I had a tutorial session recently with my group of fellow GP registrars. Part of this tutorial was a discussion about consultation models and different GP IT systems. We wanted to discuss the experiences of different trainees within different sets of circumstances.
The most interesting aspect of the discussion around consultation models was the issue about how to open the consultation. There was some considerable debate about what is and is not appropriate. For example, do a few seconds of pleasantries at the start of the consultation help to put the patient at ease or do they simply waste time? Does the phrase "How can I help?" sound reassuring, friendly and yet professional or does it come across as patronising and condescending? The most controversial discussion was around using silence as a way to open the consultation, waiting for the patient to initiate the conversation. Some (myself included) felt this would appear rude to most patients as well as feeling uncomfortable to me as the doctor. Others thought that this was a good way of allowing the patient to say exactly what they had been preparing in the waiting room, without any distraction to lose their train of thought. My educational supervisor (ES) commented that many patients have prepared what they are going to say and have often written it down. An encouraging smile is all they need to get started. If you give them time without interruption to tell their story you will lean a great deal and they will feel "heard". Silence can also be useful to acknowledge the difficulty of a situation or the gravity of what is being discussed.
We also discussed how different IT systems can have an effect on the opening to a consultation. Waiting room caller systems save time but some people feel that the doctor collecting the patient from the waiting room can be helpful. We discussed how the various IT systems can help but also hinder the doctor to concentrate on the patient during the consultation. I shared some experiences, particularly about how clunky I had found the IT system in one practice. It seemed to take me a long time to find the information I wanted from patient's records which contributed to my clinic over running. This in turn had an impact on the opening to the next consultation as the next patient was already annoyed because they were late!
I felt that the most likely conclusion was that a mix of different styles is necessary depending on the patient and the situation. I will certainly take on board the advice of my ES that it is good to practice all these techniques so that I can find the most appropriate tool for each job. I will try the approach of letting the patient speak first in a consultation. I must admit that I feel a little apprehensive about this as it is not something that I would naturally do. However, I am prepared to go along with the old adage – Silence is Golden!