Dr Carter is a GP in Lancashire and Yorkshireġ.If a consultation does become difficult you will have different strategies ready to get things back on track. The more you practice, the more your model will become automatic so you can concentrate on what the patient is saying. When you feel you have a system of questions that are working, memorise them so that you can use them if a consultation stalls or in your CSA exam. In addition, watching others consult allows you to pick up questions they use to elicit information. Ask your trainers and colleagues for feedback to identify what is working and what is not. I once said to a patient 'What do you think is wrong?' He was so impressed that I had asked him for his opinion that he sent all of his family to see me.Īnother way to improve your consultation skills is to video your consultations and watch them. I used a Post-it note with my 'question of the week' stuck on to my monitor so I would not forget, and the results were amazing. To see what works for you try adding in a different question each week. A question to aid shared decision making could be 'There are different management options you could try, these are.The section on explanation and planning is particularly helpful for looking at shared understanding and shared decision making.A 71-point model and a useful template with lots of different consulting strategies.This model looks at the process of the consultation from initiating the session, gathering information, providing structure to the consultation, building a relationship, giving information by explanation and planning, and closing the session. Questions to check understanding include: 'Could you tell me what you understand the problem to be so I can check I have explained it okay?'Ĭalgary-Cambridge Guide (Kurtz and Silverman), 1996.
Use a specific time frame, for example 'come back in two weeks if it doesn't get better'. This model outlines safety netting where the doctor and patient plan together to manage uncertainty.Summarising both the events and the emotional content is a useful way to demonstrate empathy.
It can be an effective strategy if you feel that the consultation is stalling.
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This model sees the consultation entirely from the patient's perspective using a series of questions such as: 'what has happened?' and 'why me?'
The following summary includes the models that I believe are the most useful with a brief explanation, highlights and questions to use in consultations. > More advice and information for GP trainees One of the six blueprint areas tested in the CSA is a person-centred approach using recognised communication techniques that enhance understanding of a patient's illness and promote a shared approach to managing problems. It also means you have a range of different techniques to use in difficult consultations.Ĭonsultation models are also a great way to help prepare for the clinical skills assessment (CSA). Having your own model ensures you have an internal guide to draw on during the consultation to achieve the best outcome for your patient. The best way to use consultation models is to read them all, see which you like and take the best out of each to develop your own model.Ĭonsultation models are not rules they are learning aids to help you develop your own consultation skills. This article was first published in March 2010 and reviewed in April 2018 by Dr Ravi Ramanathan.