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In this step, we will revisit the Neighbour model one last time. Housekeeping (the thumb!) is the final ‘task’ of the consultation and requires that the clinician mentally ‘check out’ between patients.

In his book titled ‘The Inner Consultation’, Neighbour describes the use of three questions that can be used to achieve the purpose[1]:

  1. In what state has the (previous) patient left me?
  2. In what state will the (next) patient find me?
  3. Am I in good enough shape for the next patient?

Answering the third question i.e. knowing when you are ready for your next patient, comes down to experience and knowing about yourself. It is important to have confidence, that irrespective of the feelings and anxieties that arrived as a result of your previous patient, you can proceed to devote your full attention to your next patient. Anything else would risk compounding anxieties and (potentially) errors, throughout the working day.

In the context of a remote consultation, this task is particularly important as barriers to communication across remote mediums could mean extra anxieties are carried forward into the next consultation.

[1] Neighbour R. The inner consultation. 2nd ed. Oxford: Radcliffe; 2005.

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Conducting Remote Consultations and Triage

UCL (University College London)