Overview
This chapter reviews key models of the medical consultation, emphasizing the evolution from doctor-centred to patient-centred approaches, and highlights essential communication skills and factors that shape effective consultations.
Definition and Background of Consultation Models
- A medical consultation is a two-way interaction where a patient or doctor initiates discussion about health.
- No single ideal consultation model fits all situations; different models offer strengths for various types of consultations.
- Consultation success depends on addressing both biomedical and psychosocial aspects.
- Patient expectations and definitions of quality may differ from those of healthcare professionals.
Main Consultation Models
Weiner (1948)
- Communication involves sender initiation, receiver interpretation, and feedback for clarity and improvement.
- Key communication steps: information source, transmission, reception, interpretation, feedback, clarification, reflection.
Maslow (1954)
- Hierarchy of human needs (physical, safety, love, esteem, self-actualization) influences why patients consult.
- Basic needs must be met before higher needs are addressed.
- Holistic care includes physical, psychological, social, spiritual, and cultural factors.
Balint (1957)
- Focuses on the doctor–patient relationship and bio-psychosocial model.
- Active listening and exploring hidden agendas are essential.
- Doctor’s feelings and responses can shape the consultation outcome.
Berne (1964)
- Transactional analysis: interactions occur in Parent, Adult, or Child ego states.
- Effective consultations aim for adult-adult transactions rather than parent-child roles.
Byrne and Long (1976)
- Six phases: relationship, reason for attendance, examination, condition consideration, treatment, and ending the consultation.
- Analyzes doctor-centred versus patient-centred behavior.
Stott and Davis (1979)
- Four areas: presenting problems, modifying help-seeking behavior, managing ongoing problems, and health promotion.
- Emphasizes task-oriented consultations with adult-to-adult respect.
Helman (1984)
- Considers cultural and social contexts in illness.
- Uses patient narratives to understand illness meaning and its broader impacts.
Pendleton (1984, 2003)
- Seven tasks focusing on understanding problems, shared understanding, involving patients, and maintaining relationships.
- Encourages a patient-centred partnership and shared decision-making.
Neighbour (1987)
- Five stages: connecting, summarizing, handing over, safety netting, housekeeping.
- Balances theory with intuitive practice.
Fraser (Leicester Assessment Package, 1994)
- Evaluates consultation competence in seven categories: interviewing, exam, management, problem-solving, relationship, anticipatory care, and record keeping.
Stewart et al. (1995, 2003)
- Patient-centred model: explores both disease and illness experience, whole person, common ground, prevention, relationship, and realistic care.
Calgary-Cambridge Guide (1996)
- Five stages: initiation, information gathering, relationship building, explanation/planning, and closing.
- Focuses on specific communication skills for collaboration.
Other Key Issues
- Empathy, empowerment, and enablement are central to effective consultations.
- Evidence-based medicine should complement patient-centred approaches.
- Narrative competence helps clinicians understand and act on patient stories.
- Consultations are complex, requiring flexibility and the ability to manage uncertainty.
Practical Communication Skills
- Establish rapport, use open and closed questions appropriately.
- Practice active listening, summarising, and reflecting.
- Use language patients understand; avoid jargon.
- Comfortably allow silence; respond to verbal and non-verbal cues.
- Explore patient ideas, concerns, and expectations.
- Share information and agree on plans with patients.
- Address psychosocial context as relevant.
- Practice honesty, safety netting/follow-up, and housekeeping between patients.
- Combine communication with clinical competence and a professional attitude.
Key Terms & Definitions
- Consultation model — Structured approach to doctor-patient interaction.
- Bio-psychosocial model — Considers biological, psychological, and social factors in health.
- Patient-centred — Approach focusing on the patient’s experience, perspective, and involvement.
- Transactional analysis — Analysis of communication through Parent, Adult, Child ego states.
- Empathy — Understanding and acting in response to the patient’s feelings and perspective.
- Enablement — Patient’s increased ability to understand, cope with, and manage their health after consultation.
Action Items / Next Steps
- Reflect on which consultation models align with your consulting style.
- Practice key communication skills outlined in the chapter.
- Explore additional reading on patient-centred care and complexity in consultations.
- Seek feedback and self-assess your consultation approach using relevant models.