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Pendleton “7 Tasks” 1
1) Define reason for attendance (patients ideas/concerns/expectations)
2) Consider other problems3) Choose appropriate action for each problem4) Achieve shared understanding5) Involve patient/accept responsibility6) Use time/resources appropriately7) Establish/maintain relationship with patient
1. Pendleton D, Schofield T, Tate D & Havelock P (1984) The Consultation: An Approach to Learning and Teaching (Oxford, OUP)
Neighbour: “5 Checkpoints”2
Connecting
Summarising
Handing Over
Safety Netting
Housekeeping
2. Neighbour R (1986) The Inner Consultation
Byrne & Long3
1) Doctor – Patient Relationship2) Discover reason for attendance3) Verbal/Physical Examination4) Doctor/Patient consider condition5) Doctor/Patient consider
Treatment/Investigation6) Terminate consultation
3. Byrne PS & Long BEL (1976) Doctors Talking to Patients (London HMSO)
Stott & Davis4
Management of presenting problems
Modification of help-seeking behaviour
Management of continuing problems
Opportunistic health promotion
4. Stott NCH & Davis RH (1979) The Exceptional Potential in each Primary Care Consultation JRCGP; 29: 201-205
Problem-Oriented Medical Records
SOAP Subjective Objective Assessment Plan
Pseudo-Latin Hx (History) Sx (Symptoms) Ix(Investigation
) Mx
(Management) Rx (Prescribe)
5 Areas of General Practice
1) Clinical Practice – Health & Disease
2) Clinical Practice – Human Development
3) Clinical Practice – Human Behaviour
4) Medicine & Society
5) The Practice
Health & Disease Normal Range Patterns of Illness Natural History Prevention Early Diagnosis Diagnostic skills/techniques Management/Treatment
Human Development Genetics Foetal Development Childhood Development
Physical Intellectual Emotional
Normal Range
Human Behaviour
Behaviour presenting to Doctor
Behaviour in Relationships
Behaviour in Family
Behaviour in Doctor-Patient
Relationship
Medicine & Society Sociological aspects Uses of Epidemiology Organisation of Healthcare in UK
comparison with abroad recent changes
Relationship between Healthcare services and other institutions of society
The Practice Practice Management The PHC Team Finance Premises & Equipment Medical Records Medico legal issues Research Lifelong Learning
Question Maker Problem Definition Management Prevention Communication Organisation Professional Values Personal Development
Situation Problems Advantages Disadvantages
Applied to: Doctor Patient Practice PHC Team Relatives Community
Healthcare General Public
Clinical Problems “HEIRS” History Examination Investigation Referral See again?
“RAPRIO(P)” Reassure Advice Prescribe Refer Investigate Observe (Preventative)
Ethical problems Utilitarianism
examines moral dilemmas seeks to make decisions based on outcomes applies to large populations e.g. “the greatest good for the greatest
number” Deontological
applies to individuals based on the duties of the doctor and the rights
of the patient (and, of course, vice versa)
Ethical solutions ABCDE Autonomy (Patient) Beneficence
“above all, do no harm” “do good where possible”
Confidentiality Do not lie (Truthfulness) Everybody else (Society)
Breaking Bad News “A KISS” Anxiety:
try to elicit anxieties Knowledge:
try to elicit knowledge Information:
give information simply re treatment, prognosis, follow up
Sympathy: give human contact (touch)
Support: give practical help
Dealing with Anger “AFVER” Avoid Confrontation Facilitate Discussion Ventilate Feelings Explore Reasons Refer/Investigate