A registrar survival guide... Structuring the consultation

Despite advances in medical investigations, the consultation will remain the most important tool that GPs have.

Prior to initiating the consultation, review the patients record and have a basic knowledge of their active problems and an overview of their medication. Ensure you review any recent consultations, whether it be within the practice or externally. This maybe crucial to the current consultation and shows you have taken an interest in the patient prior to their attendance.

Starting the consultation

Introduce yourself and ask an open question. Examples may include 'how can I help?', 'What are we doing today?', 'Whats brought you in today?' – this will vary from doctor to doctor.

Allow the patient to talk as early interruptions could lead to missed cues and a breakdown in the doctor-patient relationship. Show empathy, summarise if appropriate and set an agenda.

Check if patients have come about anything else at this point. This should avoid the dreaded: 'Oh, and by the way doctor...' Explain how the consultation will progress.

Data gathering

With the agenda set and your relationship developed, start the history taking process.

Ensure a mix of open and closed questions are used. Start with open questions, such as: 'You mentioned headache, tell me more about that,' and close it down as appropriate.

Avoid leading questions and ensure that red flag symptoms are covered. Risk assessment is critical for psychological cases. Ensure you fully explore the patients' social circumstances and the psychological impact their symptoms may be having on them.

The patient's ideas, concerns and expectations are a crucial part of the consultation and should be established within the first three to four minutes. This may require directly asking the patients or picking up on verbal or non verbal cues. Cues maybe subtle so it is important to be alert to them.

Examination and explanation

Complete a focussed physical or mental state examination. Find out what the patient knows and explain what you think the diagnosis could be while avoiding medical jargon. Use diagrams or models where appropriate.

Planning

Give the patient options if appropriate. This generates a shared management plan.

Shared decision aids are becoming increasingly used and provide useful comparisons of different treatment options available to patients. This empowers patients.

Final check and closing

Ask the patient to recap the important points, safety net appropriately and arrange follow-up if required. If appropriate, give the patient leaflets.

  • Dr Singh is a GP trainer in Wallsend, North Tyneside
Essentials checklist
  • An early-set agenda.
  • Ability to detect verbal and non-verbal cues.
  • Good non-verbal communication.
  • A knowledge of consultation models.
  • A prior knowledge of the patient's record before they arrive.

Find more advice and information for GP trainees

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

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