Information about these conditions
- To DISCOVER THE REASONS FOR THE PATIENT'S ATTENDANCE
1. Encourage/2. Respond to signals (cues)/ 3. Occupational and Social/4. ICE
-Ask the patient to come in;
-Stand and great the patient;
-Introduce yourself;
-Invite the patient to sit; be sure of right setting;
-Adopt a positive posture to encourage the patient, lean forward, smile, eye contact.
-Start with an open Question:
-How can I help you today? Encourage your patient to talk, show interest, keep eye contact, attentive listening, nodding, be aware of body language; use silent, do not interrupt the patient;
-When the patient stop talking, again ask open question:
-Would you please tell me more about that?
-According to the case & the patient answer, still ask open questions:
-Any associated symptoms?
-What else?
-If appropriate asks the patient about his job: and what about your job? you are working as; how are you coping?
-How things at home? (Married or single, children, finance etc.).
-If appropriate ask sensitively about smoking & alcohol intake but it is better to do that after you feel you break the physical barrier with the patient e.g. during checking BP or examination.
-ICE: Have you any idea what might be wrong with you? Have you any specific concerns or fears, worries; in what way I can help you? How do you feel about this? How this sound to you?
-According to the case, you need to ask close questions to fill in gaps and to confirm your hypothesis (diagnosis):
-Headache: what brings on the pain? Anything that can ease the pain? What about night time? Any similar headaches in the family? Where is the pain? Abd. Pain: What is about your bowel habits? Any bloating (distention)? Any vomiting? LBP: Where is the pain? Does it go down to your legs? Depression: for how long you feel like that? What is about your appetite? Any Wight loss? Any change in your habits or interest? Do you talk to your family / friends? Sore throat: do you have it before? Did you use antibiotics before?
-For the past history: What about your health otherwise?
-When you want to know why now: Since you have this ------for e.g. 4 Years. Any recent changes that let you thought to come today?
- DEFINE THE CLINICAL PROBLEM(S)
5. Red flag / 6. Examination / 7. Working diagnosis
- Ask the patient to exclude possible serious pathology e.g. in a case of headache: any vomiting wakes you at night time, loss of consciousness. Abdominal pain: blood with stool, fever, weight loss. LBP: fever, weight loss, numbness, impaired sensation or weakness and incontinence. Depression: suicidal ideation e.g. how do you see the future? Would you enjoy anything at the moment? Have you thought of hurt yourself or even kill yourself? Sore throat: any difficulty of swallowing?
- If appropriate do examination, take permission from your patient, explain what you are going to do and why? E.g. for Sore Throat: please open your mouth widely to see your throat; take temperature, palpate for cervical lymph node. Headache; check BP. LBP: see gait, any deformities, palpate for area of maximum tenderness, movements (flexion, extension & lateral movements) and SLR. Abdominal pain: examine the abdomen. Depression: no examination.
- Now from what you told me and from the examination, if I am right you are most probably suffered from what we call ------.
- How you feel about that?
C. EXPLAIN THE PROBLEM(S) TO THE PATIENT
8. Explain / 9. Explanation incorporates patient’s ICE / 10. Confirm the patient’s understanding.
- Have you any idea about depression, etc.?
- do you want me to tell you about LBP etc.?
- Then explain in simple language, ask the patient whether he is following and understanding.
- Try to include some of the patient’s ICE or complaints in your explanation.
- Ask the patient to tell you what he is going to tell any one of his significant.
D,. ADDRESS THE PATIENT’S PROBLEM(S)
11. Management plan / 12. Involve the patient in the management
- Tell the patient about your management plan;
- Before this, now or in history taking ask the patient whether he is tried any self treatment e.g. are you trying anything by your won?
- The management options , might be start with non-pharmacological treatment; those things a patient could do by himself or need to lifestyle changes e.g.
- Sore throat: need to encourage fluids intake, avoid smoking, used lozgines, avoid dry wheather and dust etc. Headache: adjust lifestyles, regular & sufficient sleep, manage work stress, offer a headache diary etc. LBP: Aopt right use of back, driving, bed, work station, exercise, reduce body weight. Abd. Pain: Regular meals, take more fibres e.g. vegetables & water intake, manage stress at work & home, offer a diary for 2 months. Depression: need for social support, look for postives in his life, treatment by talk (CBH).
- Ask the patient how this is sound to him, How he feel about that?
- Then go for others treatment options, from simple to more coplicated options etc. Sore throat from regular use of paracetamol to stronger pain killers e.g. NSAIDS, Antibiotics to tonsillectomy.
LBP: Paracetamol, NSAIDS, Steroids inj. Depression: Old or new treatment; referral. Headache: Paracetamol, NSAIDS. Abd. Pain; antidirroheal, treatment for constipation.
E, MAKE EFFECTIVE USE OF THE CONSULTATION
13. Enhance concordance / 14. Follow-up
- Explain your treatment (drug), expected effect, strength, dose, for how long? check his understanding, tell about side effects, consequences of withdrwal etc.
- At the end inform the patient when you would like to see him e.g. Sore throat: oftern no need for F.UP. Headache: after 2/12 to interpret the diary. Depression after 1-2/Wks. To see any side effect, offer a consultation with a psychiatric nurse. LBP: After a 1/12 to see any improvement. Abd. Pain: after 2/12 to read the diary, any improvement.
- Check understanding :After this meeting what you are going to say to your e.g. mum, husband etc.