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Workshop
WONCA APR Conference 2019 » Workshop
[WS2-14] An extended consultation model for complex & chaotic cases in primary care
Thu. May 16, 2019 10:30 AM - 12:00 PM Room 11 (2F Room K)
Organizer/Chair: Pak Yean Cheong, Lee Gan Goh(YLL School of Medicine, National University of Singapore, Singapore)
Presenter: Yi Yong PHUA (YLL School of Medicine, National University of Singapore, Singapore)
This workshop presents an extended consultation model to arrive at a formulation of the reasons for encounter that augment the diagnosis, useful especially in complex and chaotic cases. A case study of a patient with poorly controlled diabetes due to psycho-social issues is used to illustrate the principles. Video recordings of role-play are used to demonstrate the extended skills. Participants would then work out the formulation and integrative bio-psychosocial interventions.
The history is extended into the consultation period itself to understand the ideas, concerns & expectations (I.C.E.) of the patient and how it may interact with the I.C.E. of the doctor. The physical examination is extended by reflective communication (Active Listening). The investigation is extended by Socratic inquiry to understand the patient’s salient feelings, thinking and behavior.
With both idiographic and nomothetic perspectives in an enlarged open Johari window and a time-line of salient events, a formulation (4 Ps) of the Predisposing, Precipitating, Perpetuating and Protective issues can be understood. Eclectic counselling techniques may then be used with biomedical management to target the maladaptive psycho-social issues. A book The Extended Consultation Talk Matters! is used as course manual. (187 words)
Reference: Cheong PY Goh LG Ong CP Ser JS The extended Consultation: Talk matters! Singapore: Wens Holdings PL; 2017. ISBM 978-981-11-3221-6