2. 25% of consultations are patient initiated as new presentations of new problems. A further 50% are repeat consultations addressing chronic ongoing issues, a follow-up of an acute problem, or because of some disease presenting activity. The final 25% are termed recidivist. They again are patient initiated and occur on matters and reopen agenda that the doctor may have felt should be closed.
3. Data on the consultation 2/3 of illness do not get brought to the doctor 9/10 of symptoms do not brought to the doctor (the iceberg effect) 1/5 of patients make up half the work ¼ of children with URTIs present because of social factors related to parents 75% of doctors use tight doctor-centered styles
4. 90% of patients are happy with their doctors 80% of patients find their doctor easy to talk to There is 50% divergence between doctors and assessment of the presenting problem doctor’s interruption time of first patient’s opening statement is 18 seconds in average ICE generally may not be elicited
5. Transactional Model (Berne) 1964 Human psych consists of 3 ego states ‘parent, adult, and child”. At any given moment each of us is in a state of mind when we think, feel, behave, react, and have attitude as if we were either a critical or caring parent, a logical adult, or a spontaneous or dependent child.
6. Health belief model (Rosenstock-1966- and Becker and Maiman-1975) Looks at the patient’s reasons for accepting or rejecting the doctor’s opinion. More likely to accept advice, diagnosis, or treatment if the doctor is aware of their ICE People vary in their interest in health (health motivation) Patients vary in how likely they think they are to contract an illness (perceived vulnerability)
7. Health belief model (Rosenstock-1966- and Becker and Maiman-1975) 3. Patient’s belief in the diagnosis is affected by whether they feel their opinion or concerns have been understood by the doctor 4. “perceived seriousness” varies between patients for a given condition.
8. Sex - category intervention analysis (1975) [ John Heron] The doctor’s intervention fall into one of sex categories:- Informative: importing new knowledge, instructing, or interpreting. Prescriptive: giving advice or instructions, being critical or directive Confronting: challenging a restrictive attitude or behavior, giving direct feedback within a caring context
9. 4. Cathartic: seeking to release emotion in the form of weeping, laughter, trembling or anger 5. Catalytic: encouraging the patient to discover and explore his own latent thoughts and feelings 6. Supportive: offering comfort and approval, affirming the patient’s intrinsic values
10. The inner consultation (Roger Neighbour) Connecting ( rapport) Summarizing ( demonstrate to pt. That you have understood why he came) Handing over ( pt. Accept the plan we have agreed) Safety netting (anticipation) Housekeeping (ready for next patient)
11. BALINT MODEL The drug doctor Child as a ticket Collusion of anonymity (all are well and gratified and if any thing goes wrong nobody is individually responsible) Teacher-pupil relationship
12. 5. Apostolic function (somehow when we examine our patients we examine our self, so, we may expect patient to take our action for such a problem as a Model)) 6. Mutual investment company: it is not love, not mutual respect, not mutual identification, not friendship, though an element of all this enter it
13. Pendleton's model “the 7 tasks” Define reason for patient’s attendance Consider other problems: continuing problems, at risk factors. With the patient, to choose an appropriate action for each problem. To achieve a shared understanding of the problems with the patient.
14. 5. To involve the patient in the management and encourage him to accept appropriate responsibilities. 6. To use time and resources appropriately 7. To establish or maintain a relationship with the patient which helps to achieve the other tasks
15. Stott and Davies model Management of presenting problem Modification of help seeking behaviors( e.g by educating the patient about the natural history and self medication of minor illnesses) Management of continuing problems Opportunistic health promotion ( e.g vaccination, cervical screening)
