating commitment to health promotion, while recognising the potential tension between this role • and the patient’s own agenda • 􀁺 Managing the potential conflicts between personal health needs, evidence-based practice and public health • responsibilities.

  5. With the patient’s relatives, friends and supporters this means: • 􀁺 Recognising that episodes of illness may affect more than merely the patient • 􀁺 Understanding the patient’s right to confidentiality • 􀁺 Negotiating whether and how relatives and others might be involved. • With other professional colleagues this means: • 􀁺 Working successfully as a member of the primary care team • 􀁺 Working successfully with colleagues in secondary care and elsewhere • 􀁺 Working successfully with a range of other professionals such as Social Services • 􀁺 In all cases, recognising that ‘working successfully’ involves: • 􀂌 understanding the role of professional colleagues, and where their expertise lies • 􀂌 drawing on this expertise as appropriate • 􀂌 treating colleagues with consideration and respect • 􀂌 understanding interprofessional boundaries with regard to clinical responsibility and confidentiality.

  6. Consultation models which you know?

  7. Consultation models • 1957 M Balint - The Doctor, His Patient and The Illness • 1964 E Berne - Games People Play • 1975 Becker & Maiman - Sociobehavioural Determinants of Compliance ... • 1975 J Heron - Six Category Intervention Analysis • 1976 Byrne & Long - Doctors Talking to Patients • 1977 RCGP definition - Physical, psychological & social ... • 1979 Stott & Davis - The Exceptional Potential in Each Primary Care Consultation • 1981 C Helman - Disease vs Illness in Gen Practice • 1984 Pendleton et al - The Consultation • 1987 R Neighbour - The Inner Consultation • 1987 R C Fraser - Clinical Method: A Gen Pract Approach • 1996 Kurtz & Silverman The Calgary-Cambridge Observation Guide to The Consultation

  8. Traditional medical model The classic medical diagnostic process involves the following steps: • observation - history and examination • hypothesis -provisional diagnosis • hypothesis testing - investigations • deduction - definitive diagnosis.

  9. Introduction • Models enable the Dr to think where in the consultation the problems are, • There are lots of models. • Task orientated, Skills based, • Some are based on the doctor patient relationship, or the patients perspective of illness.

  10. Key elements to a consultation

  11. Core skills • Structure of the consultation • clinical, a psychological and a social component, • Techniques to limit consultation length when appropriate • Adapt communication skills to meet patient needs

  12. Key elements • Formulate appropriate diagnoses, rule out serious illness and manage clinical uncertainty • ?ways of doing this • Recognising how consultations conducted via remote media (telephone and email) differ from face-to-face

  13. blocks to good communication • interruption, rushing • ignoring cues • mismatch of agendas • making light of symptoms reported by patient • collusion, false reassurance • too much info, aimed too high

  14. Top tips for GP?

  15. My top tips • You get more than one bite… • If you are confused, the patient will be • Take time to review notes/letters<appt • Consider joint apt/rvw >bld tests • Offer to phone back later after d/w a colleague • Consider double apt • ASK. Ask to learn • Safety net

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