dr. abdullah alshahrani (mbbs/cabfm/ post graduate trainer) joint program of family medicine, aseer...
TRANSCRIPT
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 )
IntroductionIntroductionIntroductionIntroduction
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 responsibility
Patient 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 & Maintain
Doctor – 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