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Closing the consultation
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Doctor centred
- Helping on with coat/to door
- Getting up
- Turning to computer/closing down screen
- Breaking eye contact
- Silence and smile
- Sink into chair
- Buzzer system
- Time’s up!
- Prescription
- Sick note
- Bloods
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Patient centred or shared
- Plan > discuss action plan > GP and patient issues
- What’s next? When?
- Agenda setting
- Checking understanding
- Summarising
- Making an appointment
- Plan for next time
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By approaching the ending of the consultation in a patient-centred way, the
consultation will naturally end, rather than being forced by the doctor.
Research shows that
- Closure is initiated by the doctor in 86% of consultations
- New problems are mentioned in the closing section by the patient in 21% of
consultations
New problems occurring at the end of the consultation can be largely prevented
by
- Not interrupting the opening gambit
- Agenda setting
The patient-centred closure issues discussed above drop naturally into the
Calgary Cambridge “closing the session”
Closing the session
Forward planning
- Contracts with patient re next steps
for patient and physician
- Safety nets, explaining possible
unexpected outcomes, what to do if plan is
not working, when and how to seek help
Ensuring appropriate point of closure
- Summarises session briefly and
clarifies plan of care
- Final check that patient agrees and is
comfortable with plan and asks if any
corrections, questions or other items to discuss
Calgary
Cambridge