How are you feeling today?
Do you have any problem as of today?
Is there any issue that you think is a problem?
When were his/her last laboratory investigations like hemoglobin (Hb), total leukocyte count (Tlc), liver function (Lft), kidney function (kft), etc. done?
What laboratory has done these tests?
What are the details of the hemoglobin (Hb), total leukocyte count (Tlc), liver function (Lft), kidney function (Kft), etc. tests?
Do you have any problem as of today?
Is there any issue that you think is a problem?
Consultation Analysis
What is the consultation?
Why is consultation analysis important?
How can consultations be analysed?
What is the patient's agenda?
What are their fears and concerns?
Why did the patient really come? Is there a false or unrealistic expectation?
Are there fears that need to be allayed or other issues that need to be addressed?
Is there a hidden agenda?
How can consultations be analysed?
Consultation analysis is most often undertaken as part of teaching, learning or research. In general practice it has become a routine part of teaching and learning consultation skills. Consultations can be real or simulated. They can be observed or recorded in a number of ways.
•An observer 'sits in' on real consultations.
•An observer or observers may watch through one-way glass so that they are not physically present in the consultation.
•Consultations can be recorded using appropriate rules and guidelines (see below) for subsequent discussion and analysis.
•Consultations can be described and discussed after the consultation by doctors, doctor and patient or more widely with others.
•Mock consultations can be undertaken with participants playing the role of doctor or patient. Actors can be used to play the role of patient.
More obtrusive observation of the consultation is more likely to affect what goes on within the consultation.
Discussion and analysis usually take place with reference to the various consultation models described (see below).
Consultation skills
Welcoming. Does the doctor encourage comfort and trust from the outset? Is the patient at ease and ready to bare their soul? Do not be finishing off the notes for the last patient when the next arrives. Check the records before the patient enters so as to be able to offer full and undivided attention. It may be mundane to you but to the patient this is the most important thing to have happened all week.
Questions. Questions should be open, giving the patient the opportunity to expand - not closed and limited or leading. In reality we sometimes have to break this rule to get a meaningful answer from certain people. Try not to interrupt unless for clarification, although some people do need reining in. Listen and maintain a flow. Sometimes patients say something that needs further investigation but it is inappropriate to break the current chain of thought and focus. They should be returned to later in the consultation but it is very easy to forget until after the patient has left the room. A useful tip is to write a note to remind oneself before the patient leaves.
Listening. Appear attentive and maintain eye contact as much as possible. It may or may not be appropriate to make notes as the patient speaks. In the early days of computers patients used to complain, 'He was more interested in that screen than in me'. Listening includes looking and noting non-verbal cues and body language.
Response. This involves clarifying points, summarising, reflecting statements and feelings, ascertaining understanding and possibly defusing anger. Empathy forms an important response and, for some patients, may be all that is required, thus forming a therapy as well.[14]
Explanation. Use language that the patient will understand. Give important information first. Possibly repeat important points and ascertain that the patient understands. Written information or visual aids may help too.
Closure. The closing act of an consultation used to be the issuing of a prescription and no consultation was complete without one. Some form of closure is required with clarification of what is expected of the patient or the next step. Make correct, adequate and contemporaneous notes.
Safety-netting. Doctors are encouraged to consider:[9]
- What do I expect to happen if I am right?
- How will I know if I am wrong?
- What would I do then?
Asking these questions leads the doctor to advise patients what to do to cover or take account of the answers to these questions and record these clearly in the notes.
|
