Effective Consultation
Effective consultations are patient-centred and efficient, taking place within the time and other practical constraints that exist in everyday medical practice. The use of specific communication skills together with a structured approach to the medical interview can enhance this process. Important communication skills can be considered in three categories: content, process and perceptual skills (see Table 1.1); these mirror the essential knowledge, skills and attitudes required for good medical practice. These skills are closely interrelated so that, for example, effective use of process skills can improve the accuracy of information gathered from the patient, thus enhancing the content skills used subsequently in the consultation.
Table 1.1 Categories of communication skills
| Skill | Examples |
| Content skills | |
| What the doctor communicates | Knowledge-based: appropriate questions and responses; accurate information gathering and explanation to patient; clear discussion of investigation and treatments based on knowledge |
| Process skills | |
| How the doctor communicates | Skills-based: verbal and non-verbal communication skills; relationship building; organising and structuring the interview |
| Perceptual skills | |
| What the doctor is thinking | Attitude-based: clinical reasoning and problem-solving skills; attitudes towards the patient; feelings and thoughts about the patient; awareness of internal biases |
Structure
Providing structure to the consultation is one of the most important features of effective consultation. Process skills should be used to develop a structure that is responsive to the patient and flexible for different consultations. Six groups of skills can be identified and each will be considered below.
Sequential in the consultation:
- initiating the session
- gathering information (including from physical examination)
- explanation and planning
- closing the session
Throughout the consultation:
- organisation
- relationship building
Initiating the Session
The initial part of a consultation is essential to form the basis for relationship building and to set objectives for the rest of the interview. Before meeting a patient, the doctor should prepare by focusing him- or herself, trying to avoid distractions and reviewing any available information such as previous notes or referral letters.
Initiating the Session
Physical ExaminationGathering Information
An accurate clinical history provides about 80% of the information required to make a diagnosis. Traditionally, history-taking focused on questions related to the biomedical aspects of the patient’s problems. Recent evidence suggests that better outcomes are obtained by including the patient’s perspective of their illness and by taking this into account in subsequent parts of the consultation. The objectives for gathering information should therefore include exploring the history from both the biomedical and patient perspectives, checking that the information gathered is complete and ensuring that the patient feels that the doctor is listening to them.
Gathering Information
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
