Seeking Help: Consultations

Three primary goals of a medical consultation (Ford et al., 2003)

1. Develop a good provider-patient relationship

2. Exchange relevant clinical and personal information

3. Make appropriate healthcare decisions

Four core requirements of a successful consultation

• Clear communication of medical knowledge
• Understanding the patient's perspective
• Engaging the patient in collaborative decision-making
• Managing consultation time effectively

Professional-centred (paternalistic) care model

A clinician-dominated consultation approach guided by the "doctor knows best" philosophy, featuring closed questions, provider control, and passive patient compliance.

Patient-centred care model

An approach encapsulated by "nothing about me, without me," where the clinician actively listens, aligns with the patient's agenda, and engages them as an active partner.

Five steps of shared decision making (Elwyn et al., 2000)

1. Explore the patient's ideas about the problem
2. Identify their preferred level of information
3. Check understanding, fears, and expectations
4. Assess decision-making preferences
5. Make, discuss, or defer the decision

SHARE approach to shared decision making

• S: Seek patient participation
• H: Help explore and compare treatment options
• A: Assess values and personal preferences
• R: Reach a mutual decision
• E: Evaluate the decision over time

Four fundamental ethical principles in clinical consultations

• Autonomy: Respecting the patient's right to self-determination
• Beneficence: Acting to maximize benefit for the patient
• Non-maleficence: Committing to do no harm
• Justice: Ensuring fair and equitable distribution of resources

Key barriers patients face in shared decision making (SDM)

• Lack of medical vocabulary
• Emotional vulnerability
• Feeling disempowered in clinical settings
• Lower health literacy and fewer resources (especially among low socioeconomic groups, despite benefiting the most from SDM)

Functions of patient decision aids

Structured tools designed to help patients compare treatment pathways by presenting comparative risks, benefits, financial costs, potential side effects, and difficulty of discontinuing treatment.

Best practices for effective information giving in consultations

• Avoid medical jargon and define necessary terms
• Frame clinical outcomes both positively and negatively
• Provide written summaries to reinforce recall
• Prompt patient questions and check comprehension regularly
• Convey empathy

Three levels of disease prevention

• Primary Prevention: Preventing disease onset before pathology occurs (e.g., immunizations)
• Secondary Prevention: Early detection and screening of asymptomatic disease
• Tertiary Prevention: Clinical management to minimize disability from established disease

SPIKES protocol for breaking bad news

• S: Setting up the interview (privacy, seating)
• P: Perception (assessing patient awareness)
• I: Invitation (determining detail preference)
• K: Knowledge (delivering information in chunks)
• E: Emotions (addressing emotions with empathy)
• S: Strategy & Summary (formulating an action plan)

Timing of peak patient stress in medical consultations (Ptacek & Eberhardt, 1996)

Patients experience their highest levels of anxiety and stress at the very beginning of the clinical appointment.

Australian life expectancy trends by geographic remoteness (AIHW)

• Metropolitan areas: $83.3\,\text{years}$
• Regional areas: $81.2\,\text{years}$
• Remote areas: As low as $77\,\text{years}$