Communication vs consultation

Question 1

What are the 5 elements of the ‘health belief’ model?

Answer 1

1. Peoples interest in their health and the degree to which they are motivated to change it vary enormously.
2. When considering specific health problems, people think very differently about how likely they are to be affected (perceived vulnerability).
3. Patients vary in how dire they believe the consequences of contracting a particular illness or leaving it untreated would be (perceived seriousness).
4. Patients weigh the advantages and disadvantages of taking any particular course of action.
5. Patients beliefs stem from a source of information. They are prompted or created (what they read online, what parents said etc.)

Question 2

What are the 3 locus of control?

Answer 2

1. Internal controller - They are in charge of their own future health. These people could be very obsessive about health, exercise fanatics, very upset when they get ill.
2. External controller - Opposite of internal controller. These people believe in ‘what will be, will be’. They want to be told a solution but then they will decide if to listen or not.
3. The powerful other - They believe that YOU are in charge of their health. Many of these patients can have overt or covert mental health issues. These patients struggle when given more power over their health.

Question 3

How can we manage an internal controller loci patient in our consultation?

Answer 3

Explain suggestions, advice leaflets, steering the consultation to be about them. Less prompting to do things required as they are in charge of their health.

Question 4

How can we manage an external controller loci patient in our consultation?

Answer 4

Referral, more information needed.
Explore overt/covert mental health - depression? Encouraging follow up - phone follow up to keep them engaged.
Continuation of the key message to reinforce through various members of the healthcare team (repetitive advice about giving up smoking for example from everyone)

Question 5

How can we manage a ‘powerful other’ loci patient in our consultation?

Answer 5

Educate to push control of their disease back onto them.
Collective bargaining - if you do this, i can look at prescribing this.
Continuation of the key message, consistent message between clinicians.

Question 6

In terms of outcomes after a consultation, what percentage of patients actually take our advice?

Answer 6

50% choose not to follow advice.

Question 7

Are satisfied patients more or less likely to follow advice we give them?

Answer 7

More likely as they feel listened to

Question 8

What does safety netting mean in primary care?

Answer 8

Safety-netting is information given to a patient or their carer during a primary care consultation, about actions to take if their condition fails to improve, changes or if they have further concerns about their health in the future. An example of a safety-netting statement would be “please make another appointment if your symptoms do not improve”

Question 9

What is medical concordance?

Answer 9

Approach to the prescribing and taking of medicines. It is an agreement reached after negotiation between a patient and a healthcare professional that respects the beliefs and wishes of the patient in determining whether, when, and how medicines are to be taken

Question 10

What is somatisation? What can we do about it?

Answer 10

Tendency for patients to create physical symptoms out of emotional responses. We have short consultations with patients and we should try and investigate any psychological issues

Question 11

What things can contribute to our ‘power’ as clinicians? (6)

Answer 11

1. Knowledge
2. Social status
3. Experience
4. Access to resources - gateway to medications and referrals to other services
5. Unaffected by symptoms
6. Environment - clinical buildings

Question 12

What things might reduce our ‘power’ as clinicians?

Answer 12

1. Knowledge of patient - internet resources - patient preconceptions
2. Options on treatments
3. Lack of respect from patient
4. Lack of knowledge - as you develop in your clinical roles, we will have more knowledge on certain things - feeling helpless
5. Self-esteem / self-confidence
6. Public perception

Question 13

What is the rule of thirds?

Answer 13

1/3 of patients take advice and act in accordance sufficient for the advice to be effective

1/3 will take advice but not sufficient for the advice to be effective

1/3 won’t bother