Thread by @georgebellstarr

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Dr Bridget Carne - Consultation Skills

What are they?

Communication skills
- creating a relationship
- sharing information
- picking up cues
- working out a plan together

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“Consultation skills is a massive subject, so let’s focus on some some tools”

Patients often rehearse what they want to say - try introducing yourself and NOT asking a question - give the patient time to speak first.

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Practice the golden minute.

Try and keep silent for 1 minute and let the patient tell you what they want to tell you - the patient will often tell you what need to know.

Try active listening (nods, yeses, mmhm etc) to encourage the patient to speak.

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ICE!

Ideas - what do you think is going on?
Concerns - is there a specific worry you have?
Expectations - what would you like to happen next?

Try and use open questions, try to avoid yes/no answerable questions.

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Reflect back onto the patient.

Try and observe verbal or non verbal cues.

Does the patient seem emotive on a certain subject? If they do, try and explore that subject further.

This can be very hard, especially on challenging subjects.

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Onto consultation models:

- no one is perfect
- they often provide a framework or structure to help guide a consultation
- over time clinicians often develop their own model, this may change patient to patient (eg paeds Vs frail)

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Some examples:

➡️ Pendleton -

7 steps to complete within the consultation.

➡️ Neighbour (the inner consultation) -

5 steps to complete, can be done on your fingers.

Calgary-Cambridge -

Quite methodical, involves building a good relationship with the patient.

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Michael and Enid Balint theorised that the clinicians emotions have a significant impact on the consultation.

The doctor (clinician) is a drug, and has a therapeutic role.

The noted that those who ask lots of questions, only get answers to those questions.

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Micro-Skills

There are lots of really small things that you can do to help the consultation.

My favourite:

Saying thank you for your patience, rather than sorry for the delay. Dr Carne advises that it disarms angst against you running late.

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That concludes a whistle stop tour of consultation skills.

Something that all #paramedics (and clinicians) need and use, but something that not all of us understand, or use to help us (and our patients)

A very well received presentation!

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