P-R-A-C-T-I-C-A-L - A STEP-BY-STEP MODEL FOR CONDUCTING THE CONSULTATION IN GENERAL-PRACTICE

Background. It has been shown that when patients are unable to express all their major concerns, they are less likely to follow the physicia n's prescribed treatment plan and they are less satisfied. On the othe r hand, the GP has a limited amount of time to elicit all the appropri ate information and must ask certain questions about;the biological as pects of the illness in order to carry out her professional responsibi lities. By acting in a patient-centred way, first enabling the patient to express himself, the GP can make maximum use of patients' ability for problem formulation and solution. Methods. We describe a model, fo r which the mnemonic, P-R-A-C-T-I-C-A-L, will help the practitioner to remember its nine steps. The model uses a chronological succession of strategies during the consultation that balances the voices of medici ne and the lifeworld. In overview, the GP takes the patient, step by s tep, first through an exploration and clarification of his views of th e illness, then expands the problem by further examination (e.g. the p hysical examination), a negotiation about the final model of the illne ss that includes both diagnosis and management, a discussion of the tr eatment plan, and finally a moment of reflection to prepare for the ne xt visit.