Consultation Models:Consultation Models:NeighbourNeighbour

Helen LockingHelen Locking

VTSVTS

January 2005January 2005

Consultation ModelsConsultation Models

• Roger Neighbour – who is he?Roger Neighbour – who is he?• What did he do?What did he do?• Why do we need to know about him?Why do we need to know about him?• What is it?What is it?• Case StudyCase Study

Roger NeighbourRoger Neighbour

GPGP

Principal & Trainer in Hertfordshire until Principal & Trainer in Hertfordshire until 20032003

Course Organiser of Watford VTSCourse Organiser of Watford VTS

Inaugural Fellow of Assoc of Course Inaugural Fellow of Assoc of Course OrganisersOrganisers

MRCGP Examiner MRCGP Examiner

President of RCGP 2003President of RCGP 2003

What did he do?What did he do?

““The Inner Consultation” - 1987The Inner Consultation” - 1987

““The Inner Apprentice” - 1992The Inner Apprentice” - 1992

Why do we need to know?Why do we need to know?

MRCGP ExamMRCGP Exam

Easy Model to adopt & adapt.Easy Model to adopt & adapt.

Encompasses both Patient and Dr Encompasses both Patient and Dr wellbeingwellbeing

Neighbour’s Consultation ModelNeighbour’s Consultation Model

1. Connecting

2. Summarising

3. Handing Over4. Safetynetting

5. Housekeeping

1. Connecting1. Connecting

• Rapport• Gambits & Curtain Raisers• Minimal cues• What is said & not said• Eye movements• 3 cardinal mental thought processes

Speech censoringInternal SpeechAcceptance Set

2. Summarising2. Summarising

•What information do we need?I, C, E.FeelingsEffects of symptoms, treatment etc

•When should you elicit that information?•What signals can the patient give to suggest that more information could be elicited?•How should we elicit the information?

3.Handing Over3.Handing Over

•NegotiatingGive the patient options

•Influencingin my opinion…Use questions instead of statementsReframingShepherdingPre-emptingMy friend John…

•Gift WrappingChunk & CheckHow to give instructions – rule of 3.

4. Safety Netting4. Safety Netting

•“General Practice is the Art of Managing Uncertainty”

•If I am right, what do I expect to happen?Worst case scenarioInstructions to patientF/U - What if patient doesn’t come back?

•How will I know if I am wrong?

•What will I do then?What to say to the patient

5. House Keeping5. House Keeping

•Long term

•In between Patients

•During Consultations

Neighbour’s Consultation ModelNeighbour’s Consultation Model

1. Connecting

2. Summarising

3. Handing Over4. Safetynetting

5. Housekeeping