DR. ABDULLAH ALSHAHRANI(MBBS/CABFM/ POST GRADUATE TRAINER)

Joint Program of Family Medicine, Aseer

CONSULTATION MODELS

What is the consultation

What are the benefits of consultation

What are the types of consultation

How to change from traditional biological model to a more

comprehensive model

Objectives

Consultation Definition:

The essential unit of medical practice is the occasion when in the intimacy of the consultation room, the person who is ill or believes himself to be ill, seeks the advice of a doctor who he trust.

( Sir James Spence 1949 )

IntroductionIntroduction

Consultation Models

• Hospital Model( Biological Model):Hospital Model( Biological Model):

• PHC Model( Bio-psycho-social Model).PHC Model( Bio-psycho-social Model).

• Stott &Davis (The Expanded Model)Stott &Davis (The Expanded Model)

• Pendleton Model( 7 Tasks).Pendleton Model( 7 Tasks).

• Neighbour Model( Anticipatory care) (difficult Neighbour Model( Anticipatory care) (difficult consultation).consultation).

Sara is 38 years old lady, complaining of 2 weeks history of headache.

How are you going to conduct this consultation

HISTORY PRESENTING COMPLAIN

SYSTEMATIC REVIEW

EXAMINATION

INVESTIGATION

DIAGNOSIS

TREATMENT

FOLLOW-UP

A case of 2 weeks headache

Computerized Checklist of history

Taking.

Hospital Model of Consultation (Bio – Medical Model)

Characteristics of Hospital Model

It is doctor centered and disease oriented.

A diagnosis must be arrived at "objectively" before treatment.

It takes long time

No consideration of the psychosocial dimensions explanation, health education, health promotion and treatment by reassurance

PHC Model of Consultation(Bio-psychological Model)

Sara is 38 years old lady, divorced 2 weeks ago, looking after 5 children by herself, complaining of 2 weeks history of headache

Speculate how Sara think about her illness? Her ideas??? Her concern??? Her fears??? The effect of the problem in her life???

What is most likely the diagnosis???

Characteristics of PHC Consultation Model

Patient – centered

Holistic approach (Bio-psycho – social)

Prevention & Health education

Treatment by reassurance

Appropriate use of time & resources

Management of Modification of Help Presenting Problem Seeking Behaviour

Management of Opportunistic healthContinuous Problem Promotion

The Expanded Model of Consultation(Stott & Davis 1979)

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 Model

Pendleton First Task

• History• Nature of the problem• Causes• Effect of the problem

To Explore the real reasons for pt. Attendance

Patient’s Ideas:

Neurological problem.

Becoming disable or crazy.

Cannot work as a teacher anymore

?

Patient’s Concern:

Financial insecurity

Sick leave

Investigation

Treatment

explanation

Patient’s Expectation:

Pendleton Second Task

To consider other problems

Pendleton Third Task

With the patient to choose an appropriate action for each problem

Why?

Patient responsibilityPatient compliance

Pendleton Fourth Task

With the patient to reach Shared Understanding of the ProblemDoctor Patient

KnowledgeQuestions

DoubtsTheories

Experience

KnowledgeQuestions

DoubtsTheories

Experience

Pendleton Fifth Task

To involve patient in the management

Pendleton Sixth Task

To use Time and Resources appropriately

Pendleton Seventh Task

To Establish & MaintainDoctor – Patient Relationship

• Connecting (establishing relationship)

• Summarizing (physical, social & psychosocial diagnosis)

• Handing-over (management of presenting symptom)

• Safety netting (Red flags)

• House-keeping (Taking care or yourself)

Neighbor ModelThe Inner Consultation

Approach to Sara Problem

Safety-netting:

Is there any possibility of serious differential diagnoses or complications from her headache?

Approach to Sara Problem

House Keeping

This consultation may result in some negative feelings, examples:

Sad feeling because of Sara's divorce. Helpless feeling because of her financial problem.

Approach to Sara Problem

House Keeping

Sad feeling for her children. Feeling of being under pressure of time, because of this long

consultation. Feeling anxious about the reaction of the next patient for being

waiting for so long.

How to deal with these feelings?

Hospital Model of Consultation is not suitable for Family Medicine

Family Medicine Model of Consultation is characterized by:

Holistic ApproachDeep understanding of human behaviour

Conclusion

Home Messages

A lot of practice is needed to be able to adopt the proper consultation model

Consultation is a communication with a human being with feelings & thoughts…it is not just clinical skills