CONSULTATION MODELS

CONSULTATION MODELSDR. KHALID D. AL-HARBYMBBS,ABFM,SBFM

25% of consultations are patient initiated as new presentations of new problems.A further 50% are repeat consultations addressing chronic ongoing issues, a follow-up of an acute problem, or because of some disease presenting activity.The final 25% are termed recidivist. They again are patient initiated and occur on matters and reopen agenda that the doctor may have felt should be closed.

Data on the consultation2/3 of illness do not get brought to the doctor9/10 of symptoms do not brought to the doctor (the iceberg effect)1/5 of patients make up half the work of children with URTIs present because of social factors related to parents75% of doctors use tight doctor-centered styles

90% of patients are happy with their doctors80% of patients find their doctor easy to talk toThere is 50% divergence between doctors and assessment of the presenting problemdoctors interruption time of first patients opening statement is 18 seconds in averageICE generally may not be elicited

Transactional Model (Berne) 1964Human psych consists of 3 ego states parent, adult, and child. At any given moment each of us is in a state of mind when we think, feel, behave, react, and have attitude as if we were either a critical or caring parent, a logical adult, or a spontaneous or dependent child.

Health belief model (Rosenstock-1966- and Becker and Maiman-1975)Looks at the patients reasons for accepting or rejecting the doctors opinion.More likely to accept advice, diagnosis, or treatment if the doctor is aware of their ICEPeople vary in their interest in health (health motivation)Patients vary in how likely they think they are to contract an illness (perceived vulnerability)

Health belief model (Rosenstock-1966- and Becker and Maiman-1975)3. Patients belief in the diagnosis is affected by whether they feel their opinion or concerns have been understood by the doctor4. perceived seriousness varies between patients for a given condition.

Sex - category intervention analysis (1975) [ John Heron]The doctors intervention fall into one of sex categories:-Informative: importing new knowledge, instructing, or interpreting.Prescriptive: giving advice or instructions, being critical or directive Confronting: challenging a restrictive attitude or behavior, giving direct feedback within a caring context

4. Cathartic: seeking to release emotion in the form of weeping, laughter, trembling or anger5. Catalytic: encouraging the patient to discover and explore his own latent thoughts and feelings6. Supportive: offering comfort and approval, affirming the patients intrinsic values

The inner consultation (Roger Neighbour)Connecting ( rapport)Summarizing ( demonstrate to pt. That you have understood why he came)Handing over ( pt. Accept the plan we have agreed)Safety netting (anticipation)Housekeeping (ready for next patient)

BALINT MODELThe drug doctorChild as a ticketCollusion of anonymity (all are well and gratified and if any thing goes wrong nobody is individually responsible)Teacher-pupil relationship

5. Apostolic function (somehow when we examine our patients we examine our self, so, we may expect patient to take our action for such a problem as a Model))6. Mutual investment company: it is not love, not mutual respect, not mutual identification, not friendship, though an element of all this enter it

Pendleton's model the 7 tasksDefine reason for patients attendanceConsider other problems: continuing problems, at risk factors.With the patient, to choose an appropriate action for each problem.To achieve a shared understanding of the problems with the patient.

5. To involve the patient in the management and encourage him to accept appropriate responsibilities.6. To use time and resources appropriately7. To establish or maintain a relationship with the patient which helps to achieve the other tasks

Stott and Davies model Management of presenting problemModification of help seeking behaviors( e.g by educating the patient about the natural history and self medication of minor illnesses)Management of continuing problems Opportunistic health promotion ( e.g vaccination, cervical screening)