2 Models of Patient Centredness Flashcards
Q: The research around PCIs has resulted in a number of consultation models, which aim to achieve the broad concepts of patientcentredness. Name 2 of these models. Which is commonly used in general practice?
A: Calgary Cambridge model
Transformed Clinical Method.
Q: What does the Calgary-Cambridge model set out? Name the 7 phases.
A: the medical interview in phases with specific objectives to be achieved at each stage
- Initiating the session
- Gathering information
- Physical examination
- Explanation and planning
- Closing the session
- Building the relationship
- Providing structure
Q: In the Calgary-Cambridge model, how do you initiate the session? What are the basic tasks? (4)
A: establish initial rapport and to identify the reason(s) for the consultation.
greeting the patient, introducing yourself, demonstrating
interest, using open questions
Q: What does the information gathering stage of the Calgary-Cambridge model focus on? Similar to? Additional task?
A: focuses on exploring the patient’s problems and understanding the patient’s perspective
exploring the emotional aspects of the patient’s illness and getting to know the patient as a whole person.
provide a structure to the consultation to help both you and the patient to know where the consultation is going and to assist in the management of time
Q: What is it important to do in a physical examination in the Calgary-Cambridge model? Pick up on?
A: communicating with the patient during the examination to let them know what you are doing
verbal and non-verbal cues (e.g. indications of pain).
Q: What is the aim of the explaining and planning phase in the Calgary-Cambridge model? What must occur to each patient? Options depend on? What are doctors obliged to do?
A: give comprehensive and appropriate information responding to what the patient wants
Each patient must be assessed and the appropriate amount and level of information given.
You will have options in explanation and planning depending on the context - whether you are discussing opinion and significance of problems or negotiating a mutual plan or discussing investigations and procedures.
provide some information to patients (e.g. purpose and risks of proposed surgery) even if patients do not want it
Q: In the Calgary-Cambridge model, what can closing the session do? How can you involve a review and what does this do?
A: help to maintain the rapport.
A summary enables review of what has been learned as
well as checking for any other information that you may have missed or that the patient wants to tell you.
Q: When do you build a relationship in the Calgary-Cambridge model? What’s the aim? How do you do this? What does this enhance? Also includes?
A: This occurs throughout the entire consultation
You are aiming to communicate to help build the relationship with the patient and to establish rapport
In order to build an effective relationship, you need to involve the patient and share your thoughts and ideas.
This will help to enhance their understanding and you may also want to provide a rationale for the questions you are asking, the physical examination, lab tests, treatment etc.
This will also include getting consent from patients as well as discussing confidentiality.
Q: At one point in the consultation do you include structure in the Calgary-Cambridge model? How and why do you make the organisation overt?
A: throughout the entire consultation
By making organisation overt, both you and the patient will know where you are in the consultation. This can be achieved by summarising at the end of a line of enquiry, signposting the next section of the interview, structuring the interview in a logical way and attending to timing.
Q: Name the 6 phases of the Transformed clinical model. What do the first 3 focus on ? Last 3? All components make?
A: 1. Exploring both the disease and illness experience
- Understanding the whole person
- Finding common ground
- Incorporating prevention and health promotion
- Enhancing the doctor-patient relationship
- Being realistic
The first three focus on the process between the doctor and patient and the last three focus on the
context within which the doctor and patient interact.
holistic model that is patient-centred clinical practice
Q: Summarise the aim the for the first phase of the transformed clinical model (Exploring both the disease and illness experience). What does it involve? What does the doctor specifically explore? 4 letters?
A: Aim: To assess the two conceptualisations of ill health: disease and illness
In addition to assessing the disease process by taking a history and doing a physical examination, the doctor actively seeks to enter in the patient’s world to understand his or her unique experience of illness.
Specifically, the doctor explores the patient’s feelings about being ill, their ideas about the illness, how the illness is impacting on their functioning and what they expect from the doctor.
F = feelings I = ideas F = function E = expectations
Q: What is the aim of understanding the whole person in the transformed clinical model? Includes? (5)
A: Aim: To integrate the concepts of disease and illness with an understanding of the whole person.
This includes an awareness of all the aspects of the patient’s life, such as personality, developmental history, life cycle issues, and the contexts in which they live.
Q: What are the 3 aims of finding common ground in the transformed clinical model? What may a patient sometimes want? Doctor’s response?
A: Aims:
- To define the problems
- To establish the goals of treatment &/or management
- To identify the roles to be taken by patient and doctor
Sometimes patients want to play a passive role in their treatment and management but the doctor needs to be able to assess this before assuming the role the patient wants to take in managing their own health.
Q: What is the aim of incorporating prevention and health promotion in the transformed clinical model? What does this highlight? May include?
A: Aim: To promote health as well as prevent disease.
This highlights the importance of using each contact with the patient as an opportunity for prevention and health promotion.
This may include helping to educate your patients.
Q: What is the aim of enhancing the doctor-patient relationship in the transformed clinical model? What should each contact do?
A: Aim: To develop and maintain the patient-doctor relationship
Each contact should build on the relationship by including compassion, trust and a sharing of power. Self-awareness is essential as well as an appreciation of the unconscious aspects of the relationship such as transference and counter transference.
