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Consultation Models

Consultation Models. Overview. Different models lend different perspectives to the consultation. This allows you to concentrate of different individual training needs. They are commonly asked about inn the MRCGP exam. RCGP Model.

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Consultation Models

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  1. Consultation Models

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

  3. RCGP Model • Asks the doctor to look beyond the organic and include other elements of the presentation of ill health: • Physical • Psychological • Social

  4. McWhinney 1972

  5. 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

  6. Berne 1977 • Transactional Analysis Model of human behaviour • Ego states Parent / Child / Adult • May help in interpreting some situations

  7. 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

  8. Pendleton et al 1984 • Define the reason for the attendance • nature and history • aetiology • ideas, concerns and expectations • effects of the problem

  9. 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

  10. 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?

  11. 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

  12. Neighbour 1987 • The Inner Consultation • Connecting • Summarising • Handing over • Safety netting • Housekeeping

  13. 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?

  14. Cambridge-Calgary • Initiating the consultation • Gathering information • Building the relationship / facilitating the patient’s involvement • Explanation and planning • Closing

  15. 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)

  16. 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 Match problem to model

  17. Constructive Feedback • Pendleton’s Rules • SETGO

  18. Pendleton’s 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

  19. 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)

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