Identifying Reasons for Consultation in Medicine

Identifying the Reason for Consultation

• The skills required to identify the reason for consultation include:
  • Asking an open question to begin the interview
  • Listening actively and encouraging the patient to complete and expand on their opening statement
  • Confirming the patient's list
  • Screening for further problems
  • Agenda setting

Opening Question

• Start the consultation with an open question that allows the patient to speak freely without limitations or assumptions
• Examples of opening questions:
  • "Why have you come to see the doctor today?"
  • "How can I help you today?"
  • "What do you want to see the doctor about today?"

Active Listening

• Listen attentively to the patient's opening statement without interrupting or directing their response
• Use non-verbal communication to show genuine interest and encourage the patient to elaborate
• Avoid interrupting the patient, as research shows that patients are more likely to present more of their problems to the doctor if they are not interrupted

Process Skills and Content

• Process skills are the techniques used to gather information
• Content refers to the biomedical, patient perspective, and background information that the doctor needs to gather
• Gathering information involves:
  • Patient narrative
  • Question style: open to closed cone
  • Attentive listening
  • Facilitating response
  • Picking up cues
  • Clarification
  • Time-framing
  • Internal summary
  • Appropriate use of language
  • Additional skills for understanding the patient's perspective

Content of Information Gathering

• History of the Presenting Complaint
  • Biomedical perspective (disease)
    • Sequence of events
    • Symptom analysis
    • Relevant systems review
  • Patient's perspective (illness)
    • Ideas and beliefs
    • Concerns
    • Effects on life
    • Patient is encouraged to express feelings
• Background information
  • Past medical history
  • Drug and allergy history
  • Family history
  • Personal and social history
  • Review of systems

Types of Questions

• Open questions:
  • Often start with what, when, where, how, and why
  • Encourage a response that can provide a range of information
  • Do not limit the response to a "yes" or "no"
  • Examples:
    • "Tell me about that cough"
    • "What's been going on with that cough?"
• Closed questions:
  • Generally lead to a one-word answer, usually "yes" or "no"
  • Do not encourage elaboration
  • Examples:
    • "Do you have a cough?"
    • "Do you cough at night?"

Non-Verbal Cues and Emotional Cues

• Non-verbal cues:
  • Looking anxious or showing worry in body posture, facial expression, and tone of voice
  • Recognize and follow up on these cues
• Emotional cues:
  • Use of emotionally laden words like "worried", "anxious", "frightened", "dangerous", "important", "serious", or "stressed"
  • Follow up on these cues to show empathy and build rapport

Building the Relationship

• Ask direct questions to explore the patient's perspective further
• Follow up on cues that the patient gives
• Recognize and respond to informational and emotional cues

This quiz assesses skills required to identify the reason for consultation in a medical setting, including asking open questions, active listening, and agenda setting. Test your knowledge of effective patient consultation techniques!