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Author FM

Last update 10/1/97

A. Description of events occurring in the consultation (after Byrne and Long 1976)
Model was produced after analysing over 2000 recordings of consultations. They
identified six phases that form the logical structure to the consultation.

1. The doctor establishes a relationship with the patient.

2. The doctor either attempts to discover or actually discovers, the reason for the patients
attendance.

3. The doctor conducts a verbal or physical examination, or both.

4. The doctor, or the doctor and the patient together, or the patient alone consider(s)
the condition.

5. The doctor, and occasionally the patient, details treatment or further investigation.

6. The consultation is terminated - usually by the doctor.

 

B. Expansion to include preventative care

Stott and Davies described four areas which could be systematically explored each
time a patient consults (1979).

1. Management of presenting problems

2. Management of continuing problems

3. Modification of help-seeing behaviour

4. Opportunistic health promotion

C. A model of seven tasks

Pendleton et al (1984), lists 7 tasks which form an effective consultation.

1. To define the reasons for the patient's attendance including:
- the nature and history of the problem
- their cause
- the patient's ideas, concerns and expectations
- the effects of the problems

2. To consider other problems
- continuing problems
- risk factors

3. To choose with the patient an appropriate action of each problem

4. To achieve a shared understanding with the patient

5. To involve the patient in the management plan and encourage him to accept
appropriate responsibility

6. To use time and resources appropriately

7. To establish or maintain a relationship with the patient which helps to achieve the
other tasks

D. Health Belief model

Rosenstock (1966) and Becker and Maiman (1975) Looks at the patient's reasons for accepting or rejection the doctor's opinion. More likely to accept advise, diagnosis or treatment if the doctor is aware of their ideas, concerns and expectations

1. People vary in their interest in health - health motivation

2. Patients vary in how likely they think they are to contract an illness - perceived vulnerability

3. Patients' belief in the diagnosis is affected by whether they feel their opinion or 'concerns' have been understood by the doctor

4. "Perceived seriousness" varies between patients for a given condition

E. The Inner Consultation Roger Neighbour 1987

1. Connecting: Rapport building skills

2. Summarising: Listening and eliciting skills

3. Handing Over: Communicating skills

4. Safety netting: Predicting skills. Contingency plans of what and when further action may be needed.

5. Housekeeping: Taking care of yourself, checking you are ready for the next patient.

Last updated 10/1/97

 

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