Case Study: Enhancing Consultation Skills for Medical Professionals

This case study details an observation of a trainee doctor's consultation style and identifies areas for improvement in patient communication and engagement. The trainee, initially praised for his politeness and rapport, was found to lack patient-centered practices such as discussing diagnosis, offering options, and providing safety netting. The case study explores the trainee's understanding of consultation models, revealing a preference for a more authoritarian style. The author then introduces the trainee to alternative models like Roger Neighbour's and Pendelton's models, emphasizing patient involvement in decision-making and safety netting. Through a tutorial and video analysis of a consultation, the trainee recognizes his shortcomings and begins to incorporate patient-centered approaches. The case concludes with a reflection on the importance of continuous assessment and the significance of patient-centered communication in modern healthcare, with references to relevant consultation models. This case study provides valuable insights into consultation skills improvement for medical professionals.

Case 1
Good communication skills, not only about establishing a
good rapport and a positive perception.
I had a wonderful trainee when I was working in the army. My trainee was a very
competent doctor with some valuable skills.
During the induction all trainees will get the opportunity to sit with all GPs in the
practice, observing the consultations. Every GP has their own unique style of
consulting, and trainees get the opportunity to pick aspects that they feel appropriate for
them and adapting to formulate their own style of consulting.
This Doctor was well loved by the practice staff and the patients. Everybody would
comment about his politeness and ability to establish an excellent rapport with the
patients. I was very pleased about the perception that he had built up within few days.
Then it was time to have joint clinics, just before he was allowed to do his own
consultations.
I was very pleased to see how polite he was towards his patients. He will great them
with a very attractive smile. He would ask the patient to sit and explain the problem.
He would not disturb the patient until the patient finishes the story Which I found really
positive. Then he will ask few relevant clinical questions and then he will examine the
patient. Then he will come up with a diagnosis and will come up with a management
plan. He would be very gentle and soft and polite throughout the consultation. But then
I realized that there is something missing. He would not discuss with the patient and
come to a joint agreed diagnosis. He would not agree with the patient. He would not
give any options to the patient. Also he would not safety net. But maybe because of the
way he consulted and also probably because he was a captain in the armed forces,
patients were not questioning him and were always happy.
Effective communication is essential to the current practice of medicine. A fundamental
change in medical culture in this area has been the recognition and acceptance of the fact
that the way in which health professionals communicate, on all levels, can be enhanced,

irrespective of the innate and learned abilities they already possess. 1
As doctor Pawlikowska describes in her paper, the way we consult can be enhanced
irrespective of innate and learned ability. First I wanted to convince myself. Is there a gap
here? Is this something he is not aware of? Is this an unknown area of his learning? Even
though he has been praised for his consultation approach there is always room for
improvement.
I felt that there is a need to explore his knowledge of consultation models. I am confident that
once he is aware of the models and through experience he will develop his unique style.
“There is no ideal consultation model, but the evolution of the various models over time is of
particular interest as a practitioner develops their own unique consulting style.” 2
I realized that his consultations were quite similar to Byrne and Long model. Doctor centered
authoritarian style.
Byrne and Long (1976) 3
Establishing a relationship with patient
Discovering a reason for attendance
Verbal and/or physical exam
Consider the condition
Detail treatment or investigation
Terminate consultation
I wanted to explore about his knowledge about consultation models. It would be good to
explore whether he is aware of other methods that would be more appropriate and patient
centered. Is this one of his unknown areas of learning according to Johare’s window?
I quietly asked him about Consultation models. Even though he was aware of the models he
wanted to stick with a regimental type model as he found it easy in a military setting.
So I suggested it will be good for him to familiarize with other consultation models as well.
Specially to read about Roger Neighbour’s and Pendelton’s models, models that clearly
recommend engaging the patient in decision making and safety netting.
1 Pawlikowska, T. et al., 2007. Consultation models. Learning to consult, p.178.
2 Pawlikowska, T. et al., 2007. Consultation models. Learning to consult, p.179.
3 Byrne PS, Long BEL. Doctors Talking to Patients. Exeter: The Royal College of General
Practitioners; 1984 (®rst published HMSO; 1976)

So we had our first tutorial about consultation models. Before the tutorial I encouraged him to
video one of his consultations. Initially he wasn’t very keen on this but when I explained that
it is a very good way of reflecting and learning he did agree to.
I suggested that he should sit with all GPs again and consider the way they address engaging
the patient in decision making, giving the patient an opportunity to involve in their care and
safety netting.
So during our tutorial we talked about consultation models. I was pleased to see that he had
done his homework, he has read about the consultation models, specially had a good
understanding about the models that I have recommended. He has also had taken time to
watch some online videos about consultation skills that they have recommended for CSA.
Also he had one of his consultations recorded. His consultation was with a patient who had a
back pain. He identified that he didn’t give the patient any options and also didn’t explore his
ideas and expectations. He realized that he didn’t discuss the management plan with the
patient and agreeing with the patient what would be the best option for him. And also he
didn’t safety net explaining to the patient red flags to look for and what he should do if he
had any further concerns.
This example shows that even though you appear really good at doing something, there is still
room for improvement. I will probably assess the understanding of consultation models at the
beginning of each attachment and will encourage them to emphasis on important phases of
consultation. Even though all phases of a consultation are equally important, it is extremely
important to discuss with patients and making decisions about their health, considering their
ideas concerns and expectations. With advanced technology and easy access to various health
related websites patients have a huge insight to their problems before even they come to see
the doctor. On the other hand, in general practice we most of the time deal with uncertainty
and safety netting has become and extremely important part of a consultation. I would
encourage them to read about consultation models and to be familiarize before starting the
clinics.
In conclusion, I am pleased that I have managed to identify an area of a learning need that
was unknown to my trainee. I am happy that I was able to make my trainee realize his

learning need and address the situation extremely well to improve his consultation skills.
References:
Pawlikowska, T. et al., 2007. Consultation models. Learning to consult, p.178-215.
Byrne PS, Long BEL. Doctors Talking to Patients. Exeter: The Royal College of General
Practitioners; 1984 (®rst published HMSO; 1976).
Pendleton D, Scho®eld T, Tate P, Havelock P. The New Consultation. Oxford: Oxford
University Press; 2003.
Neighbour R. The Inner Consultation. Dordrecht/Boston/London: Kluwer Academic
Publishers; 1987.