1. Communication Skills Course
Consultation Models
Fayza Rayes
(MBBCh. Msc. MRCGP (UK
Consultant Family Physician
Joint Program of Family & Community Medicine – Jeddah
www.fayzarayes.com
fayzarayes@yahoo.com

2. Case Scenario
Mr. Mouneer, is a 45-year-old retired from
military service. Presented with cough for 3
months. He has hypertension. He smokes 40
cigarettes per day. His father died of coronary
.heart disease when aged 48
Cough History
DD&
months 3

3. ?!What are Mouneer problems
Mr. Mouneer, is a 45-year-old retired from
military service. Presented with cough for 3
months. He has hypertension. He smokes 40
cigarettes per day. His father died of
.coronary heart disease when aged 48
?!What does Mouneer need from his physician

4. What skills do physician need conduct
?!this consultation effectively
Managing cough & & Empathy Counseling
BP & Risk factors reassurance & advise
Cough
BP

5. The Traditional Consultation
Model
Patient Clerking
Chief Complaint
History of The Present Complaint
Past Medical History
Family History This does
Personal & Social History not cover
Drug & Allergy History Systems Review patient’s
Physical Examination need
Biological Diagnosis
 Disease Management:
 Investigation
 Prescribing
 Follow-up Appointment

6. Exercise 16 Page 49
The Traditional Medical Model
1. 50% poor compliance ?!
2. 40% pts unsatisfied ?!
3. Reassurance ?!
4. Biological diagnosis ?!
5. Dealing with uncertainty ?!
6. 5-10 min consultation ?!
7. Unsatisfied doctors ?!

7. The Traditional Medical Model
:Missing Tasks
1. Doctor – Patient Relationship
2. Pt ideas concerns expectations and feelings
3. Risk assessment
4. Psycho-social diagnosis
5. Patient management
6. Management of time & resources
7. Management of doctor feelings (Housekeeping)

8. Consultation Models

9. Consultation Models
1. Balint 1950
2. Transactional Analysis 1964
3. Physical, Psychological and Social / 1972
4. Six Category Intervention Analysis 1975
5. Stott and Davis 1979
6. Byrne and Long 1979
7. Helman’s ‘Folk Model’ 1981
8. Pendleton, Schofield, Tate and Havelock 1984
9. The Disease - Illness Model 1984
10. Neighbour 1987
11. Three Function Approach 1989
12. Brown Interview Checklist 1992
13. E4 Model 1994
14. The Patient–centered Clinical Method / 1995
15. Segue Framework 1995
16. Maas Global 1995
17. Comprehensive clinical method (CC2) / 1996
18. Calgary-Cambridge Approach /1996
19. Kalamazoo Consensus Statement 2001
20. BARD 2002
21. Model of Macy Initiative in Health Communication 2004
22. …

10. “The doctor as the drug”
Balint (1950)
The
Importance of
therapeutic
doctor–patient
Relationship
Appropriate use of doctor’s authority

12. Byrne & Long
 Patient Centred consultation style
 Less authoritarian doctor
 Encourages patient to explore their own
feelings and concerns
 Show interested in psycho-social aspect of
illness

13. Byrne & Long
 Doctor centred consultation style:
 Paternalistic - doctor is the expert and patient
expected to cooperate
 Tightly controlled interviewing style aimed at
reaching an organic diagnosis.

14. The Expanded Model of Consultation
Management of Modification of Help
Presenting Problem Seeking Behavior
Management of Opportunistic health
Continuous Problem Promotion
(Stott & Davis 1979)

15. Stott & Davis 1979
A 65-year-old retired military officer,
rarely visit the practice, he came today
with back pain, headache and
generalized weakness
Management of Management of
Presenting Problem Continuous Problem
Modification of
Opportunistic health
Help Seeking
Promotion
Behavior

16. Stott & Davis 1979
Sameera is a 14-month-old girl, her mother is
very anxious because Sameera cannot walk
independently till now. She demands that
something to be done about this. Sameera is
the youngest of five children. Her father is
.unemployed
Management of Management of
Presenting Problem Continuous Problem
Modification of
Opportunistic health
Help Seeking
Promotion
Behavior

17. Stott & Davis 1979
Mrs. Hala is a 28-year-old lady, recently
married presents with vaginal discharge.
Management of Management of
Presenting Problem Continuous Problem
Modification of
Opportunistic health
Help Seeking
Promotion
Behavior

19. Stott & Davis 1979
The Expanded Model of Consultation
 Health Education
 Health promotion

20. (Pendleton 7 Tasks (1984
1. To define the real reasons for pt attendance
2. To consider other problems
3. To choose with the pt. appropriate action for
each problem
4. To achieve a share understanding
5. To involve pt. in the management
6. To use time & resources effectively
7. To establish & maintain Dr.-pt. relationship

21. Neighbour (1992(
The Inner Consultation
Connect Summarize
Housekeeping Safety net Hand over

22. The Three-Function Approach to the
(Medical Interview (Cohen-Cole1991
Functions Skills
1. Gathering data a)Open-ended questions
b)Open to closed one
c)Facilitation
d)Checking
e)Survey of problems
f)Negotiate priorities
g)Clarification and direction
h)Summarizing
i)Elicit patient’s expectations
j)Elicit patient’s ideas about etiology
k)Elicit impact of illness on patient’s quality of life
2 Developing rapport a)Reflection
b)Legitimating
c)Support
d)Partnership
e)Respect
3 Education and motivation a)Education about illness
b)Negotiation and maintenance of a treatment plan
c) Motivation of non-adherent patients

23. Model of Macy Initiative in Health
Communication

24. The Framework of The Calgary-
Cambridge Guide (Kurtz 1996)
1.Initiating The Session
 Establishing initial rapport
 Identifying the real reason(s) for consultation
2. Gathering Information
 Exploration of problems
 Understanding the patient's perspective
 Providing structure to the consultation
3. Building The Relationship
 Developing rapport
 Involving the patient
4. Explanation And Planning
 Providing the correct amount and type of information
 Aiding accurate recall and understanding
 Achieving a shared understanding: incorporating the patient's perspective
 Shared decision making
5. Closing The Session

25. The Calgary-Cambridge Guide (Kurtz 1996)

26. Consultation Models
General Comments about Previous Models
1. Each model concentrates on particular
important task(s)
2. They are far from the traditional hospital model
3. Not easy to incorporate them in medical records
and daily clinical practice

27. The
Comprehensive Model
Fayza Rayes 2004

28. The Comprehensive Model
Objectives:
1. Integrate traditional clinical method with
effective communication skills
2. Identify the main skills needed to conduct
successful consultation.

29. The Traditional Consultation Model
Patient Clerking
Doctor – Centered:
History Taking
Physical Examination
Biological Diagnosis
This is not
 Disease Management: suitable for
 Investigation modern medicine
 Prescribing
 Follow-up
Appointment

30. The Traditional Consultation Model
Patient Clerking
Chief Complaint
History of The Present Complaint : Important Missing Tasks
Past Medical History
Doctor – Patient Relationship
Family History
Patient’s ideas concerns expectations
Personal & Social History
and effects of the problem
Drug & Allergy History
Psycho-social diagnosis
Systems Review
Physical Examination Patient management
Biological Diagnosis Management of time & resources
Management of doctor feelings
 Disease Management:
((Housekeeping
 Investigation
 Prescribing
 Follow-up Appointment

32. The New Comprehensive Consultation Model
 It is characterized by :
 Value doctor-patient relationship
 Patient – centered
 Holistic approach
 Reassurance, prevention & health education are
basic component of its contents
 Practical and easy to incorporate it in the current
medical records and daily clinical practice.

33. Integrating Comprehensive Model
in Hospital medical Records
1. Chief complaint
2. History of the present complaint
3. Pt ideas concerns expectation and feelings
4. Risk assessment
5. Past medical history
6. Family History
7. Social History ”USER FRIENDLY“
8. Systems Review
9. Physical examination
10.Bio-psycho-social diagnosis
11. Disease management & Patient management

34. Integrating Comprehensive Consultation
Model in Hospital medical Records
Tasks done but not written:
13. Doctor – Patient Relationship
14. Management of time & resources
15. Management of doctor feelings (Housekeeping)

35. NEW
The New Comprehensive
Consultation Model
 What is new in this model?
 Patient – centered
 Holistic approach
Practical and easy
 Practical and easy to incorporate it
in to the current medical records and
apply it in daily clinical practice.

36. Respecting the Experience
of Our Trainees
The New Consultation Model:
1. Comprehensive
2. Complementary
3. User friendly

37. Page 45
A Guide for Comprehensive Consultation Model
Physician-Patient Relationship:
1.Establish the relationship
2.Facilitation
3.Building Rapport
4.Empathy
5.Making use of physical examination
6.Partnership
7.Closing & maintaining the relationship Diagnosis:
Comprehensive Bio-psycho-social
8. Gathering information about disease & illness
9. Broad thinking and exclusion of all possible differential
diagnosis
10. Exclusion of possible serious complications
11. Identification of at risk factors & continuous problem
Comprehensive Management:
Patient Management:
12. Explanation and Health Education
13. Reassurance: (remember: you are the most effective drug)
14. Health Promotion
15. Modification of help seeking behavior (Denial, displacement)
16. Disease Management: intervention by investigations or
treatment
17. Management of time & resources
18. Management of physician’s feeling (House-keeping)

38. Comprehensive Consultation Model:
A Guide for Training
Physician-Patient Relationship:
1. Establish the relationship
2. Facilitation
3. Building Rapport
4. Empathy
5. Making use of physical examination
6. Partnership
7. Closing & maintaining the relationship

39. Comprehensive Consultation
Model: A Guide for Training
Comprehensive Bio-psycho-social Diagnosis:
8. Gathering information about disease & illness
9. Broad thinking and exclusion of all possible
differential diagnosis
10. Exclusion of possible serious complications
11. Identification of at risk factors & continuous
problem

40. Comprehensive Consultation
Model: A Guide for Training
Comprehensive Management:
Patient Management:
12. Explanation and Health Education
13. Reassurance: (remember: you are the most effective
drug)
14. Health Promotion
15. Modification of help seeking behavior (Denial,
displacement)
16. Disease Management: intervention by investigations or
treatment
17. Management of time & resources
18. Management of physician’s feeling (House-keeping)

41. Final Message & Conclusions
 Traditional Model of Consultation is not suitable for
modern medicine
 The New Comprehensive Model of Consultation
is characterized by :
1. Making use of the most existing and update
consultation models and guides.
2. Integrating the traditional clinical method with
effective communication skills
3. Building on what the physicians already know, so it
complements, it does not destruct nor neglect the
traditional medical model.

42. :RECOMMENDATIONS
We recommend all physicians in all medical
specialties to change to this new
comprehensive consultation model in their
daily clinical practice

43. ‫‪Consultation Models‬‬
‫)إن ا يحب أحدكم إذا عمل‬
‫عمال ف ً فليتقنه ( وفي رواية )فليتمه(‬
‫صدق الرسول الكريم صلى ا عليه وسلم‬

44. References