A Registrar survival guide ... Identifying underlying psychosocial.problems

Contributed by Dr Syed Haque, a GPST3 in East Anglia

It is Friday afternoon. In walks Mr Smith who has returned to discuss his epigastric pain that he has had since 2006. There are a number of ways to tackle the consultation:

1. Biomedical model: focus is on the physical cause of disease.

2. Bio-psychosocial model: focus is on physical and psychosocial causes. Mr Smith could be depressed and is drinking heavily, leading to gastritis.

The consultation: use the Calgary-Cambridge method (or whatever you feel comfortable with).

Initial rapport
Set the tone for the consultation. If the patient's first impression of you is positive, then they are more likely to open up about their secret bottle-of-vodka-a-day habit.

Reason for attendance
This is a good time to look for verbal and non-verbal clues. Is the story and what you see in front of you congruous? If not, why not?

Exploring the problem
So now you've opened Pandora's box. Good structure and control of the consultation is vital. It is no surprise to find chronic health conditions, such as diabetes, have a QOF question on depression.

Building the relationship
Now you're getting somewhere. It is time for significant inter- action with Mr Smith; continuing to be supportive and nurturing the discussion to maintain the trust.

Information giving
Psychosocial problems are going to require considerable effort on both parties to reach a resolution. From the GP's point of view it will mean having a good working knowledge of support services and benefits available. A shared plan is essential to making progress.

Essentials checklist
  • An open-minded approach.
  • Ability and patience to explore the issues carefully.
  • An understanding of psychosocial issues and the implications.
  • An agreed plan at the end of the consultation.

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