Clinical Review ABC of psychological medicine

The consultation

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1567
  1. Linda Gask,
  2. Tim Usherwood

    The success of any consultation depends on how well the patient and doctor communicate with each other. There is now firm evidence linking the quality of this communication to clinical outcomes.

    Embedded Image

    Visiting the sick woman, by Quiringh Gerritsz van Brekelenkam (c 1620-68)

    The dual focus—Patients are not exclusively physically ill or exclusively emotionally distressed. Often they are both. At the start of a consultation it is usually not possible to distinguish between these states. It is the doctor's task to listen actively to the patient's story, seeking and noticing evidence for both physical illness and emotional distress.

    Involving patients—Changes in society and health care in the past decade have resulted in real changes in what people expect from their doctors and in how doctors view patients. In addition, greater emphasis has been placed on the reduction of risk factors, with attempts to persuade people to take preventive action and avoid risks to health. Many patients want more information than they are given. They also want to take some part in deciding about their treatment in the light of its chances of success and any side effects. Some patients, of course, do not wish to participate in decision making; they would prefer their doctor to decide on a single course of action and to advise them accordingly. The skill lies in achieving the correct balance for each patient.

    Three functions of the medical consultation

    1 Build the relationship
    • Greet the patient warmly and by name

    • Detect and respond to emotional issues

    • Active listening

    2 Collect data
    • Do not interrupt patient

    • Elicit patient's explanatory model

    • Consider other factors

    • Develop shared understanding

    3 Agree a management plan
    • Provide information

    • Appropriate use of reassurance

    • Negotiate a management plan

    • Make links

    • Negotiate behaviour change

    A comprehensive model—The “three function” model for the medical encounter provides a template for the parallel functions of the clinical interview. This is now widely …

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