There are many models that are and have historically been used during consultations. Although the aim of each consultation is the same, different approaches may be needed depending on the setting, the presentation and the patients history. These include the Neighbour Model, Helmann’s Folk Model, the Calgary Cambridge Guide, The Fraser Model and so on. If you are interested, there are resources here and here. There are no correct or incorrect methods as long as the patient received the standard of care expected in a safe and caring manner. Reading and appreciating all is the first step and your own practice will develop from that. I also recommend shadowing as many different clinicians as possible. The basic structure of my average primary care consultation is below – this is just an example and not to be used, professional judgement must always prevail in each circumstance that you encounter. I guess that I have had many influences and of course I use this as reflection during the consultation rather than act as a robot following a rule. Use the references above, take note of peers, especially those that you have been impressed with, and create your own consultation. Remember that safety is always key and rule out sepsis with all acute presentations.
1. Greet patient and introduce yourself.
2. Ask/confirm the patent’s name
3. Confirm their DOB (always double check ID)
4. Ask ‘How can I help you?’
5. Ascertain their expectations (ICE)
6. Take/ascertain condition history
7. Take/ascertain comorbidity history
8. Take family and social history
9. Check for allergies
10. Summarise what has been said
11. Perform tests e.g. Sats, RR, PR, Temp, BP and assess the presenting issue – depending on the presentation of course
12. Give an opinion and check they are concordant
13. Handover treatment plan – describe duration, treatments, actions and realistic expectations
14. Safety net e.g. Come back if symptoms do not resolve within a set period or if they change. Call 111 or 999 OOH
15. House keep (complete notes, ensure all IDs taken, results recorded and cleared away)
ICE = Ideas, concerns and expectations of patient
If tests suggest that further assessment is needed, refer for bloods, ECG etc. If you suspect that the patient is potentially critical e.g. cardiac, hemorrhage, TIA, sepsis etc. or any other, refer to emergency care immediately.