Consultation skills

Calgary-Cambridge Model for Consultations

• Initiation

• Gathering Info and Med History

• Physical Exam

• Explanation and planning

• Closing the session

Why is gathering an accurate med history important?

• Helps build the therapeutic relationship

• Determines how the condition may have affected the patient and their family

• Explores the patients' ideas, concerns and expectations

• Eliminates serious problems

• Determines more accurately what is wrong with the patient

Taking a poor history results in a greater error rate in diagnosis

SOCRATES

• Site

• Onset

• Character

• Radiation

• Associated Symptoms

• Time

• Exacerbating and relieving factors

• Severity

Respiratory Red flags

• SOB

• Exercise tolerance

• Wheeze

• Chest pain

• Cough

• Phlegm

• Haemoptysis

• Stridor

• Hoarse voice

GI Red flags

• Weight loss or gain

• Appetite

• Indigestion/heartburn

• Dysphagia

• Nausea/vomiting

• Haematemesis

• Abdominal pain

• Jaundice

• Swellings

• Change in bowel habit

• Description of stool

CNS Red flags

• Headaches

• Fits/faints/loss of consciousness

• Dizziness

• Vision- acuity, diplopia

• Hearing

• Weakness

• Numbness/tingling

• Loss of memory/personality change

• Anxiety/Depression

General Red flags

• Fatigue

• Malaise

• Fever

• Rigors

• Night sweats

• Weight

• Appetite

• Skin: rashes/bruising

• Sleep disturbance

• Mood

Differential vs Provisional Diagnosis

Differential:

• A differential diagnosis  is a list of possible medical causes behind the presenting symptoms or physical findings.

Provisional:

• Most likely diagnosis based on symptoms, findings and information gathering but not a fully committed diagnosis

Barriers to effective communication

• Poor questioning technique

• Listening

• Not identifying patient agenda/concerns

• Distractions

How do we gather information during a consultation?

• Do they know what they’re here for?

• Review the case beforehand and figure out what to ask

  • Symptomatic

  • Lifestyle

  • Personal motivations?

• Does the patient look like their diagnosis?

• Anything that could’ve affected results

Clinical Inertia

Failure to start/ intensify treatment when an patient’s goals are not being met based off of the evidence provided