LO: Demonstrate effective verbal and non-verbal communication behaviour that builds the relationship from the opening of a consultation

Negotiation of agenda

• Involve patient
• Collaborative partnership between patient and doctor
• Doctor helps organise consultation and avoid incomplete information gathering
• Structure is clear and patient has more responsibility and involvement in the consultation

Calgary Cambridge guide

Gathering information

• Explore reason for the visit to discover both disease and illness perspective
• Gather accurate and complete information
• Ensure patient feels listened to
• Build supportive relationship with patient

Disease/illness model

flowchart LR
	subgraph Disease
		Symptoms
		A[Medical history]
		B[Medication history]
		Allergies
		C[Social history]
		D[Family history]
		Lifestyle
		E[Systems review]
	end
	
	subgraph Illness
		Ideas
		Concerns
		Expectations
		F[Effects on life]
		Feelings
	end

• Doctors gather information by integrating the two frameworks

Open-to-closed cone style of question

• Start with open questions
  • Encourages patient to tell their story
  • Prevents 'shot in the dark' closed questioning
  • Time and space to listen and think
  • Helps explore both disease and illness frameworks
  • Pattern of patient partnership

Open questions

• Ideas
• Concerns
• Expectations
• Effects on life
• Feelings

Closed questions

• Specific areas not emerged from patient's account
• Explore symptoms in detail (SOCRATES)
• Gather background information

Systems review

• "Are you otherwise well?"
• If no or hesitant
• "Do you have any problems with sleep, appetite, weight, temperature, energy, mood"
• SAWTEM: Sleep, Appetite, Weight, Temperature, Energy, Mood

LO: Demonstrate a patient-centred approach, including behaviours that show respect for and interest in the patient

LO: Demonstrate the communication skills required to explore the patient's experience of their health concern (illness perspective) alongside eliciting the clinical information

Multiple questions

• Block information gathering
• More than one question asked simultaneously
• Confusion

Leading questions

• Imply the answer
• Different to educated guess

LO: Demonstrate active listening and observation skills

LO: Gather accurate and comprehensive clinical information to elicit a chronological and complete patient account