Frameworks for consultation - History Taking

History Taking

Frameworks for consultation

·        4 tasks for consultation:

o   Management of presenting problems

o   Modification of help-seeking behaviour (did they come too soon/too late)

o   Management of continuing problems

o   Opportunistic health promotion

·        Objective: integration of:

o   Doctor‟s agenda: Correct diagnosis, preventative health care

o   Patient‟s agenda: expectations, feelings, fears, understanding of illness experience

·        Silverman and Kurtz: - five phases of the consultation:

o   Initiating the session: introduce yourself, why are you here, how can I help (not how are you)

o   Gathering information: start with open questions, physical exam

o   Building the relationship

o   Explanation and planning: what you‟ll do, what you want the patient to do. Involve patient in planning. Give them as many choices as possible

o   Closing the session: any more questions, check understanding, follow up, emergencies, etc

·        Double Diamond model:

o   First phase: patient presents problems, doctor hones down 

o   Second phase: diagnosis reached, expansive phase of explanation, management options, then brought to closure

·        FIFE: Feelings, Ideas, Function/Dysfunction, Expectations

·        Remember: listen, reassure