Consultation Models | OnCallPrep

📋 Calgary-Cambridge Model

The most widely used consultation model in UK general practice

When to use: Most consultations, especially complex cases requiring comprehensive assessment

1

Initiating the session

Establish rapport, identify reason for attendance

Example: "Hello, I'm Dr. Smith. What brings you in today?" - Open question, maintain eye contact, show interest.

2

Gathering information

Explore patient's perspective, biomedical perspective, background information

Example: "How has this been affecting you?" (patient perspective) → "When did the pain start?" (biomedical) → "Any family history?" (background)

3

Physical examination

If required, explain and gain consent

Example: "I'd like to examine your chest to listen to your breathing. Is that okay? I'll need you to remove your top."

4

Explanation and planning

Share information, reach shared understanding, involve patient in decisions

Example: "Based on what you've told me, this sounds like asthma. We have a few options: inhaler, lifestyle changes, or both. What do you think would work best for you?"

5

Closing the session

Summarize, safety net, arrange follow-up

Example: "So we've agreed on the inhaler. If your breathing gets worse or you're not better in a week, come back. I'll see you in 2 weeks to check how you're getting on."

✅ Pendleton's 7 Tasks

A task-based approach to consultations

When to use: Teaching, structured assessments, complex cases requiring systematic approach

1 Define the reason for attendance
Example: "So you've come in about the chest pain you've been having?"
2 Consider other problems
Example: "Is there anything else you'd like to discuss today?"
3 Choose an appropriate action
Example: "Given your symptoms, I think we should do an ECG and some blood tests."
4 Achieve a shared understanding
Example: "So we both agree this is likely anxiety-related chest pain?"
5 Involve the patient in management
Example: "Would you prefer to try breathing exercises first, or would you like to consider medication?"
6 Use time and resources appropriately
Example: "I think we can manage this here without needing a referral at this stage."
7 Establish or maintain relationship
Example: "I'm here if you need to talk about this again. How are you feeling about everything we've discussed?"

⚡ Neighbour's Inner Consultation

Five checkpoints for effective consultations

When to use: Quick consultations, time-pressured situations, when you need a simple framework

1

Connecting

Establish rapport and understand the patient's agenda

Example: "Hi, how can I help you today?" - Simple, open, welcoming.

2

Summarizing

Check understanding before moving forward

Example: "So you've had this cough for 3 weeks, it's worse at night, and you're worried it might be something serious?"

3

Handing over

Share decision-making and management

Example: "I think this is likely a post-viral cough. We could try a simple cough medicine, or wait another week. What would you prefer?"

4

Safety netting

What to do if things don't improve

Example: "If it's not better in a week, or if you develop a fever or breathlessness, come back or call 111."

5

Housekeeping

Manage your own feelings and maintain boundaries

Example: Reflect after consultation: "Did I handle that well? Am I feeling frustrated? Do I need to debrief with someone?"

🔄 Byrne & Long Model

Doctor-centred vs patient-centred approach

When to use: Understanding consultation styles, teaching communication skills, reflecting on your approach

❌ Doctor-Centred

Doctor controls the consultation
Closed questions dominate
Biomedical focus
Doctor makes decisions
Less patient involvement

Example: "Where does it hurt? When did it start? Take this medication twice daily."

✅ Patient-Centred

Patient's agenda is explored
Open questions used
Psychosocial factors considered
Shared decision-making
Patient actively involved

Example: "How has this been affecting you? What are you most worried about? What would you like to do about it?"

💡 Key Learning: Most effective consultations blend both approaches - patient-centred for understanding, doctor-centred for efficiency when appropriate.

🎯 Stott & Davis Model

Four areas to address in every consultation

When to use: Ensuring comprehensive consultations, teaching, checklist for complex cases

A

Management of presenting problem

Address the reason for attendance

Example: Diagnose and treat the chest pain, prescribe appropriate medication

B

Modification of help-seeking behaviour

Address inappropriate attendance patterns

Example: "For minor issues like this, you could try the pharmacy first next time"

C

Management of continuing problems

Address ongoing chronic conditions

Example: Review diabetes control, check blood pressure, adjust medications

D

Opportunistic health promotion

Use the consultation for prevention

Example: "While you're here, have you thought about stopping smoking? I can help with that."

💡 HELPER Mnemonic

A simple mnemonic for consultation structure

When to use: Quick reference, teaching, memory aid for consultation structure

H

History

Take a comprehensive history

Example: Presenting complaint, history of presenting complaint, systems review

E

Examination

Perform relevant physical examination

Example: Cardiovascular exam for chest pain, respiratory exam for cough

L

Likely diagnosis

Formulate differential diagnoses

Example: "This sounds like anxiety-related chest pain, but we should rule out cardiac causes"

P

Plan

Develop management plan

Example: Prescribe medication, arrange investigations, refer if needed

E

Explanation

Explain diagnosis and plan to patient

Example: "Based on what you've told me, this is likely anxiety. Here's what we can do..."

R

Review

Arrange follow-up and safety netting

Example: "Come back in 2 weeks, or sooner if things get worse"