Consultation Analysis VTS 3/10/07. Analysis of consultations How could consultations be analysed?...
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Transcript of Consultation Analysis VTS 3/10/07. Analysis of consultations How could consultations be analysed?...
Consultation Analysis
VTS 3/10/07
Analysis of consultations
How could consultations be analysed?How could we derive any models?
Byrne & Long (1976), “Doctors talking to patients”.
5 models of the consultation
Stott & Davis Pendleton et al Roger Neighbour Cambridge-Calgary John Heron
RCGP curriculum COT
Consultation models.doc
Stott & Davis - The unique potential of each primary care consultation
Dealing with the acute problem Dealing with chronic problems Opportunistic health promotion Modification of help-seeking
behaviour
Stott NC, Davis RH, “The Exceptional Potential in each Primary Care Consultation”, Journal of the Royal College of General Practitioners 1979; 29: 201–5
Stott & Davis - The unique potential..
What is the meaning of “Modification of help-seeking behaviour”? Not wasting resources – making better
use Empowering patients – encouraging self-
reliance and reducing dependency Controlling demands on NHS An example might be to suggest that
someone who repeatedly presents within 24 hours of the onset of a sore throat might consider self medication for future episodes
Stott & Davis - The unique potential..
What is the meaning of “Opportunistic health promotion?”
Timely advice Relevant to the presentation Directs attention to aetiological factors Evidence that it is more effective then
Pendleton et al – 7 tasks of the consultation
Why did the patient attend? Consider other problems Choose appropriate action(s) Share understanding Involve patient – management and responsibility Effective use of time & resources Establish/ maintain relationship with
patient
Pendleton et al, “The Consultation: an approach to learning and teaching”, Oxford Medical GP Series
Roger Neighbour - The Inner Consultation
Connecting Summarizing Handing Over Safety-netting House-keeping
Neighbour, R (1987), “The Inner Consultation”, Kluwer Academic
Cambridge-Calgary
Initiating the session Gathering information Explanation and planning Closing the session Kurtz SM, Silverman JD, Draper J (1998)
Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press ( Oxford)
Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford)
John Heron - interventions
Six types of intervention:
AuthoritativePrescriptive – directing patient’s behaviourInformative – imparting informationConfronting – raising patient’s awareness
FacilitativeCathartic – enabling abreaction of painful
emotionCatalytic – eliciting Supportive – affirming patient’s worth
Heron – interventions 2
Prescriptive - Directs the behaviour of the patient - treatment and follow up
Informative – Imparts knowledge, information and meaning to patient
Confronting - Raises the patient’s consciousness about some limiting factor
Cathartic - Enables patient to abreact painful emotion
Catalytic - Seeks to elicit self discovery
Supportive - Affirms worth & value of patient
Heron – interventions 3
Degenerate Intervention Fails in one or more of these aspects Practitioner lacks personal development, training, experience,
awareness or combination of these
Unsolicited Insensitive blundering into territory - intrusive
Manipulative Motivated by self interest regardless of needs of patient From stress, lack of control, lack of awareness Facipulation - using facilitation to manipulate a desired
outcome
Compulsive
Unskilled
Heron J, “Helping the Client: A Creative Practical Guide”, 2001 (First published 1975)
RCGP Curriculum Statement 2: The General Practice Consultation
Six core competencies:
Primary Care Management Person-Centred Care Specific Problem-Solving Skills A Comprehensive Approach Community Orientation A Holistic Approach
Being a GP.pdf
Competencies following on from the RCGP
curriculum statement:
Communication and consultation skills
Practising holistically Data gathering and interpretation Making a diagnosis / decisions Clinical management
What is the aim…..
A doctor who is competent to practise independently as an unsupervised GP
Assessed by…..
COT
CSA
Assessing the consultation for the COT
Insufficient evidence Needs further
development Competent Excellent
Units of Competence and Performance Criteria
Discover the reason for the patient’s attendance Define the clinical problem(s) Explain the problem(s) to the patient Address the patient’s problem(s) Make effective use of the consultation
Performance Criteria
PC1: The doctor is seen to encourage the patient’s contribution at appropriate points in the consultation
PC2: The doctor is seen to respond to signals (cues) that lead to a deeper understanding of the problem
PC3: The doctor uses appropriate psychological and social information to place the complaint(s) in
context
PC4: The doctor explores the patient’s health understanding
Performance Criteria
PC5: The doctor obtains sufficient information to include or exclude likely relevant significant conditions
PC6: The physical /mental examination chosen is likely to confirm or disprove reasonable hypotheses
PC7: The doctor appears to make a clinically appropriate working diagnosis
PC8: The doctor explains the problem or diagnosis in appropriate language
Performance Criteria PC9: The doctor specifically seeks to confirm the
patient’s understanding of the diagnosis
PC10: The management plan (including any prescription) is appropriate for the working diagnosis
PC11: The patient is given the opportunity to be involved in significant management decisions
PC12: The doctor makes effective use of resources
PC13: The doctor specifies the conditions and interval for follow up or review