Octobre 2001
Analyses of consultations show little structure in the majority of the consultations. At the same time we have learned that a good management of a well-structured consultation enhances the quality, and is beneficial for the patient and gratifying for the doctor.
In the management of a consultation one has to deal with at least four elements :
- the complaint of the patient;
- the demand for care of the patient;
- the ‘contract’ between doctor and patient, and
- the frame of ‘rules of the game’.
The complaint.
A well structured consultation begins with a clear discussion about the reason for encounter of the patient. The complaint is the well-known part for the doctor. It’s what makes the patient suffer or worry. Having a complaint mày be the motive to go to the doctor, but is not a sufficient reason. Many people with the same complaint will not decide to visit their doctor. So more is needed for the decision to see the doctor than just having a complaint. Most doctors make no clear distinction between the complaint or disease of the patient on the one hand and the demand for care on the other hand.
The demand/request.
The demand for care indicates what the patient expects from the doctor. That can be recovery, reassurance, more information, a discussion about the disappointment of the patient about the treatment, measures to prevent the complaint in the future and so on. It could be what the doctor already was thinking, but it also could be a surprising request, the doctor would never know about when he would not have spent enough time on the clarification of the demand for care.
Most doctors think they know what the patients expect, what the patients ask for from the doctor, after they have heard the complaint. Investigations made clear that in many cases the visions of the doctors were not (completely) right when they did not verify these visions. Even in the second or third contact about one and the same complaint doctors mistakenly think they know what the patients expect from them. In the repeat encounters it can even be more dangerous to trust the own opinion, because doctors more often automatically think that the reason for encounter can be deduced from the former consultation.
Taking (some) time for clarifying the demand for care may seem a waste of time. But in the daily practice it proofs to benefit over and over. In many cases the process of clearing the demand of the patient helps to clarify to the patient what it is he asks help for and what he could do himself. It can also clarify the responsibility of the patient, help the doctor to be more aware of what he or she is doing and it can increase the possibility that the doctor performs the way that the patient expects.
The contract.
Only when the demand for care is clear the doctor can decide whether and how he or she can respond or wants to respond to that demand (= ‘the contract’).
The situation is clear by then : both doctor and patient know what the patient is asking for and the doctor is clear about his or her offer. Of course these steps will remain implicit when the case is very simple. But be careful ! Even in the most simple cases a discussion about the request by the patient can deliver surprising results.
The rules of the game.
It is easier for the doctor when there is clarity about ‘the rules of the game’ in both parties. Some of those rules are: the time-limit of the consultation, the presentation of only one complaint at the time, the ‘agreement’ to respect the role of the doctor, and so on. Clarity about the rules gives the doctor the possibility to give all the room needed by the patient, because then the doctor knows that there’s little chance that the consultation will run out of his control.
In the management of a consultation one has to deal with at least four elements :
- the complaint of the patient;
- the demand for care of the patient;
- the ‘contract’ between doctor and patient, and
- the frame of ‘rules of the game’.
The complaint.
A well structured consultation begins with a clear discussion about the reason for encounter of the patient. The complaint is the well-known part for the doctor. It’s what makes the patient suffer or worry. Having a complaint mày be the motive to go to the doctor, but is not a sufficient reason. Many people with the same complaint will not decide to visit their doctor. So more is needed for the decision to see the doctor than just having a complaint. Most doctors make no clear distinction between the complaint or disease of the patient on the one hand and the demand for care on the other hand.
The demand/request.
The demand for care indicates what the patient expects from the doctor. That can be recovery, reassurance, more information, a discussion about the disappointment of the patient about the treatment, measures to prevent the complaint in the future and so on. It could be what the doctor already was thinking, but it also could be a surprising request, the doctor would never know about when he would not have spent enough time on the clarification of the demand for care.
Most doctors think they know what the patients expect, what the patients ask for from the doctor, after they have heard the complaint. Investigations made clear that in many cases the visions of the doctors were not (completely) right when they did not verify these visions. Even in the second or third contact about one and the same complaint doctors mistakenly think they know what the patients expect from them. In the repeat encounters it can even be more dangerous to trust the own opinion, because doctors more often automatically think that the reason for encounter can be deduced from the former consultation.
Taking (some) time for clarifying the demand for care may seem a waste of time. But in the daily practice it proofs to benefit over and over. In many cases the process of clearing the demand of the patient helps to clarify to the patient what it is he asks help for and what he could do himself. It can also clarify the responsibility of the patient, help the doctor to be more aware of what he or she is doing and it can increase the possibility that the doctor performs the way that the patient expects.
The contract.
Only when the demand for care is clear the doctor can decide whether and how he or she can respond or wants to respond to that demand (= ‘the contract’).
The situation is clear by then : both doctor and patient know what the patient is asking for and the doctor is clear about his or her offer. Of course these steps will remain implicit when the case is very simple. But be careful ! Even in the most simple cases a discussion about the request by the patient can deliver surprising results.
The rules of the game.
It is easier for the doctor when there is clarity about ‘the rules of the game’ in both parties. Some of those rules are: the time-limit of the consultation, the presentation of only one complaint at the time, the ‘agreement’ to respect the role of the doctor, and so on. Clarity about the rules gives the doctor the possibility to give all the room needed by the patient, because then the doctor knows that there’s little chance that the consultation will run out of his control.