The First Consultation

The first consultation has been defined as part of the “cycle of care” with therapist and patient on two  ends of a spectrum working towards a common goal.  The patient is focused on the problem for which they are seeking help and the reasons why they have chosen to seek care at this time.

These reasons include:

Their understanding of the possible nature of the problem,

The significance and meaning to them

Their expectations of what help the therapist may be able to provide,( often based on their previous experience of healthcare).

All these factors will also be influenced by the patient’s cultural background.

Therapists are likely to be influenced by some general factors including cultural, professional and personal issues.

Cultural influences include the expectations about the role of the Physiotherapist in society and the roles they are expected to play.  Professional issues include ethical and other rules of conduct and their current state of beliefs about the appropriateness of intervention.

Interestingly the quality of care as a therapist has been shown to be influenced by:

Therapist’s current workload and perceptions

Therapist mood state

Current pressures on time

The state in which the last patient left the room.

These are all exceedingly variable factors.  Another variable to be recognised is the therapist’s perspective on patients who are about to be seen.  As we are all human – we can expect to anticipate the arrival of some patients with delight and others with dread and most with some reaction in between.

Conversely a new patient consultation should provide an exciting opportunity to assist and provide help.

The professional expert

Interestingly, although the common perception is of the professional as the expert with high levels of knowledge on specific topics and the patient seeking the benefit from this knowledge an alternative view has been suggested as the consultation being a “meeting between experts” in which the therapist and the patient each bring specialist knowledge.

The therapist could justly claim to know a great deal about how the body works, how diseases present and progresses and how they should be investigated and treated.  The patient knows a great deal about him/herself, about the experience of the problem, about the personal values and needs which will govern how a problem is approached, about his/her lifestyle and the social context into which any proposed management plan must fit.

Both perspectives will influence the effectiveness with which any problem is addressed and both perspectives need to find a place in the consultation.  This can be summarised as a key principal of mutual understanding between both parties.

Consequences of the Consultation

There are very different types of outcomes which can occur once the consultation has ended.

For the patient the immediate outcomes include such factors as:

Commitment to the management plan agreed in the consultation

His/hers satisfaction with the consultation itself

His/her memory of what was said and any change in the initial level of concern.

From the therapist’s perspective the immediate outcomes include the pleasant and unpleasant consequences of certain aspects of a consultation.  As a result of these rewards and punishments certain consulting styles will be encouraged or discouraged.

When a practitioner zealously brings new approaches to an established practice the patient’s reactions to these approaches determine whether the therapist presses on with greater enthusiasm or drops the novel practices completely.  Other immediate outcomes include the therapist’s satisfaction with the consultation and any immediate feedback the patient gives.  Clinical practice’s desire to find a root cause of the problem can often cloud the necessity to achieve patient “buy in”, in order to deliver effective care.  The best clinical skills and the most contemporary management protocols will ultimately fail unless this collaborative management strategy has been achieved.  The initial consultation is the prime opportunity to establish this framework.

Enjoy the clinical challenge.

David.

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