A registrar survival guide... follow up and safety netting

A critical component of the Calgary-Cambridge model for consultations comes right at the end of the consultation: safety netting and follow up.

Once a focussed history has been taken, examination performed and an explanation provided, it is vital that the patient understands what to expect, any red flags and the implications of thse red flag symptoms.

Describe symptoms

Explain to patients what symptoms they may experience based on your knowledge of the disease process. Patient information leaflets are very valuable in supporting your discussion.

Time frames

Some conditions may resolve within days but other pathologies may last years. Giving false expectation can lead to unnecessary re-consulting for the same problem and overall patient and doctor dissatisfaction. Providing a realistic time frame may prevent unnecessary consulting for similar future symptoms, thus empowering and educating patients.

Be open and honest

As primary care clinicians, we often see patients extremely early on in the illness process and a large proportion of symptoms will be medically unexplained following initial assessment. If you are not sure of the aetiology, explain this to the patient. This reduces the risk of false reassurance and most patients appreciate the honesty.

It is also important to understand what patients' thoughts and concerns are around their symptoms in order to avoid a mismatch of doctor and patient agenda.

Red flag symptoms

Most symptoms will have a set of associated red flags and clinicians must be aware of them in order to explain them to patients. Should patients notice any red flags, advise them to: call the practice during open hours; contact the out-of-hours service if the practice is closed; or attend A&E if it is felt to be life threatening.

Check that the patient has understood the information provided.

Follow up

Arranging follow up will depend on appointment availability and will be case specific. An acute problem or initiation of medication may require close follow up (two or three days).

A different type of consultation, for example PPI initiation, could be reviewed in one month, and certain problems can be left up to patients to re-present if the problem persists. It is helpful to specify duration in this instance.

  • Dr Singh is a GP trainer in Wallsend, North Tyneside
Essentials checklist
  • A familiarity with the Calgary-Cambridge consultation model.
  • An ability to give a realistic time frame for symptoms.
  • Open and honest communication with the patient.
  • A good knowledge of red flag symptoms.

Find more advice and information for GP trainees

  • This is an updated version of an article that was first published in 2010.

Photo: iStock

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