Reflection and Analysis
The consultations was performed according to the Calgary-Cambridge guide where the main components of a consultation procedure include initiating the session with the patient and communicating and gathering information from him (Silverman, Draper and Kurtz 288-299), diagnosing the problem, decision making and establishing a solution to the problem, designing a management plan and convincing the patient to follow that management plan (Elwyn et al. 5-22). The present consultation happened in front of me between the GP and the patient where GP tried to build a comfortable atmosphere for the patient in the presence of mine. In this case, the patient was admitted to the Emergency section due to a sudden problem that was referred to the medical ward for advanced level care after several investigations. The patient was unaware of the earlier prescribed medicine schedule that shows the lack of communication at the time of discharge between the patient and GP. The patient was confident, independent and possessed good communicating skills. Thus, this time, the relationship between GP and patient was evident that helped the patient discussing all of his complaints regarding his condition as well as his previous experiences with practitioners (Kurtz and Silverman 83-89).
I am impressed with the GP’s approach of initiating the consultation session. Instead of the patient was new to the GP, he successfully retrieved all the required data and eased the patient to express all of his current as well as past experiences. GP developed an apposite rapport with the patient that helped in investigating the social, individual and medical information of the patient.
Collecting information from the patient is an essential component of a medical consultation because without proper knowledge regarding the patient it is not possible to design an effective intervention plan. For gathering information from the patient, he should be encouraged to discuss problem from the starting in his own words that is possible through strategically planned open and closed questions (Schirmer 184-192). The GP has asked suitable questions after building a good rapport with the patient. The information provided by the patient included the history of his case, as well as current conditions that show the relationship between patient and GP had become very strong. The consultation was started from the introduction and demographics of the patient that was followed by the current complaint of the patient that led him to visit the hospital. The patient complained of his shortness of breath, especially on exertion. He also described his medical history of two weeks with the severe symptoms of deteriorating dyspnoea with a productive cough. The patient informed GP about feeling tremors. On further investigations, he accepted that he was not feeling any other associated symptoms and was neurologically healthy. He denied any type of fever, chills, nausea, and rigors. Patient informed the GP regarding his right side pneumonia which was diagnosed two weeks earlier. He additionally showed GP a list of medicines including Lorazepam, Thiamine, Folic acid and therapeutic puffs prescribed on his discharge letter but he claimed that he was not asked to take those medicines, so he didn’t take those medicines.
I am impressed with the approach of GP for retrieving information from the client. The GP successfully gathered all type of information from the client that include the current complaint, past medical as well as social and family history, recommended medicines in last medical consultation, and other therapeutic information. I think the level of rapport made by GP was adequate that the patient exposed all of the information, even his misunderstanding with the practitioner in the last hospital visit.
It is critical for a practitioner to gather all of the information and listen to the patient attentively without interrupting his answers. The extent of the information indicates that GP had questioned in a very systematic way and extracted all the required information that would be necessary for planning an efficient intervention plan (Schirmer 184-192). GP assisted the patient in his verbal and non-verbal responses such as silence, thinking, encouragement, repetition, pauses, and interpretation of his condition. The patient also unraveled that he had been a chain smoker earlier but later on he had switched to e-cigarettes with a frequency of 3-4 per day.
I liked the way of GP of handling the responses of the patient. He summarized the data very appropriately after understanding what patient had said. He encouraged the patient to share more details and past experiences and habits in a very effective way that led the patient reveal all of the current and past experiences. Though in this consultation the patient’s belief, concerns, and expectations are not discussed. The consultation also lacks the discussion on the sequence of the events and sequel of the management plan by the GP as well. The three main component of gathering information section include the bio-medical perspective, the patient’s perspective, and background information. This shows the absence of that factors that could encourage the patient to express his feelings regarding his faiths, beliefs and expectations (Main et al. 219-225). In this case, I noticed that the bio-medical perspective and context perspective had been covered very brilliantly but the patient’s perspective was missing (Kurtz 23-29).
The two primary determinants of the next segment that is “providing structure to the consultation” include making organization overt and attending to flow. The case was summarized very well in the end and GP confirmed his understanding towards the case. GP assessed all the test reports and readings of vital signs that were normal. GP diagnosed the condition and further recommended other necessary test and investigations based on the past and current conditions. The patient was further recommended for the Arterial Blood gasses test by the GP as a part of the management plan. The readings observed in the following tests were showing that the patient was slightly suffering from respiratory alkalosis. The main diagnosis was an exacerbated COPD condition that may be induced by several factors which are not discussed in the consultation. I believe that before moving to the next section GP proceeded in a systematic manner that was according to the essential flow and the interview was structured in a rational sequence (Silverman, Draper and Kurtz 288-299).
While building a rapport with the patient the verbal and non-verbal communication play a significant role. The non-verbal behavior may include making eye contacts with patient, observing the facial expression, posture, and position of the patient, as well as the vocal cues. Demonstration of confidence, empathy and support can strengthen the rapport between the patient and the GP (Kurtz 23-29). I observed that GP had built an appropriate verbal and non-verbal relationship with the patient. He encouraged the patient to express his health related conditions. But somewhere I feel that the GP could not connect with the sensitive issues of the patient such as his concerns, beliefs, and fears regarding his physical and health complaints.
The closing session was very short and practitioner just referred the patient to the medical ward with several tests, medicines and nebulisation therapies. He also recommended him for chest physiotherapy. The GP did not discuss any treatment and tests with the patient. The patient was not also informed about the short term and long term consequences of the problem or the severity of the problem. The patient education was not also considered important (Nikendei et al. 94-99; Greenhill 423-431).
I feel that the patient was not told regarding the next level tests and therapies in the management plan. I think which was necessary to be discussed with the patients that could assist in dealing the treatment more smoothly and provide more confidence to the patient in the provided management plan. The patient was not educated on the management plan, though he was living alone, I think educating him on how to recover the condition and how to prevent it from recurring would be beneficial for the patient. This type of short session can impact the relationship between the patient and practitioner. An expanded form of discussion can psychologically impact the patient and help him to recover quickly (Nikendei et al. 94-99).
It has been a very informative and knowledgeable session for me and I learned a lot from this medical consultation session. First of all, I learned the significance of making a relationship between general practitioner and the patient which is not in fact an easy act. It requires a whole commitment from both sides. Hurry at any stage can disrupt the rapport and impact the confidence of the patient in the management plan.
I believed that the relationship built in this case was average that provided support to the patient and he revealed all the current and past medical and social information. But when it comes to gathering information segment, the patient’s perspective was missing. The GP successfully retrieved all the bio-medical and context related information but the worries and expectations of the patient were not discussed. Secondly, the patient was not told about the severity level of his condition as well as its consequences, prevention, and management. I believe that gathering data from a patient’s perspective and provide complete knowledge to the patient regarding his condition as well as management plan can build a stronger relationship that can influence the outcomes of the treatment plan.
Elwyn, Glyn, et al. "Measuring the involvement of patients in shared decision-making: a
systematic review of instruments." Patient education and counseling 43.1 (2001): 5-22.
Greenhill, Nicola, et al. "Analysis of pharmacist–patient communication using the Calgary-
Cambridge guide." Patient education and counseling 83.3 (2011): 423-431.
Kurtz, Suzanne M. "Doctor-patient communication: principles and practices."The Canadian
Kurtz, Suzanne M., and Jonathan D. Silverman. "The Calgary—Cambridge Referenced
Observation Guides: an aid to defining the curriculum and organizing the teaching in
communication training programmes." Medical education 30.2 (1996): 83-89.
Main, Chris J., et al. "Addressing patient beliefs and expectations in the consultation." Best
Practice & Research Clinical Rheumatology 24.2 (2010): 219-225.
Nikendei, Christoph, et al. "Outcome of parent–physician communication skills training for
pediatric residents." Patient education and counseling 82.1 (2011): 94-99.
Schirmer, Julie M., et al. "Assessing communication competence: a review of current
tools." Fam Med 37.3 (2005): 184-192.
Silverman, J., J. Draper, and S. M. Kurtz. "The Calgary-Cambridge approach to communication
skills teaching 1: Agenda-led outcome-based analysis of the consultation." Education for
General Practice 7 (1996): 288-299.