Preparing for the consultation
Having considered different approaches to physical examination, we review our preparation for the consultation itself.
Thinking back to Step 1.7 How should I approach patient assessment?, where we considered our safety and the dignity of the patient, how best can we prepare ourselves and the environment prior to commencing the consultation?
A good place to start is to review any patient notes or referral letters relating to this patient (Silverman, Kurtz and Draper 2005). You may not have access to previous notes, for example if the patient is a visitor to the area, or presents outside ‘normal working hours’; however, if you do, it can provide reliable background information.
Beware of prejudging the patient as a result of another health professional’s notes, however: their interpretation may be biased or incomplete. Always regard the patient you have in front of you without preconceived ideas. Never decide what is wrong with them before they enter the room – you will approach the diagnosis in a ‘blinkered’ fashion, and may miss vital signs which would have led you to the correct diagnosis for this presentation.
Consider whether you will need an interpreter for the consultation. These usually require booking well in advance if you are using an interpretation agency. You may consider using a friend or relative of the patient. This can be beneficial as the patient knows them and may be able to chat freely with them; however, if the subject is personal or the examination intimate, the patient may not be comfortable discussing this with a friend or relative present. Also there is the issue of the interpreter giving their own version of the answers, not translating the exact words of the patient. This scenario is much less likely with an official interpreter.
Do you need a chaperone to protect yourself professionally? Or is the patient a potential risk to you, the other health professionals, or the other patients in the area? Are you considering infection prevention in waiting rooms and within the consultation area?
Share any difficult consultation scenarios you may have experienced, as a health professional or as a patient or carer.
How did you deal with the situation?
Silverman, J., Kurtz, S., and Draper, J. (2005) Teaching and Learning Communication Skills in Medicine. Abingdon, UK: Radcliffe