3.7.1 A ‘patient centred’ approach
From the GP’s perspective, the role of the consultation is to interpret the symptoms, establish whether there is illness, manage appropriately, and then inform and educate the patient.149 Whereas, from the patient’s perspective, the role of the consultation is to resolve their concerns, reduce anxiety about possible diagnoses and outline management, if any is needed.150 A ‘patient centred’ consultation ensures that the patient’s perspectives are addressed.151 The doctor attempts to more actively involve the patient in the consultation, respecting their autonomy and encouraging their role in decision making.
The doctor also embraces a more holistic approach that includes health promotion and disease prevention. Encouraging more active patient involvement and inclusion in the consultation has a number of benefits. There is clarification of what is expected of you by the patient and stronger patient autonomy, patient responsibility and patient self management. As a result, there is increased patient and doctor satisfaction and better adherence to the recommended prevention activities and therapeutic regimens. There may be an increased demand for and use of appropriate referrals to other health services professionals and agencies. This can reduce the cost of care through the use of more efficient resources and having better informed patients. At the same time, the communication processes are improved. A patient centred approach (Figure 7 ) includes exploration of the patient’s disease and illness experience. Patients need to be asked specifically:
- what they think is wrong with them
- what their feelings and fears about the problem are
- what is the impact of the problem on their daily functioning, and
- what they expect of the GP during the consultation.
Figure 7. The patient centred model Source: Levenstein J, et al. A model for the doctor-patient interaction in family medicine. Fam Pract 1986;3:24–30
There is now evidence that many other factors determine how clinical care, including preventive care, is offered and accepted by patients. These include the patient's literacy, income, cultural values and their access to services. The attitudes and beliefs of GPs and all health workers contribute to the variations in the provision of care to patients. It is incorrect to assume that socioeconomically disadvantaged people are less interested in health information. During the consultation, GPs could do the following:
- reflect on their approach and attitudes, ie. avoid victim blaming
- explore the social circumstances and barriers that patients face 152,153
- help patients address then prioritise their own adverse circumstances
- identify and collect data
- understand the patient’s social circumstances (this should be done in a sensitive manner).