The Naked Consultation

A Practical Guide to Primary Care Consultation Skills, Second Edition

Liz Moulton

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781315343662
• Edition: 2
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Don't Wait Until Something Goes Wrong to Think About Your Consultation Skills

Designed specifically for busy health professionals working in primary care, The Naked Consultation: A Practical Guide to Primary Care Consultation Skills covers all aspects of the primary care consultation in a clear, concise, and highly readable manner.

The book begins by breaking the primary care consultation into its components, making it easier to focus on particular areas and practise skills such as encouraging patients to explain what's wrong, summarising and reflecting, and giving information to patients. The book then describes how to effectively use educational tools—such as videoing, random case analysis, problem case debriefing, and feedback—to improve consultations. It also explains in detail how to demonstrate proficient consultation skills in the Membership of the Royal College of General Practitioners (MRCGP) exam and the importance of these skills in appraisal/revalidation.

Certified for continuing professional development (CPD®) by The CPD Certification Service, this fully updated and revised Second Edition incorporates new thinking and consultation models, including the 6 S model and the new doctor, patient, illness model. It also provides detailed analysis of the latest Royal College of General Practitioners (RCGP) assessment tools, such as the clinical skills assessment exam (CSA) and the consultation observation tool (COT).

Complete with illuminating case studies, photocopiable forms, and a jargon-busting appendix, The Naked Consultation: A Practical Guide to Primary Care Consultation Skills, Second Edition offers valuable insight into the key phases of the primary care consultation, the best features of common consultation models, and the real-world application of popular consultation techniques.

Contents

1. Foreword to second edition
2. Foreword to first edition
3. About the Author
4. Acknowledgments
5. Introduction
6. Part 1 Deconstructing the consultation
7. Prologue
8. 1 Consultations: the good, the bad and the difficult
9. 2 Models and milestones
10. 3 In the beginning
11. 4 Building rapport
12. 5 Speaking the patient’s language
13. 6 Managing feelings: your own and the patient’s
14. 7 Getting patients to tell you what’s wrong
15. 8 Summarising and reflecting
16. 9 Giving information to patients
17. 10 Safety-netting and ending
18. 11 Managing time
19. 12 Transactions in consultations
20. 13 You, the patient and the computer
21. 14 Looking after yourself
22. Part 2 Tools and techniques for learning and improving consultation skills
23. 15 Knowing where to start and what to learn
24. 16 How adults learn
25. 17 Working with colleagues to improve your consultation skills
26. 18 Case discussion
27. 19 Getting and giving effective feedback
28. 20 Using role play to help with consultation techniques
29. 21 Videoing
30. 22 Consultation skills and the RCGP
31. 23 Making a personal learning plan
32. Conclusion
33. Appendix 1: Jargon buster
34. Appendix 2: Some useful resources
35. Index

Foreword to second edition

Liz Moulton is one of the heroes of general practice at a time when our profession badly needs its heroes.

Our health service is facing unprecedented changes and the pace of change seems to increase year on year. We have seen both the organisation and the context of general practice change. There are demands to deliver general practice at scale, to integrate vertically with secondary care providers or horizontally with other community providers and social care. Every new government presents another new idea that involves changing the way the primary care is funded or run. Still one thing remains constant: the helping nature of the human contact between clinician and patient that empowers the patient. This is the subject of Liz’s book, a book that I would advise those new to general practice to read and those experienced in our art to re-read.

I have known Liz Moulton for as long as I have been involved in GP Education and we share many role models who have been influential in our personal development and journey as GPs. She is one of the best GPs and educators that I know, with a passion for helping people understand the consultation and develop their abilities and skills.

As Royal College of General Practitioner’s district faculty tutors, we participated together in a personal development course and later organised and facilitated the same course for other GPs. Running this course over many years, we were struck by the number of wounded healers in our profession.

On the course we sometimes read poetry and told stories. One of these was “The Fisher King” of Arthurian myth and legend. The Fisher King is the wounded keeper of the Holy Grail; a vessel sought after for, amongst other things, its healing properties. Not only is he damaged and suffering, but the King’s wounds are so severe that the entire kingdom has slipped into a deep malaise. Searching for the Grail, Parzival (or Percival if you prefer) meets the Fisher King but fails to ask “What ails thee?” — a simple and obvious question, yet one with the power to heal the King. Parzival misses the opportunity to succeed in his quest and claim the Grail because, fearful of causing offence, he holds back and restrains his natural curiosity.

In another of Parzival’s wanderings, he encounters a raven lying in the snow, surrounded by three drops of bright red blood. He is transfixed by the beauty, the sadness, the passion, the contrast and the deep meaning of what he sees before him and falls into a contemplative trance. This lasts for many days and is not broken even by a succession of other knights who, appalled by Parzival’s rudeness in failing to respond to their chivalrous greeting, challenge him to combat and try, but fail, to unseat him. It seems that this state may never be broken until Parzival’s brother comes and breaks the trance by the deceptively simple procedure of covering the black raven and the three red drops of blood with a large white handkerchief.

What has this to do with General Practice today? Some consultations in general practice are straightforward but many are layered with complexity. At times you can ask the simple healing question — the right words, framed in the right way at the right moment. For other consultations, full of challenge, deep meaning and metaphor, you may need a toolkit of techniques to help and empower you to break through the barriers preventing a person to move on. This book will, I believe, enable you to understand your interactions with patients better and, amidst the ever-changing context and environment, ensure you have the skills you need for effective consultations.

Dr Mark Purvis

Director of Postgraduate General Practice Education

Health Education Yorkshire and the Humber

University of Leeds

September 2015

Foreword to first edition

Liz Moulton comes from what (to me at least!) is a newer generation of hands-on GP trainers and educators. She takes it for granted (in a way that some of her own successors may yet need to be persuaded) that good consulting should be endemic in the general practice community, and has set out to ensure that her own enthusiasm for the consultation is as infectious as possible. Her book is exactly what it says on the tin: ‘a practical guide to consultation skills for any health professional working in primary care’.

We in the UK might modestly claim that ideas from British general practice have, over the last few decades, colonised much of that dark continent of the medical world, ‘communication’. During that time, much has been achieved. The maps and models are now pretty well draft ed and the territory reasonably comprehensively explored. We are probably past a time when much that is fresh remains to be discovered about what makes an eff ective consultation. Instead we are now into a period of consolidating, explaining, encouraging — motivating the next generation of GPs to take pride in their own consulting abilities and showing them how to get comfortable with the necessary skills.

In the first part of this book, Liz Moulton presents in her own approachable style the key features of most of the established consultation literature. The second part, of as much interest to teachers and trainers as to clinicians in training, reviews a wide array of current teaching and learning methods. She covers PUNs and DENs, working with colleagues, case discussion, role play and video in eminently practical ways. The Naked Consultation is a practical and readable vade mecum for the would-be skilled consulter.

Roger Neighbour MA, DSc, FRCP, FRCGP

Bedmond

October 2006

About the Author

Liz Moulton is a freelance general practitioner (GP) in West Yorkshire and is also a GP appraiser, Visiting Lecturer at the University of Leeds and advisor to the Royal College of General Practitioners (RCGP) Practice Support Unit.

Liz graduated from Leeds University and was a GP registrar on the Airedale training scheme. She then moved, via Sheffield and New Zealand, to Dundee, where she worked in the Medical School Teaching Practice, before finally settling in Yorkshire, working in two very different GP training practices. Liz was a GP trainer for more than 20 years and has been course organiser for the Leeds Vocational Training Scheme for General Practice, Associate and Deputy Director at HEE Yorkshire and the Humber, worked in primary care development for Leeds Health Authority and was a GP advisor to t...