Consultation Models

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Consultation Models
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Overview

• Different models lend different perspectives to
  the consultation. This allows you to concentrate
  of different individual training needs. They are
  commonly asked about in the MRCGP exam.

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RCGP Model

• Asks the doctor to look beyond the organic and
  include other elements of the presentation of ill
  health
• Physical
• Psychological
• Social

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McWhinney 1972

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Byrne and Long 1976

• Establish a relationship
• Discover the reason for attending
• Perform verbal and physical examination
• The doctor, patient or both then consider the
  problem
• Discuss management

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Berne 1977

• Transactional Analysis Model of human behaviour
• Ego states Parent / Child / Adult
• May help in interpreting some situations

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Stott and Davis 1979

• Management of presenting problem
• Modification of help-seeking behaviour
• Management of continuing problems
• Opportunistic health promotion
• may be helpful in extending your outlook
• into the potential of each consultation

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Pendleton et al 1984

• Define the reason for the attendance
• nature and history
• aetiology
• ideas, concerns and expectations
• effects of the problem

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Pendleton et al 1984 (cont)

• Consider the other problems
• Choose an appropriate action for each
• Achieve an understanding with patient
• Involve them in management plan
• Use time and resources appropriately
• Establish / maintain relationship

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Helman 1984

• Anthropological model
• What has happened
• Why has it happened? Why me? Why now?
• What would happen if I did nothing?
• What should I do about it?
• What can you do about it?
• How can I stop it happening again?

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Heron 1986

• Six-category intervention analysis
• Prescriptive - advising / telling
• Informative - instructive / interpreting
• Confronting - challenging / feeding back
• Cathartic - releasing emotions
• Catalytic - encouraging exploration
• Supportive - comforting / affirming

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Neighbour 1987

• The Inner Consultation
• Connecting
• Summarising
• Handing over
• Safety netting
• Housekeeping

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Murtagh 1998

• What is the probability diagnosis?
• What serious diagnosis should not be missed?
• What conditions are often missed?
• Is this a masquerade?
• Is the patient trying to tell me something that I
  have missed?

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Cambridge-Calgary

• Initiating the consultation
• Gathering information
• Building the relationship / facilitating the
  patients involvement
• Explanation and planning
• Closing

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Neurolinguistic Planning

• Based on models of how the brain handles
  information. Identify the predominant system the
  patient is using and modify your communication
  accordingly.
• Kinaesthetic (feeling)
• Visual (seeing)
• Auditory (hearing)

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Match problem to model

• Doctor Centred
• Expand outlook
• Difficult patients
• Difficult situations
• Anxious
• Body language
• Hospital based
• Practical teaching

• Helman
• Stott and Davis
• Heron
• Berne (TA)
• Murtagh
• Neighbour
• McWhinney
• Cambridge-Calgary

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Constructive Feedback

• Pendletons Rules
• SETGO

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Pendletons Rules

• What do you think you did well?
• What do I think you did well?
• What could have done differently?
• What do I think you could have done differently?
• How do you feel about this
• Finish on a positive reinforcement

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SETGO

• What did you See?
• What Else did I see?
• What do you Think about this?
• What Goals can we now set?
• What Offers have we got to achieve
  these goals? (Role Play)