Consultation

Question 1

Name the 3 main consultation models

Answer 1

1. Bio-medical SOAP model
2. stott and Davis ABCD model
3. 3 stage assessment and plan or biopsychosocial model

Question 2

What is soap biomedical model?

Answer 2

Subjective
Objective
Assessment
Plan

Question 3

What is Scott and Davi’s model main tasks of consultation?

Answer 3

ABCD
Acute presenting problem
Behaviour health seeking
Chronic problems
Disease prevention

Question 4

What is the 3 stage assessment and plan?

Answer 4

•Clinical
• individual (ice)
Ideas
Concerns
Expectations
• Contextual

Or soa3p4
Subjective
Objective
Assessment: clinical, individual, contextual
Plan: CIC and investigations PRN (as necessary)

Question 5

What is the juggler consultation model

Answer 5

Do more than one thing at a time
3 balls:
• facilitation: Facilitation = making something easier. Active listening to uncover their story ,build rapport, ask open questions, recognise cues, reflect cues, summarise story.
• clinical reasoning: making an assessment based off of information from history and physical, doctor’s agenda. Observe cues, hypothesis formation and testing, focused investigation, rational Decision making, evidence based practice, biopsychosocial assessments, comprehensive management plan
• collaboration: involve patient in understanding problem and solution through mutual plan. negotiation if disagreement - give options!

Question 6

Name the 8 steps of negotiation

Answer 6

• Recognise difference
• value difference
• verbalise and clarify difference
• understand difference
• find areas of agreement
. Find solution
• maintain relationship
. Arrange follow-up

Question 7

What is the central part of the consultation according to the juggler model?

Answer 7

The assessment

Question 8

How break bad news (6)

Answer 8

• Set up interview: have results ready, privacy, who should be present, introductions
• sharing info: warn that difficult info coming. Share simply, directly, honestly. Give time to process. Do you understand?
• assess understanding + interpretation: allow “shut down” time , acknowledge shock. Encourage to express emotions. Ask if questions. Ask how pt understands + interprets
• address emotions with empathy
• strategy, summary: plan, way forward, realistic hope
• follow up: early, ask if would like family meeting

Question 9

how assess depressed/suicidal patient

Answer 9

SIGE caps (phq -9 questions)

Sadness
Interest loss, insomnia
Guilt
Energy decrease
Concentration difficulty
Appetite /weight changes
Psychomotor agitation/retardation
Suicidal ideation (if yes: plan? )

Question 10

How perform mental state exam (8)

Answer 10

ABcDEFGH

Awareness (insight, judgement)
Behaviour: eye contact, facial expression, psychomotor activity slow/increased, level of arousal calm/agitated /aggression, ability to follow requests, body language/ gestures/ mannerisms
Cognition: orientation to time, place, person; attention + concentration; short term memory (can do detailed testing with mmse)
Deliberation (thought): thought form (speed, flow eg circumstantial ), content eg delusions, possession eg broadcasting
Expression (mood+ affect quality, range, intensity )
Fluency of speech: rate, quantity, tone, volume, rhythm
Grooming (appearance): distinctive features, clothes,posture/gait, hygiene, evidence harm
Hallucinations (perceptions)

Question 11

Counsel on top (10)

Answer 11

• Assure confidentiality
• I’d like to first assess your health and ask some questions, then we can discuss your options. Is that okay?
• confirm pregnancy with test
• gynae hx: lnmp (GA), any bleeding, has been pregnant before, contraception, any abortion attempts
• social: is partner supportive, how many partners, ask about abuse (this is just a routine question ), smoke / alcohol/drug
• discuss laws + whether pt fits
• discuss options: medical (one tab now then another in 48h, heavy bleeding then spotting 2 weeks) vs surgical (only if <14 weeks. Short, uncomfortable, 3h before med to soften cervix, then stay in hosp for 1h to monitor)
• Questions?
• written consent
• offer contraception

Question 12

Choice on termination of pregnancy act 92 of 1996?

Answer 12

12 weeks or less = on request

12-20 weeks

• rape/incest
• Risk fetus suffer
• risk to mom
• significantly affect social/economic circumstances woman

> 20 = 2 Drs

• endanger mom life
• risk / injury to foetal
• severe foetal malformation