Consultations with a doctor can focus on just the presenting problem or cover all areas of a person’s health. The same applies to any walk of life and any setting where some care or service is being provided. Everyone would wish to have, and to provide, a thorough and complete consultation, but there are limitations of time to be considered.
A reactive consultation deals with the immediate problem and is actually appropriate in many circumstances, especially when time is short, in emergencies, or when a more specialist opinion has been requested.
A proactive consultation addresses the presenting problem, other problems given by the patient, problems identified by the doctor and tasks required for good practice and to meet external standards.
Before the consultation this involves reading the records, anticipating and preparing for expected problems and recalling previous consultations. During the consultation itself the doctor may also pick up on comments or cues which further open up the range of issues to discuss. The aim is to identify all issues and discuss how to deal with these over time, possibly staged, at a later consultation. A proactive doctor may examine the patient more to check nothing obvious is missed. They will usually ask if there are any other questions, ask if all is understood, and ask if all has been covered. After the person has left they will briefly rechecks past records, make a good immediate record, edit the problem list, and enter any templates necessary. This may generate between five to ten tasks in a consultation to be reviewed or addressed over time.
This involves planning ahead. It may be anticipating a care need for say a walking frame, in six months time, if someone has a progressive illness. It could be discussing screening for a future risk such as cervical smears or prostate assessment. It is going outside the current situation and looking at anticipating or preventing a problem in the future.
Part of being proactive in the future is education for the patient. Education on how to handle the same problem if it recurs. Advice on when to contact the relevant services if certain symptoms occur. Information on warning symptoms that might need urgent review.
A pictoral approach to considering all the problems that could be addressed during the consultation is available under the downloads section of docrick. Choose “consultation – proactive options sheet”.
In the boxes write each of the presenting problems, each problem that arises during the consultation and any problem arising from the healthcare records. Along the lines from each box write the options for management. Most consultations will fill 5-10 boxes of problems when the whole person is considered.