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Child development

September 2011

Professional

A competency history

An additional model of history taking

Volume 40, No.9, September 2011 Pages 735-738

A competency historySimon Bridge MBBS, DipO&G, MPH, GDipFamTher, FACRRM, is Senior Lecturer, Department of Medicine, James Cook University, Queensland and general practitioner, Melbourne, Victoria.

Background

Taking a medical history is an effective way of finding out important information about the patient and their presenting problem/s but this approach may inadvertently be disempowering for the patient. An increased sense of agency can increase the likelihood of behavioural change, so facilitating empowerment of the patient in the context of a medical consultation is an important challenge for general practitioners.

Objective

This article describes an alternative or additional model of history taking – the ‘competency history’. It describes its theoretical base, components and appropriate use, and gives examples of how a competency history can be used in general practice.

Discussion

A competency history uses strength based empowerment approaches and is especially appropriate with patients who have a poor sense of agency. The core elements of a competency history include an understanding of the patient’s past and current context, respect for the patient’s expertise and strength based interventions, including alternative narratives and solution focused conversations. Another important aspect of this approach is to allow the patient to take the initiative in making a change in their behaviour, and to take responsibility for their health. Taking a competency history is a useful additional skill for GPs, and may be a valuable addition to undergraduate medical training.

Taking a medical history is centred on a presenting problem and includes assessing and describing the problem according to a learned protocol.1 After an examination, the next step is usually for the doctor to suggest solutions. In many cases this process is very successful. However, if the solution requires behavioural change, other factors can come into play, affecting the likelihood of change.

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Correspondence afp@racgp.org.au

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Topics

Consultation & communication Patients

Type

Professional