consulting skills by husam abu-siedo

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Information about consulting skills by husam abu-siedo
Education

Published on September 21, 2008

Author: ashrafalabasiry

Source: authorstream.com

Consulting Skills : Consulting Skills Hussam Abu-seido Roger Neighbour : Roger Neighbour GP 1974-2003 in Abbots Langley, Hertfordshire, England GP Trainer Course Organiser of Watford VTS 1979-1986 Experimental psychology (the relationship between doctor and patient) Roger Neighbour : Roger Neighbour Examiner for the MRCGP examination for 20 years President of the Royal College of General Practitioners The Inner consultation 1987: explores the necessary skills that GPs must possess if they are to manage their central activity Consulting effectively OBJECTIVES : OBJECTIVES 1. To demonstrate that consulting skills are different from, and supplementary to, the traditional skills in diagnosing and treating that were taught at the medical school. 2. “Models of consultation” look at some of the ways in which the consultation has been studied and analysed to make consulting skills easier for trainees to acquire. 3. Learn about Roger Neighbour’s “Five (en route) check points” along the way of each consultation. The Art of General Practice : The Art of General Practice Subtlety: the extra quality that goes to make a general practice consultation skilful instead of merely adequate. Can you recognise subtlety? Is it quite precise and specific? Is there a possibility that you can take hold of subtlety and make it your own? The Art of General Practice : The Art of General Practice There are plenty of good doctors who are very understanding with patients, or who seem to get straight to the heart of their problems Do you think that type of skill can be taught to someone who hasn’t already got it The Art of General Practice : The Art of General Practice Books are good ways of passing on information at a conscious intellectual level, but unfortunately it’s often a matter of chance whether new ideas get far enough beneath the surface to change our behaviour at the unconscious level. The Art of General Practice : The Art of General Practice Do you think that consulting skills can be taught to someone who has not already got it? Can New ideas and skills get far enough beneath the surface to change our behaviour at the unconscious automatic level.? Clerking patients as medical students. Driving a car. Doing it without thinking. Skilled consultation: expressions, positions, posture, cues (verbal and non verbal). The Art of General Practice : The Art of General Practice A general criterion is the ability to pay attention to clues and events in the periphery and to be sensitive to the meanings underlying the behaviour patterns of the patients There is more in a situation than just the obvious mechanics CASE ILLUSTRATION : CASE ILLUSTRATION There’s a lump in my throat, doctor: Mrs Timid sometimes, but not always, feels it’s an effort to swallow her saliva. Food does not stick, although she’s afraid it might. She feels well in herself, has not lost any weight, and she has no other gastro-intestinal symptoms. CASE ILLUSTRATION : CASE ILLUSTRATION Doctor A carries out a physical examination, which is entirely normal. “nothing to worry about here”, he says, “ just some tension in the throat muscles, which we call globus. Best thing to do is try and put it out of your mind”. As Dr A escorts her to the door, Mrs. Timid turns and asks “ can’t I have an x-ray?”. CASE ILLUSTRATION : CASE ILLUSTRATION Doctor B: Before examining Mrs. Timid, Dr B says “So this feeling of a lump comes and goes, and it doesn’t actually interfere with swallowing your food, but nevertheless it’s been worrying you”. Mrs. Timid nods. CASE ILLUSTRATION : CASE ILLUSTRATION Dr B continues “I expect you’ve been thinking about this for a while, and I dare say you had some thoughts yourself about what it could be. I was wondering what had gone through your mind”. “ well actually, Doctor” says Mrs. timid, “what made me come was I saw that programme on the Television about throat cancer………”. CASE ILLUSTRATION : CASE ILLUSTRATION A New Diabetic Mrs Hogg, a widow aged 64, has just been found to be suffering from maturity-onset non-insulin-dependent diabetes. She will need weight reduction, an oral hypoglycaemic drug, and regular surveillance. CASE ILLUSTRATION : CASE ILLUSTRATION Doctor A: ‘Right’, says Dr A. ‘I’ve explained to you all about your pancreas, and your blood sugar. Now I’ll go over the dose of tablets, and tell you about your repeat prescription system. You’re going to need to come for regular check-ups – ask the receptionist to book you in to the next clinic, and tell her you’ll need a blood test a few days beforehand. I’ll be making you an appointment to see the dietician, but in the meantime here are some leaflets about carbohydrate and fibre intake’. From one of Mrs Hogg’s glazed eyes a tear begins to trickle. CASE ILLUSTRATION : CASE ILLUSTRATION Doctor B: ‘Right’, says Dr B. ‘The main thing is to get you feeling well again. You’re going to need to come and see me again soon so that I can keep a check on how things are going, and today I’m going to start you on some tablets. Now while I write out the prescription, you be thinking of the questions you want to ask me’. How have you been taught previously? : How have you been taught previously? The centipede was happy, quite, Until a toad in fun Said, ‘Pray, which leg goes after which?’ This worked his mind to such a pitch He lay distracted in a ditch Considering how to run How have you been taught previously? : How have you been taught previously? Informal chat over coffee. Lectures. Ward rounds. Tutorials. Sitting In. Teaching Methods : Teaching Methods MODEL OF SKILLS TRAINING : MODEL OF SKILLS TRAINING Model of participatory skills training, after Heron : Model of participatory skills training, after Heron MAPPING DISCRIMINATION MODELLING PRACTICE FEEDBACK Model of participatory skills training, after Heron : Model of participatory skills training, after Heron Mapping: Teacher and pupil agree in broad terms the concepts or skills to be acquired. Discrimination: Teacher and pupil observe, describe, analyse and categorise the components of the desired skill. Modelling: Teacher and pupil study, demonstrate and rehearse the component skills in a pure and simplified form. Practice: Pupil tries to put newly-learned skills into practice. Feedback: Teacher, or pupil, or both, or peers, comment on degree of achievement. Systematic model of consultation skills training , after Pendleton et al. : Systematic model of consultation skills training , after Pendleton et al. Secure Agreement Discriminate Pre-learning self assessment Agree learning Goals Practice Implementation Feedback Systematic model of consultation skills training , after Pendleton et al. : Systematic model of consultation skills training , after Pendleton et al. Secure agreement: Teacher offers pupil rationale for learning consultation skills. Pupil and Teacher agree relevance and acceptability. Discriminate: Teacher assists pupil to recognise when a particular skill is being attempted. Pre-Learning Self Assessment: Teacher and Pupil assess extent to which skill is already displayed in consultation. e.g. by using video or checklists. Agree Learning Goals: Teacher assists Pupil to set own goals. Practice: Pupil practises proposed changes before consulting with patients e.g. using video or role playing. Implementation: Pupil attempts newly-learned skills in actual consultations. Feedback: Pupil, or Teacher, or both, review learning and agree fresh goals. The assumptions underlying traditional skills training methods : The assumptions underlying traditional skills training methods Concepts 1 are organised into Theoretical Models 2 from which are derived Component skills 3 which, once Seen and described 4 can be Consciously Practised 5 Practice, with a bit of luck, leads to Improvement 6 which somehow or other becomes Internalised and Incorporated 7 into the doctor’s Repertoire of Consulting Skills 8 which, if he can use them appropriately, add up to Competent Consulting The Centipede : The Centipede Sadly he thought, ‘The Toad was right I can’t think how to run’ ‘I’m trapped here for good’, he cried. But then, as in despair he sighed, He felt his feet themselves decide The way back to the sun OBJECTIVES : OBJECTIVES 1. To demonstrate that consulting skills are different from, and supplementary to, the traditional skills in diagnosing and treating that were taught at the medical school. 2. “Models of consultation” look at some of the ways in which the consultation has been studied and analysed to make consulting skills easier for trainees to acquire. 3. Learn about Roger Neighbour’s “Five (en route) check points” along the way of each consultation. MODELS OF CONSULTATION : MODELS OF CONSULTATION Why all this talk of models? What’s the point of making models of the consultation, or of anything else in medicine, for that matter? What types of models are there? What use is a model when you’ve made it? MODELS OF CONSULTATION : MODELS OF CONSULTATION Model making is an essential step in mastering consultation skills. Models are all about us, all around us and all to do with us. Maps are models of real world THE MEDICAL MODEL : THE MEDICAL MODEL State of normal health Disease processes Diagnosis Management Successful therapy restores diseased processes to normal. THE MEDICAL MODEL : THE MEDICAL MODEL The one most thoroughly taught to medical students. Attractive because it stretches their intellects ( which tend to be well developed anyway) and spares them much involvement of their feelings ( of which they are much less sure). Shortcomings---the apparent disregard for the patient as a person. MODELS OF CONSULTATION : MODELS OF CONSULTATION “Doctor-Centred” or “Patient-Centred” Consultations “Task” or “behaviour” – orientated models focus on tasks to be achieved as opposed to the behavioural methods used in the consultation. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Physical, Psychological and Social Terms : Physical, Psychological and Social Terms Triad derived from the Job definition of a GP formulated by the working party of The Royal College Of General Practitioners. The General Practitioner is a doctor who provides personal, primary and continuing medical care to individuals and families. He may attend his patients in their homes, in his consulting room or sometimes in hospital. He accepts the responsibility for making an initial decision on every problem his patient may present to him, consulting with specialists when he thinks it appropriate to do so… His diagnoses will be composed in physical, psychological and social terms. He will intervene educationally, preventively and therapeutically to promote his patient’s health. Physical, Psychological and Social Terms : Physical, Psychological and Social Terms Extend the doctor’s thinking process beyond consideration of the purely organic, to include the patient’s emotional, family, social and environmental circumstances in his diagnosis. If the doctor’s awareness of these factors is heightened, he is more likely to include them in his management. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Stott and Davis : Stott and Davis Paper called (the exceptional potential in each primary care consultation). Four areas which could be systematically explored each time a patient consults. The presenting problem. Modify the patient health seeking behaviour. Review any of the patient’s long-term problems. Take the opportunity to undertake health promotion measures. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Byrne and Long (i) : Byrne and Long (i) Patrick Byrne and Barrie Long published Doctors talking to patients: a study of the verbal behaviour of general practitioners consulting in their surgeries. 1976. Analysed more than 2000 tape recordings of consultations made by over 100 doctors. Derived a classification of the sequence of events in the consultation. Describe six phases forming a logical structure to the consultation. Admit the logical form rarely appears in practice and should be seen as an ideal. Byrne and Long (i) : Byrne and Long (i) The six phases are: The doctor establishes a relationship with the patient. The doctor either attempt to discover or actually discovers the reason for the patient’s attendance. The doctor conducts a verbal or physical examination or both. The doctor, or the doctor and the patient, or the patient ( in that order of probability ) consider the condition. The doctor, and occasionally the patient detail further treatment or further investigation. The consultation is terminated usually by the doctor. Byrne and Long (i) : Byrne and Long (i) Went on to look in more detail at those “dysfunctional” consultations. Consultations are particularly likely to go wrong if there are shortcomings in Phase II or Phase IV, or both. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Pendleton et al. : Pendleton et al. Detail seven tasks, taken together, form comprehensive and coherent aims for any consultation. To define the reason for the patient’s attendance, including: (i) the nature and history of the problems (ii) their aetiology (iii) the patient’s ideas, concerns and expectations (iv) the effects of the problems. Pendleton et al. : Pendleton et al. 2. To consider other problems: (i) continuing problems (ii) at-risk factors. 3. With the patient, to choose an appropriate action for each problem. 4. 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 responsibility. 6. To use time and resources appropriately: (i) in the consultation (ii) in the long term. 7. To establish or maintain a relationship with the patient which helps to achieve the other tasks. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Helman : Helman A patient with a problem comes to a doctor seeking answers to six questions: 1. What has happened? 2. Why has it happened? 3. Why to me? 4. Why now? 5. What would Happen if nothing were done about it? 6. What should I do about it or whom should I consult for further help? CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Health Belief Model : Health Belief Model Becker and Maiman synthesised a number of patient beliefs and attitudes into a “health belief model”. Patients’ decisions to accept or reject medical advice are affected by many factors. The beliefs and motivations the patient brings into the consultation significantly governs the understandings and intentions he takes away from it. From the doctor’s point of view, remember: Ideas / Concerns / Expectations ( ICE ). Health Belief Model Elements : Health Belief Model Elements The individual’s general interest in health matters, which might correlate with personality, social class, ethnic group. How vulnerable the patient feels himself to be to a particular disease, and how severe a threat the disease is believed to pose The individual’s estimate of the benefits of treatment weighed against the costs, risks or inconvenience of treatment Factors that prompt the individual to take action, such as the development of alarming symptoms, advice from family or friends, or items in the mass media CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED BYRNE AND LONG (ii) : BYRNE AND LONG (ii) Analysis of verbal behaviours that doctors used when talking to patients. Gradation of styles from closed information gathering to non directive counselling depending on whether the doctor is more interested in developing his own line of thought or the patient’s. BYRNE AND LONG (ii) : BYRNE AND LONG (ii) Profiles of doctors’ consulting styles according to the frequency with which they used the various types of behaviour. Few of them demonstrate the capacity for variations of normal style and performance to meet the needs of those patients. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Six-Category Intervention Analysis : Six-Category Intervention Analysis Described by John Heron in mid-1970s. Model of the array of interventions a doctor could use with a patient. These fall into six Categories. Six-Category Intervention Analysis : Six-Category Intervention Analysis The categories are: 1.Prescriptive – giving advice or instructions, being critical or directive 2.Informative – imparting new knowledge, instructing or interpreting 3.Confronting – challenging a restrictive attitude or behaviour, giving direct feedback within a caring context. 4.Cathartic – seeking to release emotion in the form of weeping, laughter, trembling or anger 5.Catalytic – encouraging the patient to discover and explore his own latent thoughts and feelings. 6.Supportive – offering comfort and approval, affirming the patient’s intrinsic value. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Transactional Analysis : Transactional Analysis Eric Berne’s model of the human psyche. Three ego states Parent , Adult and Child. Critical or caring parent Logical adult Spontaneous or dependent child Transactional Analysis : Transactional Analysis Familiarity with TA introduces a welcome flexibility into the doctor’s repertoire which can break out of the repetitious cycles of behaviour (‘games’) into which some consultations can degenerate. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Counselling : Counselling The extreme patient centred behaviour Allow the patient to explore in his own way and at his own pace the origins and implications of and solutions to his problem Requires the doctor ability to keep his own opinions and suggestions to himself. Instead to use reflecting, interpreting and judicious use of silence in order to bring the patient to an insight which is his own and nobody else’s. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Bendix : Bendix The anxious patient ( practical book). Seven rules of thumb as the essential ingredients of counselling. CLASSIFICATION OF CONSULTATION MODELS : CLASSIFICATION OF CONSULTATION MODELS TASK ORIENTATED Phys,psych,social Helman Stott and Davis Health Belief Model Byrne and Long (i) Pendleton et al. DOCTOR PATIENT CENTRED CENTRED Byrne and Long (ii) Counselling 6-Category Analysis Bendix Transactional Analysis Balint BEHAVIOUR ORIENTATED Balint : Balint Michael Balint was a Hungarian psychoanalyst who in the 1950s led a series of case-discussion seminars with general practitioners at the Tavistock Clinic, London. The experience of this group formed the basis of one of the most important of all contributions to general practice literature: The Doctor, His Patient and the Illness. Explored the importance of the doctor patient relationship. The pharmacology of the drug “doctor”. Balint groups. CONCLUSIONS : CONCLUSIONS All you have to do now is go away and practise, make some video recordings of yourself consulting, and correct whatever faults you see. CONCLUSIONS : CONCLUSIONS The importance of making a diagnosis in physical, psychological and social terms. Clear about the patient’s reasons for attending. Deal with all Ideas, Concerns, and expectations. CONCLUSIONS : CONCLUSIONS Remember it is an opportunity for Health Education, screening and managing chronic disease. Treat patient as equal partner in the decision making. Get the right balance of being doctor-centred and patient-centred. OBJECTIVES : OBJECTIVES 1. To demonstrate that consulting skills are different from, and supplementary to, the traditional skills in diagnosing and treating that were taught at the medical school. 2. “Models of consultation” look at some of the ways in which the consultation has been studied and analysed to make consulting skills easier for trainees to acquire. 3. Learn about Roger Neighbour’s “Five (en route) check points” along the way of each consultation. The Inner Consultation : The Inner Consultation In a consultation you can hear 3 voices: 1. the patient’s voice 2. your own voice 3. silent voice in your head. This is the voice of you thoughts, whispering a commentary or instructions or questions in your minds ear. The Inner Consultation : The Inner Consultation In a consultation you have four Heads: 1. your head that Talks out loud. 2. Your second head as your internal dialogue that the patient does not hear. 3. The patient’s head that talks out loud. 4. The patient’s second head. The Inner Consultation : The Inner Consultation In a consultation there are two consultations: 1. The Outer Consultation between you and the patient. 2. The Inner Consultation : The thoughts that go back and forth between you and your second head. The Inner Consultation : The Inner Consultation If the comments from your second head become too insistent or complicated, then you get distracted from the outer consultation. Your concentration goes and you grow frustrated because your internal dialogue does not match up with the turn of events in the real consultation. The Inner Consultation : The Inner Consultation Having a successful outer consultation with the patient depends on having an inner consultation that contributes and works for you, rather than getting in the way and working against you. The Inner Consultation : The Inner Consultation Two Heads 1. The Organiser: The intellectual part of your brain. It analyses, plans, anticipates and sets goals. Its preferred mode of thought is analytical, logical and verbal. The Inner Consultation : The Inner Consultation 2. The Responder: The spontaneous and naive part of you. Its preferred mode is pattern recognition, imagery, and the association of ideas. The Inner Consultation : The Inner Consultation Your Two Heads take it in turns to be in charge. When you are consciously making plans and thinking carefully about how you are going to carry them out, you are being an Organiser. When you are perceiving sensory cues and reacting spontaneously to them, you are being a Responder. The Inner Consultation : The Inner Consultation Outer consultation: It’s half way through morning surgery You buzz for the next patient. ‘Hallo, Mr. Grizzly, Come in, sit down. What can I do for you?’. Inner consultation: I wonder how this will go. Try and look friendly. Maintain eye contact, smile, lean forward a bit. I don’t like this man. I’ve never liked him, he’s prickly. Even now I can feel my neck and hands and jaw getting tense. If he says I’m too young to be a doctor… The Inner Consultation : The Inner Consultation ‘I’d like a check up please, doctor’. You ask some questions, then examine him. There’s nothing abnormal to find…. That means he is afraid of something but he wants me to guess what. Heart disease, maybe, or the big C. I am doing this rather well. Perhaps he’s not so bad after all. Who does he remind me of? Maybe that’s why I don’t like him. I know, that dreadful anatomy lecturer I once had. The Inner Consultation : The Inner Consultation …but he is a smoker. ‘Mr. Grizzly, part of the routine check up is a chest X-ray. I’ll just fill this form in, and you send it to the hospital. He really ought to have a chest X-ray, but he’ll think I think he thinks he’s got lung cancer and I’m just humouring him, so he probably won’t go; but it is just possible, but I can’t say in case he thinks I think that’s what he’s got, and then what will he think?. He’s not looking at me. Look at me when I’m talking to you. He’s in a world of his own. I wonder what he’s thinking. Coo-eee!. The Inner Consultation : The Inner Consultation ‘Got that then?’ ‘Come back and see me about a week after you have your X-ray –’ Now, have I forgotten anything? Height and weight, urine, blood pressure, chest X-ray. It’s not worth doing a haemoglobin. I’ll do that when he comes back. If he comes back. Or an ECG. Maybe an ECG next. When with a bit of luck I’ll be on holiday. The Inner Consultation : The Inner Consultation He leaves. Not bad. Try asking a few more open-ended questions. He took five minutes too long, though. I’ll need to hurry the next patient along a bit. I could murder a cup of coffee. Who’s next? Oh no, Mrs. Linger. She always takes a long time, blast her. The Inner Consultation : The Inner Consultation Inner consultation: -(R) I wonder how this will go. -(O) Try and look Friendly. -(O) Maintain eye contact, smile, lean forward a bit. Comments: The Responder notices a little anxiety, some slight ‘fear of the unknown’. The Organiser tells you what to do about the tension the Responder has noticed… …and, remembering some of the things you learned about non-verbal communication, specifies precisely how to ‘try and look friendly’. The Inner Consultation : The Inner Consultation (R) I don’t like this man. I’ve never liked him, he’s prickly. (R) Even now I can feel my neck and hands and jaw getting tense (R) If he says I’m too young to be a doctor… The Responder remembers previous encounters with Mr. Grizzly, and associate them with a bad feeling… …and confirms to you that the same bad feeling is starting this time too. The Responder senses a chance to display a currently sensitive attitude, and, whatever the patient says, is poised to feel patronised. Tension + Negative attitude = Potential Trouble. The Inner Consultation : The Inner Consultation (O) That means he’s afraid of something but he wants me to guess what. Heart disease, maybe, or the big C. When it hears the patient’s request for a check-up, an opening gambit full of double messages, the Organiser is quick to jump in and diffuse the situation. The Organiser advises ‘don’t get cross, get competent,’ and makes some suggestions. The Inner Consultation : The Inner Consultation (R) I’m doing this rather well. Perhaps he’s not so bad after all. Who does he remind me of? Maybe that’s why I don’t like him. (R) I know, that dreadful anatomy lecturer I once had. You’re feeling better. The Responder pats you on the back and shifts to an attitude of curiosity… …and having made a connection between this patient and a previous acquaintance, feels satisfied. “Five (en route) check points” : “Five (en route) check points” Check point 1 – Connecting Check point 2 – Summarizing Check point 3 – Handover Check point 4 – Safety-netting Check point 5 – Housekeeping “Five (en route) check points” : “Five (en route) check points” “Five (en route) check points” : “Five (en route) check points” Connecting: Rapport-building skills. Establish rapport, getting on the same wavelength and achieving empathy. “Five (en route) check points” : “Five (en route) check points” Connecting: Means being able to see the world as if through the patient’s eyes; knowing how they are feeling as if inside their skin; telling how they think from the words that they use. When you communicate as closely as that with a patient, the rapport that develops has a richness which fertilises the remainder of the consultation. “Five (en route) check points” : “Five (en route) check points” “Five (en route) check points” : “Five (en route) check points” Summarising: listing and eliciting skills. Explore and acknowledge the patient’s reasons for attending, his hopes, feelings, concerns, expectations. “Five (en route) check points” : “Five (en route) check points” Summarising: Telling the patient the impression you’ve so far formed of his or her needs– is a good practical test of whether you’ve understood or not. If you direct your history taking towards a point where you could confidently sum up the patient’s worries and wishes, and say them out loud, you will find that you become more far ranging and accurate in the assessments you make. If you get it wrong, the patient has the chance to correct or amplify your summary. “Five (en route) check points” : “Five (en route) check points” “Five (en route) check points” : “Five (en route) check points” Handover: Communication skills. explain, negotiate and agree a management plan. Negotiating, influencing and gift wrapping. “Five (en route) check points” : “Five (en route) check points” Handover: the Test of whether or not you have adequately dealt with patient’s Needs The point at which the patient feels well enough equipped to depart – adequately informed and sufficiently confident of progress. “Five (en route) check points” : “Five (en route) check points” “Five (en route) check points” : “Five (en route) check points” Safety-netting: predicting skills. The art of managing uncertainty. “Five (en route) check points” : “Five (en route) check points” Safety-netting: To anticipate what you expect to happen to the patient and what conceivably might happen, and to have some contingency plans formulated. It reminds you to consider ‘What if?’ questions, ‘What shall we do if’ the patient’s symptoms persist or worsen? ‘What if’ treatment doesn’t work? ‘what if’ the tests or X-rays show this or that? “Five (en route) check points” : “Five (en route) check points” Safety-netting: the patient is probably wondering much the same. If you can indicate that you too are thinking ahead and anticipating various possibilities, the patient will feel reassured and appreciative, and is more likely to accept your suggestions. “Five (en route) check points” : “Five (en route) check points” “Five (en route) check points” : “Five (en route) check points” Housekeeping: taking care of yourself. Clearing the mind to a state of readiness. “Five (en route) check points” : “Five (en route) check points” Housekeeping: It attaches no less importance to looking after your own physiological and mental health than you do to patients. Doctor is Human, has hopes and concerns and feelings. He cannot fail to feel some personal involvement in his patient’s destinies, or to have some personal reaction to the demands general practice makes on him. “Five (en route) check points” : “Five (en route) check points” Housekeeping: Your most powerful diagnostic and therapeutic tool is yourself – your intellect, memory, perceptiveness, intuition; your two heads, the Organiser and the Responder. On this precision instrument, rust and dust tend to accumulate in the form of fatigue, boredom, stress, frustration, loss of concentration, the preoccupation of your private life, and a range of emotions from elation and joy to sadness, anger and guilt. “Five (en route) check points” : “Five (en route) check points” OBJECTIVES : OBJECTIVES 1. To demonstrate that consulting skills are different from, and supplementary to, the traditional skills in diagnosing and treating that were taught at the medical school. 2. “Models of consultation” look at some of the ways in which the consultation has been studied and analysed to make consulting skills easier for trainees to acquire. 3. Learn about Roger Neighbour’s “Five (en route) check points” along the way of each consultation.

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View Husam Darwish’s professional profile on LinkedIn. LinkedIn is the world's largest business network, ... Skills. Testmanagement; Testautomatisierung;
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Husam Tayeh | LinkedIn

View Husam Tayeh’s professional profile on LinkedIn. ... Management Consulting. Current: Perla Health Care & Therapy; ... Skills. Microsoft Office ...
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Husam Zein | LinkedIn

View Husam Zein’s professional profile on LinkedIn. LinkedIn is the world's largest business network, helping professionals like Husam Zein discover ...
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hosam el moghany | LinkedIn

View hosam el moghany’s professional profile on ... Extensive project management skills with the ability to meet tight ... (pro bono consulting)
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hussam abu-seido | LinkedIn

... helping professionals like hussam abu ... Skills. Healthcare ... Medical Education; Medicine; Pediatrics; Public Speaking; Surgery; Internal Medicine ...
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Husam Hijazi | LinkedIn

عرض ملف Husam Hijazi الإحترافي الشخصي على LinkedIn. ... ALMAHARY Eng. Consulting office, ... Reporting Skills, ...
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