consultation skills dr. ekram a jalali. initiating the consultation objectives establishing a...
TRANSCRIPT
INITIATING THE CONSULTATION
OBJECTIVES Establishing a supportive
environment Developing an awareness of the
patient’s emotional state Identifying as far as possible all the
problems or issues that the patient has come to discuss
Establishing an agreed agenda or plan for the consultation
Enabling the patient to become part of a collaborative process
SKILLS
Preparation• Puts aside last task, attends to self comfort • Focuses attention and prepares for this
consultationEstablishing initial rapport• Greets patient and obtains patient’s name • Introduces self and clarifies role• Attends to patient’s physical comfort,
demonstrates interest and respect
Identifying the reason(s) for the patient’s attendance
• Opening ended question: identifies the problems or issues
that the patient wishes to address (e.g. “What would you like to discuss today?”)
• Listening to the patient attentively without interrupting or directing patient’s response
Identifying the reason(s) for the patient’s attendance
Checking list of problems or issues that the patient wishes to cover (e.g. “so that’s headaches and tiredness, is there anything else you’d like to discuss today as well?”)
• Agenda setting: negotiates agenda and format of interview taking both patient’s and physician’s needs into account
INFORMATION GIVING, EXPLANATION AND PLANNING
Gauging the correct amount and type of information to give to each individual patient
Providing explanations that the patient can remember and understand
Providing explanations that relate to the patient’s illness framework
INFORMATION GIVING, EXPLANATION AND PLANNING
Using an interactive approach to ensure a shared understanding of the problem with the patient
Involving the patient and planning collaboratively to increase the patient’s commitment and adherence to
plans made Continuing to build a relationship and
provide a supportive environment
Pendleton 7 Tasks To define the real reasons for pt attendance To consider other problems To choose with the pt. appropriate action for
each problem To achieve a share understanding To involve pt. in the management To use time & resources effectively To establish & maintain Dr.-pt. relationship
Pendleton 7 Tasks To Explore the Real Reasons for Pt.
Attendance History Nature of the problem Etiology Effect of the problem Ideas Concern Expectation Fears
Pendleton 7 Tasks Skills Needed To Explore the Real
Reasons for Pt. Attendance Open ended questions Indirect questions Use of silence Recognition of patient’s cues Immediate response to patient’s cues Confrontation Reflection Probing Summarization
Pendleton 7 Tasks Practicing Consultation Skills Establishing & maintaining Dr- Pt
Relationship Prior to consultation Welcoming the patient Initiating the interview Showing interest Balance between intimate relationship &
professional relationship Maintaining the relationship Showing empathy Legitimation Showing support
Practicing Consultation Skills Ethical Considerations
Respecting patient autonomy Confidentiality Non judgmental attitude
Diagnosis in PHC
Pattern of recognition Hypothetical deductive reasoning
method Using clinical epidemiology Living with uncertainty 50% No diagnosis
Diagnosis in PHC Hypothetical Deductive Reasoning
Method Present Complain + Context of the consultation + Previous knowledge about the patient. + Verbal & non verbal cues 3-5 Hypotheses (Dr. clinical + epidemiological knowledge + Dr. experience) Inclusion or exclusion of hypotheses (Dr. conducting verbal examination or physical examination or selective investigations
Management Skills Negotiation skills Reassurance skills Health Education Counseling Prescribing Investigations Referral Follow up Modification of help seeking behavior Use of medical records House keeping
Difficult Consultation
Different Patients Need Different Consultation Skills Patient Reluctant to Talk Freely Angry Patient Demanding Patient Talkative Patient Poor Compliance
Difficult Consultation Patient Reluctant to Talk Freely
Causes : Patient Factors Dr. Factors Circumstances Examples :
The topic Cultural barrier Social class barrier
Dr. authority Time constrains Presence of 3rd party
Difficult Consultation Approach to Patient Reluctant to
Talk Freely Verbal Communication
Giving reason for the question. Comments on the patient attitude Generalization of the problem Asking at the right time Reflection Mirroring Confrontation
Difficult Consultation Approach to
Patient Reluctant to Talk Freely
Non - verbal Communication.
Showing sympathy & empathy
Showing real interest Unhurried manner Touch for reassurance Use of physical
examination
Difficult Consultation Angry Patient
Communication Skills Empathy Legitimation Non-judgmental
attitude Respect patient
autonomy Support Flexibility
Difficult Consultation Demanding
Patient communication Skills Discuss the effect
of the problem in the patient life
Focus on immediate concern
Deal with feelings
Difficult Consultation
Demanding Patient communication Skills Comment on the process of the
interview Negotiate agenda & goals :
1. Set limit 2. Reinforcement
3. Compromise & Be flexible Focus on patient as well as his
demands & complaints
Difficult Consultation
Talkative Patient Summarization Prioritization Use of touch Sympathy &
empathy