Comms 2 (Consultation) Flashcards
What’s the balance between a doctor or patient centred consultation?
Clinical professional tends to be paternalistic and come with an attitude of ‘I know best’ but this leads to a power struggle between the patient and the clinician.
So we need a patient-centred approach.
But it can’t be totally patient-centred because they have come for advice and they don’t want to do all the work themselves.
So we need a happy medium between the two.
What contributes to your power as a clinician?
Knowledge, experience, ability to refer (gatekeeper), ability to diagnose, drugs, therapies, title/reputation, authority/status, ability to give sick notes etc.
What breaks down the power of a clinician?
Broken trust of a patient
Societal view of reputation
Arrogance
Not meeting the patient’s expectations
How do patients usually respond to advice from a clinician?
1/3 take advice sufficiently for it to be effective
1/3 take advice but insufficiently for it to be effective
1/3 don’t bother
What is the health belief model?
People’s interest in their health and their motivation to change it varies hugely.
People think very differently about how likely they are to be affected by any given health problem.
Patients’ beliefs about the consequences of illness or leaving something untreated vary.
Patients weigh up the advantages and disadvantages of taking any particular course of action.
Patients beliefs are not fixed – they are prompted or created by a number of stimuli and triggers.
What is the locus of control?
How we explain to ourselves what is likely to happen to our health
What are the 3 types of patient?
Internal controller
External controller
Powerful other
What are the characteristics of the internal controller?
Believes that they are fundamentally in charge of their own future health
Tend to like explanations, dialogue and critical thinking
The arguments do not necessarily need to be rationale
What are the characteristics of the external controller?
Do not believe they control their health “there’s a bullet with my name on”
Tend to want to be told what to do to be rejected or accepted as they see fit
Not really into involvement in decision making
Many have covert or overt mental health issues
What are the characteristics of the powerful other?
They believe that YOU are in charge of their health
Resist strategies to make them take control of their own health
Will not follow advice if their own agenda does not match with the doctors
How to best cope with the 3 different types of patient?
Internal controller - give them that little bit more explanation, myth-busting, give them choices, autonomy and help them to find rational links.
External controller - encourage decision-making on their part, focus on their expectations and ideas as concerns may be low
Powerful other - try to get on the same page, not accepting the dumping of their problems on you
What are the two major outcomes of a consultation?
POSITIVE: good progression, understanding, happy patient, well-informed, commitment to a plan, satisfaction, reduction in concerns
NEGATIVE: lack of trust, more anxious, poor health, doctor shopping, ill-informed, remaining mismatch in expectations, increase in concerns
What the balance between good and bad stress for a patient?
We want the patient to be concerned enough to allow them to comply to treatment but not too concerned that they are distressed.
What are the different stages of change?
Pre-contemplation: does not recognise the need for change or is not actively considering change
Contemplation: Recognises problem and is considering change
Preparation: Getting ready to change
Action: Initiating change
Maintenance: Adjusting to change and practicing new skills and behaviours to sustain change
Can lead to permanent exit from this cycle OR relapse whereby the cycle is started again.
How do we easily satisfy patients?
Patients don’t want to hear health messages (eat better, exercise, stop smoking)
Easy way to sastify them is to give the patients what they want
BUT not always best
So our goal should be shared understanding where both parties are happy with the outcome
