Consultation and prescribing skills

TO GAIN CONSENT

…FOR ANY GIVEN SITUATION.

ENGAGE with the person

Gain CONSENT to question 

  - Why? How?

What feels right for:

You

The person

The situation

Structuring the consultation

•Adapting speech

o Non jargon language

•Adapting body language

•Active listening

•Asking sensitive questions

•Questions with purpose 

•Avoid irrelevant questions

•Health Literacy 

cultural competence

•CONFIDENCE AND COMPETENCE  

o Trust and Rapport

Consultation skills

Golden Minute

Calgary-Cambridge Guide

TED

ICE

LICEF

4 Es- Health coaching Model

Neighbour- Closing consultations

SOCRATES

MR-CAT

Golden minute

•The FIRST 60 seconds is where the patient should NOT be interrupted and be part of the patient's history taking.

Asking relevant OPEN questions will allow the patient to share almost 80% of what has brought them in

Calgary - Cambridge model

Initiating session- Introduce yourself, build rapport, establish agenda

Gathering information- Explore- use model- ICE 

Physical examination- Not always required and if needed should occur at this point

Explanation and planning- provide appropriate information. Develop action plan

Closing the session- summarise key messages- 'safety-net ' the patient 

TED

•TELL

Tell me more about ….

•EXPLAIN

Explain to me why/what....

•DESCRIBE 

Can you describe....

ICE

• IDEAS

• CONCERNS

• EXPECTATIONS

LICEF

•L – Lifestyle

•I – Ideas

•C – Concerns

•E – Expectations

•F - Feelings

The 4 E’s model

Explore- patient knowledge, perception and lifestyle goals

Educate- Link information to patient agenda, use 'teach back' method

Empower- Help patient to make decisions on taking medicine

Enable- ensures patient works out how they will incorporate taking medicines into their lives for e.g. some statins used at night when sleeping but this can’t be done for patients who work night shifts.

Neighbour model

CONNECTING

-develop rapport and empathy

SUMMARISING

-reasons and ICE

HANDING OVER

-agreed agenda and management plan- empower patient

SAFETY-NETTING

-contingency plans

HOUSEKEEPING

-check yourself- are you okay to continue?

SOCRATES

Where is the pain?

What were you doing when the pain started?

What does the pain feel like?

Does the pain go anywhere else?

Do you have any other symptoms with the pain?

How long have you had the pain?

Does anything make the pain better or worse?

On a scale of 1-10 how severe is the pain?

MR-CAT

•Building Rapport

•Active Listening

•Questioning Techniques

•Providing Information

•Empathy and Sensitivity

•Patient Involvement

•Summarising and Clarifying

•Non-Verbal Communication

Clinical empathy

• embarrassed

• difficulty in explaining

• feeling the worst

• symptoms induced by anxiety

show you understand what the patient has concerns about

Sensitive questions

Address:

Your own anxiety about approaching certain topics

The person’s anxiety to approach certain topics

HOW to ask the questions!

Reassure the person:

Decrease their anxiety

Addressing facts rather than judgements

Be specific in your questioning rather than general

How?

Unnecessary questions

•Does it matter if you ask something that is unnecessary or that they have already told you?

- wastes time (patient’s and pharmacist’s)

- indicates you aren’t listening to or engaging with the person – this relates to trust and empathy

- can damage confidence in pharmacist (which can impact on adherence)

- unnecessary questions are UNNECESSARY!

Closing and safety netting

• closing and follow up

• time frame

• further advice

• professionalism

• documentation

Patient agenda

• person centred consultation - tailored information

• exploring hidden agendas and unvoiced agenda

Prescribing skills

Adopted from the military to give brief, concise and focused information

When would you use it?

•Escalation

•Urgency

•Handover

Warwick 4 frame model

PC

• HX of PC

• Red flags

PMH, DRUGS AND ALLERGY

Social and family Hx

ICE