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Communication Skills

Consultation Skills is the bread and butter of General Practice

You will hear time and again how consultations skills form the ‘bread and butter’ of General Practice.  “Bread and butter” is a simple phrase which has a few different meanings and uses. 

  1. Bread and butter may be refer to the item or process that forms the essence of one’s sustenance and, in our context, GP work-life.. 
  2. It is often used to mean something ordinary, something that we do everyday. 
  3. When the term bread and butter was first used in the 1700s, it referred to one’s basic needs. 

In GP, when we say that the consultation is the bread and butter of General Practice, we mean all of these things.  It is the fundamental thing to get skilled up in and be the best you can because it is the fundamental glue that holds everything together and makes every other part of your GP job ten times easier.

Consultation Skills are not just communication skills​

Lot’s of people (trainees and trainers) equate consultation skills with communication skills.   Yes, communication skills is a massive big subset of consultation skills but it is not the only part.   Consultation SKILLS and all of the above SKILLS listed in the Downloads section.

Consultation Skills include:

  1. Communication Skills (most of the things in the Downloads section are communication things)
  2. Data-Gathering Skills
  3. Decision-Making Skills
  4. Using the Computer in the Consultation

There's so much. Where do I start? I feel overwhelmed.

Yes, there is lots to being a GP.  Our job is not as easy as some of our colleagues in other specialties would make out.    That’s why General Practice is a specialty in its own right.   You can’t just lumber a qualified GP into an Opthalmology department and ask them to become an Eye consultant.  Intense training is required.  In the same way, you cannot just lumber a any qualified hospital consultant into a GP job and ask them to be a GP expert!   (By the way, this used to be possible in the 70’s and 80s!).   Again, it requires a lot of specific, GP-orientated training over a number of years.

So, where do you start.   Yes, there is lots and lots.

  • First, get a consultation book.  Any will do.  Most of them are pretty good.  They will touch on most of what is on this webpage (although we are proud of the fact that our webpage provides greater depth and more practical advice and guidance).  Books I particularly recommend are
        • The Inner Consultation by Roger Neighbour (particularly good if you like reading novels)  OR
        • The Naked Consultation by Liz Moulton OR
        • The New Consultation by Tate et al
        • And later on….. Skills for Communicating with Patients by Silverman et al
  • But you will need to practice these skills, not just read about them.   And many are tested in the CSA.   So, do tutorials and practise with your Trainer.   Practise on patients and video the consultations and get your trainer or educated others to help you do better.
  • And of course, read the resources on this webpage.   

Things to concentrate on when starting off...​

  • Active Listening skills
  • Understanding Empathy & Compassion
  • Agenda Setting – which also means exploring ICE and PSO (see Downloads section if you don’t know what these are)
  • Data gathering Skills
  • Decision Making Skills
  • Signposting and Summarising Skills
  • Explanations – especially explaining skills in general, breaking bad news, explaining risk.
  • Medical Analogies – this is an excellent section and I think ALL trainees should learn how to use medical analogies and try to use analogies in their explanations.  Medical analogies make it so easy to help the doctor explain but also help the patient understand and retain.
  • Scripts and Phrases for use in the consultation – and remember to develop your own.

How’s that for starters?  And then you can move onto the more advanced stuff when you’ve covered these basic things.   Advanced stuff like handling conflict, Negotiation and Persuasion skills, Using non-heterosexual bias in language (see under the LGBTQ section).

5 Communications things to achieve in all consultations...

This was developed from an e-discussion with Dr Vishal Naidoo – a GP Educator in Cambridge, UK.  These 5 things are here to remind you of what you are trying to achieve in all consultations from a communication perspective:

  • I – Intention
      • Remind yourself of your intention: to help the patient, and guide them through their medical journey, in order to reach a shared understanding.
  • L – Listen to your patient
      • Use active listening/open questions/silence to help you understand your patient.   Try and withhold judgement to anything that is shared with you.
  • R – Read your patient
      • Look at them and read their non-verbal cues.   Pick up nuances in their speech.   Does their body language marry with what they are saying?   Again, this will help you explore and understand your patient.
  • E – Engagement
      • The consultation should be bilateral; a 2 way sincere engagement.  Not like the parent-child relationship of days gone by.   The way to do this is through you body language – an open relaxed posture, appropriate eye contact.   Show genuine empathy and sympathy and concern.   Show confidence too.   Confidence plays an important part of this engagement, as the patient is seeking the doctor’s expertise and opinion.
  • D- Delivery
      • Reflect on the tone of your speech, eye contact.  Pleasantness and respect go far in building rapport and providing palatable medical input.

Doctors Speak Up - an amazing resource for teaching consultations skills to IMGs

Medical Educators

Medical and clinical educators involved in the training of IMGs can use the Doctors Speak Up resource to gain a greater understanding of the language and communication issues that IMGs may find challenging; it can also be used as a teaching resource in communication skills workshops for IMGs. 

IMG trainees:

Understanding language and communication issues that some IMGs can find challenging: the introductions to the various activities on this site often contain simple explanations for common language issues. Supporting activities were developed to address specific communication issues with a focus on pronunciation.  The issues were identified from analysis of videos of practise OSCE workshops, and they were also informed by discussions with supervisors of IMGs.

Doctors Speak Up is an AMAZING Australian resource.

Suggestions for communication skills workshops:  

  • As a group – awareness raising – discuss the process and content skills necessary for an effective medical interview using the Calgary-Cambridge guide as a framework, then watch the videos with workshop participants, asking them to comment on the interactions using the Calgary-Cambridge framework as a guide.
  • Run a workshop with a simulated patient using a case similar to the ones shown on Doctors Speak Up. Request participants to view the videos prior to the workshop. Depending on your resources, run one or several stations asking some participants to act as observers and provide feedback. If you have access to an English as a Second Language (ESL) teacher, ask the ESL teacher to provide feedback using the CALF template (Woodward-Kron, Stevens and Flynn, 2011).

Suggestions for using Doctors Speak Up with individuals:

  • The activities on this site relate to the specific cases presented in the videos and focus on vocabulary, grammar, communication or pronunciation. A spreadsheet of the activities has been provided so that users can monitor the activities they have completed.
  • Ask participants to reflect on the communication activities – either in group discussion or reflective journals.  If this is not practical, participants can also discuss their reflections with close colleagues or family members.

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource. And of course, if you have developed a resource of your own, please email it to me to share with others.

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