Consultation Dr. JAWAHER AL-AHMADI MB. ABFM. SBFM.

consultationconsultation

Dr. JAWAHER AL-AHMADIDr. JAWAHER AL-AHMADIMB. ABFM. SBFMMB. ABFM. SBFM

What are the reasons for pt What are the reasons for pt consulting ?consulting ? For relief of For relief of

symptoms & symptoms & diagnosisdiagnosis

For normal For normal medical servicemedical service

For reassuranceFor reassurance For supportFor support For playing gamesFor playing games As habitual As habitual

response to response to anxietiesanxieties

For certificationFor certification For follow-upFor follow-up For referralFor referral For prescriptionFor prescription

What are the doctor’s objectives What are the doctor’s objectives from the consultation ?from the consultation ?

Establishing and maintaining Establishing and maintaining relationshiprelationship

Obtaining information relating to Obtaining information relating to the pt problemthe pt problem

Conveying appropriate Conveying appropriate information to the ptinformation to the pt

Terminating the consultation in Terminating the consultation in the shortest possible time the shortest possible time

Some early truths to Some early truths to rememberremember

The patient is as frightened as The patient is as frightened as you areyou are

The patient think is more serious The patient think is more serious than youthan you

Illness is frightening but Illness is frightening but understanding what is going on understanding what is going on helpshelps

The health belief modelThe health belief model

Health Health motivationmotivation

Perceived vulnerabilityPerceived vulnerability

Perceived Perceived seriousnessseriousness

Perceived costs Perceived costs

and benefitsand benefits

Locus of controlLocus of control

The internal The internal controllercontroller

The external The external controllercontroller

The powerful The powerful otherother

Diagnostic processDiagnostic process

CuesClinical,behvioral

Hypothesis

SearchHistory.exam,invest

managment

Follow-up

Unexpectedcues

revise

Psychological & Social Psychological & Social Component of Physical ProblemComponent of Physical Problem

Illness behaviorIllness behavior Interaction Interaction

between psyho-between psyho-social and social and physical physical problemsproblems

Models of consultationModels of consultation

Pt centeredPt centered Use of pt’s Use of pt’s

knowledge & knowledge & experienceexperience

PHCPHC

Doctor centeredDoctor centered Use of doctor’s Use of doctor’s

skills & skills & knowledgeknowledge

Hospital Hospital

Pandleton seven tasksPandleton seven tasks

To establish & maintain Dr-pt To establish & maintain Dr-pt relationshiprelationship

To define the real reasons for pt To define the real reasons for pt attendanceattendance

To consider other problemsTo consider other problems To choose with the pt appropriate To choose with the pt appropriate

action for each problemaction for each problem To achieve a share understandingTo achieve a share understanding To involve pt in the managementTo involve pt in the management To use time & resources effectivelyTo use time & resources effectively

To establish & maintain Dr-pt To establish & maintain Dr-pt relationshiprelationship

Why ?Why ? What ?What ? How ?How ?

Dr – Pt RelationshipDr – Pt Relationship

To establish & maintain Dr-pt To establish & maintain Dr-pt relationshiprelationship

Welcoming the Welcoming the ptpt

Showing Showing sympathy & sympathy & empathyempathy

Showing Showing respectrespect

confidentialityconfidentiality

Communication appearanceCommunication appearance

Pt response to Pt response to questions about questions about items of Dr’s dressitems of Dr’s dress

Believe male doctor Believe male doctor should wear:should wear:

1.1. white coat 15%white coat 15%2.2. Suit 44%Suit 44%3.3. Tie 64%Tie 64%4.4. Jeans(object) 59%Jeans(object) 59%

Communication appearanceCommunication appearance

Believe female Believe female doctor should doctor should wear:wear:

1.1. White coat White coat 34% 34%

2.2. Skirt Skirt 57% 57%

3.3. Jeans&jewelryJeans&jewelry(object) 63%(object) 63%

Communications environmentCommunications environment

Communications environmentCommunications environment

Communication Communication

Verbal Verbal communication communication

Nonverbal Nonverbal communicationcommunication

Paralanguage Paralanguage Touch Touch Body languabgeBody languabge body positionbody position head positionhead position faceface eyeeye legleg armsarms

To define the real reasons for pt To define the real reasons for pt attendanceattendance

Nature of the Nature of the problemproblem

EtiologyEtiology Pt ideasPt ideas Pt concernPt concern Pt expectationPt expectation Pt fearsPt fears Pt effect of the Pt effect of the

problemproblem

To define the real reasons for pt To define the real reasons for pt attendanceattendance

Pt ideasPt ideas

To define the real reasons for pt To define the real reasons for pt attendanceattendance

Pt concernPt concern

To define the real reasons for pt To define the real reasons for pt attendanceattendance

Pt expectationPt expectation

Sabah is 38 years old lady, Sabah is 38 years old lady, divorced 2week ago,running divorced 2week ago,running small business, looking after 5 small business, looking after 5 children by herself, complaining children by herself, complaining of 2 week history of headache. of 2 week history of headache. Speculates how she may think Speculates how she may think about her illnessabout her illness

To consider other problemsTo consider other problems

Continuous Continuous problemproblem

At risk factorsAt risk factors

To choose with the pt appropriate To choose with the pt appropriate action for each problemaction for each problem

Pt responsibilityPt responsibility Pt compliancePt compliance

To achieve a share To achieve a share understandingunderstanding doctordoctor patientpatient

KnowledgeQuestions

DoubtsTheories

experience

KnowledgeQuestions

DoubtsTheories

experience

To involve pt in the To involve pt in the managementmanagement

To use time & resources To use time & resources effectivelyeffectively

The expanded model of The expanded model of consultationconsultation

Management of presenting Management of presenting problemproblem

Management of continuous Management of continuous problemproblem

Modification of help seeking Modification of help seeking behaviorbehavior

Opportunistic health promotion Opportunistic health promotion

Modification of help seeking Modification of help seeking behaviorbehavior

DenialDenial Sick roleSick role Hidden agendaHidden agenda By the way doctorBy the way doctor

Inner consultationInner consultation

ConnectConnect SummarizeSummarize Hand overHand over Safety nettingSafety netting House keeping House keeping

PRACTICALPRACTICAL

PPrior to the consultationrior to the consultation RRelationshipelationship AAnxieties nxieties CCommon languageommon language TTranslationranslation IInteractionnteraction CConverting insight into actiononverting insight into action AAgreement check, safety nettinggreement check, safety netting LLeave from consultation, time for eave from consultation, time for

reflectionreflection