Consultation Models - Bradfordvtsbradfordvts协商模型.pptVIP

Consultation Models Dr Darren Tymens, 2003 Consultation Models Bad consultations result from having insufficient clinical knowledge, from failing to relate to patients or from failing to understand the patients behaviour, his perception of his illness or its context“ - JGR Howie (1985) Consultation Models Descriptive Normative Conceptual Practical The Biomedical Model Take an accurate and relevant history (OBSERVATION). Perform an accurate and relevant examination (OBSERVATION). Make a provisional diagnosis (HYPOTHESIS). Order and interpret the results of appropriate investigations (HYPOTHESIS TESTING). Make a definitive diagnosis (DEDUCTION). M Balint (1957) The Doctor, His Patient and The Illness The Apostolic Function The Drug Doctor The Sick Role The Long Consultation Berne (1964) Games People Play / Transactional Analysis Games Parent / Adult / Child RCGP Model (1972) Physical, Psychological and Social‘The Triaxial Model’ Extend thinking beyond organic Consider Emotional, Family, Social and Environmental factors Becker Maiman (1975) Health Belief Model Ideas Concerns Expectations Heron (1975)Types of Intervention Prescriptive Informative Confronting Cathartic Catalytic Supportive Byrne Long (1976)6 Phases of the Consultation 1. The doctor establishes a relationship with the patient 2. The doctor discovers or attempts to discover the reason for the attendance 3. The doctor conducts a verbal and/or physical examination 4. The doctor, the doctor and patient, or the patient (in that order of probability) consider the condition 5. The doctor and occasionally the patient detail further treatment or investigation 6. The consultation is terminated, usually by the doctor Byrne Long (1976)Consultation Styles doctor-centred dominates the consultation asks direct, closed questions rejects the patients ideas evades the patients questions patient-centred asks open questions actively listens challenges and reflects the patients words and behav