Sunday, May 3, 2015

Agenda setting and aligning goals for the consult

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One of the most important skills in General Practice is clear agenda setting at the beginning of the consultation. In this way, we can get all of the agendas out early in the consultation rather than getting a big surprise at the end. There are a few strategies to help us out with this.
  1. Ask, "How can I help you today?" and use the 90sec rule to allow our patient to talk. The key here is to listen intently rather than interrupting. 
  2. How can I help you and then ask, "Is there something else?" until there is nothing else. 
  3. What are you hoping to achieve from today?  Do you have a list for me?
  4. What’s your expectation of today? 

Interestingly, I was told in a Health Coaching training many years ago that there was a study which showed that "Is there something else?" is more effective than "Is there anything else?".  Unfortunately, I cannot locate this study.  In any case, I think both can be effective although "something else" might be slightly more effective anecdotally.  When you ask "Is there anything else?", patients tend to reply "no" more often possibly.

After you have outlined all the agendas, this will give you and the patient the opportunity to negotiate what can be addressed today.  You can address all of the issues or prioritize and address some of the issues only due to time limitations. For example, you can say…..

"Thanks for that John.  I can see that you have a number of concerns today.  It’s good to see that you are proactive about your health. As we only have a standard appointment today, which one of these issues is most important to you?  We can sort this out properly today and with the other issues, can we book in a long appointment next week to give us time to address all of your health concerns.  Is that Okay?”

(Note: For the OSCE exam, I personally don’t use the 90sec rule.  It’s an artificial environment and 90sec rule in the OSCE setting may not work as well as in real life.  Furthermore, in the OSCE exams, you will most likely, be expected to address all of the issues.  Read the instructions carefully.)

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