Consulting in a Nutshell
A practical guide to successful general practice consultations before, during and beyond the MRCGP
- Available for pre-order. Item will ship after November 26, 2020
‘…a unique book, written by a unique GP. There is no-one better placed to pull together decades of learning and experience on how to achieve the greatest success in the general practice consultation. The relaxed pace of writing, the accessible examples, the clear narrative and the engaging anecdotes make this a resource that it is accessible and useful to all who seek to improve their clinical consulting skills.’
Helen Stokes-Lampard, former Chair of the Royal College of General Practitioners
This brand-new book aims to help GPs establish ways of thinking, talking and behaving in the consultation that are most likely to lead to good outcomes. It describes a simple three-part approach to the consultation’s essential task, which is to convert a patient’s problem into a plan acceptable to both patient and doctor. It combines reader-friendly explanations, helpful illustrations and examples from everyday practice.
- Written by a respected GP, teacher, and author of the highly-regarded trilogy The Inner Consultation, The Inner Apprentice and The Inner Physician
- Gives GPs a framework for consulting that is easy to remember, comprehensive, adaptable, robust, exam-friendly and quickly becomes second nature
- Identifies and addresses key areas of anxiety for GP trainees and MRCGP candidates, including ‘How do I complete in 10 minutes?’, ‘How do I deal with difficult patients?’ and ‘What do I do when it all goes pear-shaped and I don’t know what to do?’
- Gives advice and practical suggestions for how to make the difficult transition from theory to practice, from reading about the consultation to actually doing it better in real life
Consulting in a Nutshell will help GPs at every career stage – from medical student to CSA candidate to experienced practitioner – to analyse, develop and grow their personal consulting style. Coming at a time of profound change in primary care, it aims to ensure that seeing patients and having good consultations becomes and remains a source of satisfaction and fulfilment.
Roger Neighbour is a retired GP, former Convenor of the Panel of MRCGP Examiners, and past President, Royal College of General Practitioners, UK.
Table of Contents
FOREWORD: Prof. Helen Stokes-Lampard
ABOUT THE AUTHOR, ILLUSTRATOR AND FOREWORD WRITER
- AS WE BEGIN
- THE BIG PICTURE
- THE CONSULTATION IN A NUTSHELL
- MAKING A SUCCESS OF THE THREE-PART CONSULTATION
- SOME PARTICULAR CHALLENGES
- BEFORE YOU GO …
What are the goals of the consultation?
Converting a problem into a plan
Whose version of the problem?
What good consulting is, and is not
What consultation models are, and are not
Something else consultation models are not
How does the ‘three-part’ framework fit in with other consultation models?
Do we really need another model of the consultation?
‘Doctor-centred’ or ‘patient-centred’?
The ‘right’ problem’
A typical consultation
The three-part consultation
More about the Patient’s part
More about the Doctor’s part
More about the Shared part
Before we move on
Making a success of the Patient’s part
Greetings and introductions
Starting the Patient’s part
Keeping it going
Give ‘receipts’ for important points in the patient’s story
Don’t ‘medicalise’ too soon
Ideas, concerns and expectations
How long should the Patient’s part last?
More about receipts
What and when to receipt
Two-part ‘steering’ remarks
Turning a receipt
Using receipts in the Patient’s part
Cues and hidden agenda
Cues and hidden agenda in the CSA
Transitioning from the Patient’s part to the Doctor’s part
Summarising as a transition
Transitioning without a summary
Introducing the Doctor’s part
Making a success of the Doctor’s part
Things you might include in the Doctor’s part
Sequencing your questions
Adding your own agenda to the consultation
Knowing when to stop
Transitioning from the Doctor’s part to the Shared part
Making the transition
Making a success of the Shared part
Does shared decision-making matter?
Why is the Shared part difficult?
Options and choice
Checking for understanding
Closing the consultation
More about thinking aloud
Four things that will get you out of most difficulties
The patient with a list
‘While I’m here, Doctor …’
The potentially time-consuming consultation
The uncommunicative patient
The over-talkative patient
The emotional patient
Breaking bad news
When it all goes wrong
Telephone and video consultations
Preparing for the CSA
Roger Neighbour OBE MA MB BChir DSc FRCP FRCGP FRACGP
Roger qualified from King’s College, Cambridge, and St Thomas’ Hospital. After vocational training in Watford, he practised as a GP in Abbot’s Langley, Hertfordshire, from 1974 to 2003. He was a trainer and programme director with the Watford Vocational Training Scheme for many years, an MRCGP examiner for 20 years, and the Royal College of General Practitioners’ Chief Examiner from 1997 to 2002. In 2003 he was elected President of the RCGP for a three-year term. In 2011 he was awarded an OBE for services to medical education.
Having studied experimental psychology instead of biochemistry as an undergraduate, Roger found himself fascinated by the psychology of the consultation and the doctor-patient relationship in general practice. This interest led him to write his ‘Inner’ trilogy: The Inner Consultation (1987), The Inner Apprentice (1992) and The Inner Physician (2016). A collection of his medico-philosophical writings, I’m Too Hot Now, was published in 2005.
Now retired from clinical practice, Roger continues to write, teach and lecture in the UK and worldwide on consulting skills and medical education. He plays the violin to semi-professional standard, and enjoys spending time at his second home in Normandy.