Consultation Skills: Intro

Consultation Skills – not the most exciting topic in medicine, but these are essential skills we use every day.  I think most doctors learned the basics in Med School, then went into real-world practice, found some approaches that worked and some that didn’t and ‘evolved’ a style.  My guess is that we opt for what works without thinking about it too hard.  Most of us get by, on average we are nice people and like to help where we can.  Basic communication skills are not too hard to master.  But can we do better?

If done well – good consultation can save you time, make your outcomes and compliance better and you might avoid complaints and even getting sued.  Mostly though – they make the job more fun!

GP training actually spends quite a bit of time and effort in improving one’s consultation skills – though I am not sure how much the other specialties do this?  I have spent a lot of time watching specialists from specialties massacre consults.  To be fair though, there are a lot of great ‘consulters’ out there – some are surgeons.

There is a lot of material out there.  It seems every state has a guru who has written a book on the topic, and some are better than others – though a lot of pop-psychology and idealised rhetoric must be waded through!  So I thought I would enter the fray with a few posts on one of my favourite topics – communication, the doctor-patient relationship and some evidence around this – yes, there is actually evidence!

For me there are two basic types of “consultations” [I use the term to describe any interaction between a doctor and a patient / family].  In true Broome Docs style I have gone for massive simplification as that is how my brain functions.

This is a bit analagous to ventilator strategies for the Crit Care folk out there –

  •  there is the one that is pretty good for most patients, normal people who understand the context and dynamics of the interaction
  • and then there is the strategy I use when I am dealing with abnormal  psycho-dynamics: where the relationship is strained, there is a heavy emotional component, the patient is not playing by normal social rules (read: personality disordered, or just having a really bad day), or sometimes where we just have different agendas / outcomes we are trying to achieve.

So why not just use the first strategy and see how it rolls, then switch if necessary ??  Well, the problem is that if you go with the “normal” strategy you just might get taken for a big ride, find yourself agreeing to all sorts of odd things and getting very frustrated / angry at the patient.  If you recognise you are not in “normal consult” territory – then you can use the other strategy up front and “Own the Consult” – ensure the conversation goes where you need it to, and save your cortisol / hair dye!

Why have I decided to do this?  Well I have been reading a few great books lately and they have inspired me, crystallized my usually random, free-floating ideas into a more coherent order.  Oh, and I have to start teaching a new crop of students in a few weeks and want to start with something that they can use for the next 30 years hopefully!

So here are the proposed titles of a series of posts on Consultation Skills:

  1. The “normal” people strategy – Understand the patient’s point-of-view and prosper
  2. When Agendas Collide – dealing with the difficult patient
  3. The emotional consult – Being Good at Bad News
  4. Dealing with Poor Outcomes: how to run the ‘sorry consult’

I am not an expert and hope to get a conversation going around this topic so we can all learn.  Let me know what you think and comment below.   Casey


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