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Consultation Navigation Tool and Microskills

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Damian Kenny

on 23 October 2013

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Transcript of Consultation Navigation Tool and Microskills

Gathering Information
Explain the chosen management plans, treatments, tests, etc
Check for drug allergies

Safety Net
Ensure the
patient understands

Discussing Management
Discuss management options
Seek the
patient's preferences

Explain the problems or diagnoses, linking your explanation to the patient's ideas, and concerns
Consultation Navigation Tool
Clarify the details of the problems
Share results of investigations
Examine: physical, mental
Discover the patient's ideas, concerns, expectations, and health beliefs
Explore how the problems affect the patient, school, their family, etc
Find out why the patient has come
Summarise, check
you understand
the issues ... then ...
Short encouraging words/noises/gestures eg “go on, right, okay, um-huh”, nodding, smiling.
Verbal Echoing
Repeat back the patient's last word/phrase in a mildly questioning way; use patient’s own words.
Body Mirroring
Adopt a similar posture to the patient
(be careful not to mimic).
Remain quiet and allow the patient space to think about what they want to say.
Ensure that this is a dynamic encouraging silence, with good eye contact, nodding, smiling, etc.
Soft commands
Saying straight commands (“go on, tell me more,” etc) can appear abrupt. Giving soft commands can be helpful:
“Could you tell me a little more about what happened ...”
Statement as a question
Make a relevant statement as a neutral comment, and then leave a silence. The patient may respond as if you had asked a question:
“There's been a lot on TV recently about bullying.”
Checking for understanding
(mini summary)
Give a brief summary of the main points the patient has mentioned so far:
“So you've had tummy pain all night, and … and some spots? “Have I missed out anything?”
Explain why you are asking something
Tell the patient the reason you asking about something, particularly if the patient may not consider it relevant:
“I would like to ask some questions to check how well your heart is working … is that ok with you?”
My Friend John/Jane
Make a statement about some third party with whom the patient may or may not wish to identify:
“Many children are worried when their breasts start to grow, but it is part of growing up.”
“I remember another patient with (similar symptoms) and he thought it may be X.”
useful to ...
the History
Making Joint Decisions
I was wondering ...
How about ...
How do you feel about ...
How would you like to ...
Use Positive Language
Full exam
(rather than 'quick')
Use tentative phrases:
(rather than 'should')
Full transcript