BMC Public Health. In my outpatient (office) consultations, about half of the new patients do not even know that they have been referred by their general practitioner. Patient understanding is rarely checked as it is usually assumed after the prescriber has given the prescription. endstream endobj 56 0 obj<>stream Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: an approach to learning and teaching, Oxford, Oxford University Press, 1984. At any given moment each of us is in a state of mind when we think, feel, behave, react and have attitudes as if we were either a critical or caring Parent, a logical Adult, or a spontaneous or dependent Child. I propose 10 quality indicators that would be simple to measure and could be used to improve clinical consultations. Physician and Patient Characteristics Associated With More Intensive End-of-Life Care. 10 MRS - Management 1: Coping with uncertainty 11 MRS - Management 2: Using community resources 12 MRS - Management 3: Prescribing (a) Technical 13 MRS - Medical Records 14 MRS - Emergency care 1: Initial assessment 15 MRS - Emergency care 2: Management 16 MRS - Professionalism 1: Availability 17 MRS - Professionalism 2: Involvement Models have developed and now have a broader focus on patient-centred care rather than symptoms and physical health. 2006 Aug;62(2):205-11. doi: 10.1016/j.pec.2005.07.003. During a new patient consultation the clinician is firstly trying to work out whether the patient is ill. Then the clinician is trying to answer What is the diagnosis? so that the appropriate investigations, treatment and review can be planned. It was very significant that the authors concluded that many of the errors were associated with assumptions or guesses on the part of the healthcare professional, and in particular a lack of awareness of the relevance of patients ideas and beliefs which influenced their compliance with the prescribed treatment. The curtains are usually pulled around, but everyone in the bay can hear the consultation. The other person is also a second set of ears. Dignity is often fairly minimal with patients expected to accept physical examination in front of several strangers. It is always cheaper in the long run to get it right first time. In my experience, the patient then divulges a fuller, richer history of presenting complaint because the patient is confident the clinician is interested and trustworthy. This site needs JavaScript to work properly. The best pieces make a single topical point. Please enable it to take advantage of the complete set of features! A thorough assessment and examination of the respiratory system will follow, together with a rationale for examination skills used and a critical analysis of the clinical findings. 0000006866 00000 n Consultation models are clearly useful tools for practitioners to use during the patients journey. At the same time, we have to battle either with illegible paper notes (charts) or hugely inefficient software purporting to be electronic patient records. official website and that any information you provide is encrypted (2005) concluded that effective consultations give positive outcomes. And discusses the side effects of the medication and not forgetting addressing safety netting for example, in the section What to do if you forget to take your medication? In the case of primary care and Out of Hours (OOH) appointment times are strict and therefore spending more time consulting has an effect on waiting times. It is therefore essential that the consultation is documented and good record keeping adhered to, to ensure safe and effective continuation of care (NMC 2009), Nurse prescribing was translated into reality in the latter part of the 1990s when a cohort of about 1,200 nurses received specialist training in order to allow them to feel confident and competent in the prescription of certain drugs and medications.Critical Analysis Of A Consultation Model Essay. . Patient Educ Couns. The Me First (2017) consultation and communication tool is widely used as part of a paediatric consultation whether this be consultant or nurse-led. Pendleton advises drawing out whether there are any other problems early on in the consultation. Simple facts like known pre-existing diagnoses, medications and results of tests can be impossible to find or, once found, difficult to read and assimilate. In this way, I can give the patient confidence that at least I know what other clinicians have concluded about their case and I know what to be sceptical about! I do much the same for rounds. Questions to try include: 'Was there anything else you were hoping to discuss today? The impact of general practitioners patient-centredness on patients post-consulatation satisfaction and enablement. Many take the view that simply arriving at and stating a diagnosis is sufficient credibility for the provision of a prescription. He was so impressed that I had asked him for his opinion that he sent all of his family to see me. EVANS, A. Eet al., 2001. (2003) have shown that although the CAIIN framework is useful, there are problems faced in its use such as the lack of assessors and protected learning time required. %%EOF Better learning for students was mentioned by 89% of the teachers. Would you like to have an original essay? Consultation models are used in healthcare as a framework and guide for the practitioner when in contact with a patient, this can be at any point of contact through the patients journey (Harper and Ajao 2010; Nutall and Rutt-Howard 2015). Published: 11th Feb 2020. After all, these models are guides for practitioners (Perry 2011). We welcome submissions for consideration. 0000001531 00000 n Epub 2011 Jul 31. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. . I believe this is crucial to correct diagnosis. 2004 Jul;59(1):93-102. doi: 10.1016/j.socscimed.2003.10.007. (Cox et al 2000). Patient-doctor decision-making about treatment within the consultationA critical analysis of models. It can be an effective strategy if you feel that the consultation is stalling. Conversations can become fruitful and productive only when there is All your friends are doing it, so you join in. Med Educ 1996; 30: 83-9. The Calgary-Cambridge referenced observation guides: An aid to defining the curriculum and organising the teaching in communication programmes. The attention required to handle the computer programs or locate the current notes and nursing charts to find important information can further detract from being able to hear oneself think. ILLINGWORTH, R., 2010. The https:// ensures that you are connecting to the Preferences of patients for patient centred approach to consultation in primary care: observational study. The Consultation, Assessment and Improvement Structure for Nurses (CAIIN) is considered a useful tool which can be used for ongoing assessment and development of consultation skills in nursing practice (Hastings and Redsell, 2006). According to Roger Neighbour, author of The inner consultation a book familiar to most generations of GPs, while consultation models are a helpful guide, the key to being a good consulter lies not only in the technique of the consultation, but in the ability to listen and respond to our patients. Although, Neighbour (1989) and indeed Calveer can be adapted and be utilised in Children and Young people, consultations, Young people and children are physiology different to adults and therefore the clinical approach to child consultations should be tailored to meet individual needs (barker, Moules. Other analyses compared studies that assessed combined psychiatric consultation models versus a single model, type of psychiatric consultation, by outcome and whether the intervention included a consultation letter. (Drew et al. 0000004184 00000 n *You can also browse our support articles here >. References and further information 0000003991 00000 n And discusses the side effects of the medication and not forgetting addressing safety netting for example, in the section What to do if you forget to take your medication? Consultation models are not rules; they are learning aids to help you develop your own consultation skills. HR;0Siq0\TRRp|"m(e5n(T Lph>&9FghA4Fg;37#gll8Fx6{xR^1|'#Ns;uXZOuQ. A 71-point model and a useful template with lots of different consulting strategies. Further studies have shown that where prophylactic (or preventative) prescribing has occurred the situation is statistically worse. If an incorrect diagnosis is made, a good outcome can only arise by good luck eg if the clinician believes that the diagnosis is a urine infection but is actually pneumonia, by good luck the antibiotic might treat the pneumonia. NHS Plan (2010) encourages shared decision making with the patient and family to aid concordance. The issue of communication in relation to prescribing has received much less prominence. Jones IR, Berney L, Kelly M, Doyal L, Griffiths C, Feder G, Hillier S, Rowlands G, Curtis S. Soc Sci Med. If the diagnosis is incorrect, the treatment will be incorrect and recovery delayed or derailed completely. 0000002642 00000 n PMC The clinician should be aware of the whole workload for the session. We also know that a substantial proportion of the medication that is currently prescribed is not taken or, worse still, inappropriately utilised. and transmitted securely. Even when drug therapy is considered essential (such as insulin and thyroxin) many patients will experiment with dosages and drug-free periods. Clinical decision-making: Patients' preferences and experiences. The doctor forms rapport with the patient 2. The .gov means its official. This site needs JavaScript to work properly. However, yesterday Roger Neighbour reminded us that rigid use of these models in practice can lead to consultations that are prescriptive and formulaic at the expense of individual style and flare. %PDF-1.6 % Consultation models are also a great way to help prepare for the clinical skills assessment (CSA). This meant that there was not a ready supply of information into the consultation. 0000065334 00000 n There is evidence that failure to actively engage in, or even consider, the patient s perspective is a common failing amongst prescribers. None of the others have been given a copy of the referral letter. A skilled advanced clinical practitioner (ACP) in this area has the potential to make a significant contribution to several fundamental outcomes: patient satisfaction, patient concordance with prescribed therapies/interventions, overall diagnostic accuracy and overall patient outcomes. For example, there is a wide-ranging set of possible problems that a patient with Parkinson's disease might be experiencing and we could help patients to prepare their information. <]>> Nurse prescribing was therefore proving itself to be both an effective and efficient resource for the NHS. (Barry et al. 2000 and Shum et al. This model looks at the process of the consultation from initiating the session, gathering information, providing structure to the consultation, building a relationship, giving information by explanation and planning, and closing the session. official website and that any information you provide is encrypted The hostile and the heart-sink patient can be a particular headache to the prescriber and inappropriate decision can be made unless great care is taken to specifically tackle these issues. When I ask patients to tell medical students What makes for a good doctor? by far and away the commonest answer is A doctor who listens. A seemingly hurried clinician cannot appear to be listening. As the clinician listens to and examines the patient, their brain is full of clinical reasoning, which is high-level thinking around possible diagnoses. Home / Essay Samples / Life / Communication Skills. Therefore, this model does not appears as patient-centred as the aim and more doctor-centred. Bethesda, MD 20894, Web Policies The aim of the consultation is to develop a therapeutic relationship with the patient and their family and to ensure accurate history taking in order to reach an accurate diagnosis. The .gov means its official. Concordance with medication and consultations with pharmacists . 0000000016 00000 n 2000). Many studies have looked at the influence of communication skills on prescribing and other factors related to the consultation. We live in a dynamic medical world where technology is rapidly evolving, new treatments continue to come to market and approaches to disease management are often revised. Background The intensive care unit (ICU) staffing model affects clinical outcomes of critically ill patients. Systematic review of whether nurse practitioners in primary care can provide equivalent care to doctors. How nurse prescribers influence the role of nursing. He reminded us that in its simplest form, the consultation is where an exchange of stories takes place and where a patient and doctor share their ideas about the problem at hand. The aim of the consultation is to develop a therapeutic relationship with the patient and their family and to ensure accurate history taking in order to reach an accurate diagnosis. Their clinical reasoning directs the closed questions and focused physical examination. (Richards 1999). Promoting critical thinking and academic writing skills in nurse education. 0000001290 00000 n Postgrad Med J 2017;93:58. The Consultation, Assessment and Improvement Structure for Nurses (CAIIN) is considered a useful tool which can be used for ongoing assessment and development of consultation skills in nursing practice (Hastings and Redsell, 2006). This article will discuss some of the more common consultation models in use today and their relative advantages and disadvantages. GP trainees will be familiar with the works of Pendleton, Calgary Cambridge, and Roger Neighbour to name but a few, who provide helpful consultation skills models to frame consultations and get trainees through the CSA. Expert clinicians know that the majority of the information directing towards the correct diagnosis comes from attentive listening to the patient's history of the presenting complaint, set in the context of the patient's life and known medical conditions. model for the functional analysis of resistance in clients. Not all are useful for OOH, often the situation needs to be judged by the practitioner and use which consultation method they feel fits best. Epub 2005 Aug 31. (1984) model is mostly known for its consultation base on patients ideas, concerns and expectations. I believe that better clinicians seek information prior to and during the consultation. 2021 Oct 6;9(28):8312-8326. doi: 10.12998/wjcc.v9.i28.8312. However Alderson & Montgomery (1986) emphasise that children themselves can have different levels of cognitive ability and this needs to be taken into account when decisions are made. (Richards 1999) it follows that if patients are to be involved then their particular priorities must be ascertained and addressed, usually in the mechanism of the consultation. 2018 Jul 30;6(1):50-58. doi: 10.1002/nop2.180. I am sure that I can discharge more patients from clinic after one attendance because I try to make the consultation unhurried. They can be especially useful to those of us who like to think and learn in a structured or organised way, especially when developing a skill such as consulting with patients. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. The patient's account of the presenting complaint is crucial to correct diagnosis. For more information on how to submit, please see our instructions for authors. If healthcare providers realised that clinical consultations are the crucial productive process of their business and worked to improve the process of clinical consultation, we could see fewer misdiagnoses with substantial improvements in patient outcomes and experiences, along with happier more fulfilled staff within 2 years from now. This model outlines safety netting where the doctor and patient plan together to manage uncertainty. THOMSON, R., EDWARDS, A. and GREY, J., 2005. Disclaimer: This essay has been written by a student and not our expert nursing writers. (Coulter 2002)Critical Analysis Of A Consultation Model Essay, As a result of this, the prescriber, in general terms, has to be aware of the possibility of what is know, in academic circles, as intentional dissent. Game theorya theory based on assumptions of rational choice and focusing on interactive decision makinghas the potential to provide models of the consultation that can be used to generate empirically testable predictions about the factors that promote quality of care. 2003 Feb;56(3):589-602. doi: 10.1016/s0277-9536(02)00056-4. Most students having concrete experience in cooking were able to accommodate the new learning, and developing their metacognition as explained by Haley (2020). (1984) model would be appropriate for use in OOH as it is a useful way of building a relationship with the patient, involving them in care and decisions during the short time the practitioner will meet them. Essay, My Experience in Excite and Execute Dynamic Groups Essay. 4. This model introduced the concept of eliciting the patient's ideas, concerns and expectations. HTSM0W R#Sn "r@{&U]iT{UAAy*A. [%-7qe[1BJ]@p+enjx!J6ttVXg]slZ'{:9/P%{>f1xP5U]fPiYt`Buy h~8`v Behavioral Consultation Model Behavioral consultation is a problem-solving process that includes four stages, problem A review consultation is as important. Similarly to Pendleton et al. MeSH Sprague (2005) identifies that consultation models should be straightforward, practical and. The aim of this case study is to illustrate how prescribing decisions can be enhanced through the use of systematic consultation, reflection on practice and relevant information seeking. 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