Some of the common problem patterns which occur in consultations are as follows:
- The learner does not discover all the issues or problems the patient wishes to discuss
- The learner does not listen, often not asking open-ended questions initially or interrupting with closed questions
- The learner does not elicit the patients ideas, concerns, expectations and feelings; or establish a collaborative relationship, and instead takes a doctor-centred position throughout the interview
- The learner develops little rapport or is not responsive to the patient the learner misses important cues from the patient
- The learner obtains an inaccurate or incomplete clinical history because of failure to get the balance right between open and closed questions, summarising, checking, or sharing his thinking process
- The learner forgets to find out what the patient already knows before giving an explanation
- The learner gives too much information at once and uses jargon
- The learner does not negotiate with the patient and check that the patient is agreeable to the plan
- The learner makes inadequate follow up arrangements or none at all
A useful set of questions to ask yourself as the facilitator as you are watching any consultation are:
- Can you recognise any patterns here?
- Have you seen this problem before?
- How might the learner who performed the consultation be feeling?
- How might the patient be feeling?
- What does the group already know?
- How could you generalise away?
- When would the best time be to do it?
- What area or what research and theory would be relevant to teach on?
- Do you have the knowledge? Do any of the learners have the knowledge
- Is the overall balance of experiential work with didactic material from the literature right for the group?
- Have you got an aide-memoire/handout for the group