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Case study feedback

Now you have listened to and discussed the consultation, read through the following feedback and compare your discussion points.

Does the clinician use an identifiable model for the consultation?

It appears that the clinician has used a mixture of the Pendelton and the Neighbour model.

Following the Neighbour model, the clinician builds rapport through the consultation and at times does a recap of the patients presenting complaint to ensure they have understood what they have been told.

In following the Pendelton 7- task model, the clinician with the patient, chooses an appropriate action for each problem when discussing how to deal with chest infection, further investigations etc.

Was it appropriate to hold this consultation remotely?

There is no right or wrong answer for this consultation. Having carried out the consultation via video link, the clinician can make a judgement call regarding the patient’s presentation for any acute signs of distress. On the other hand, seeing the patient face-to-face would have allowed for better physical examinations and the use of calibrated devices in the clinic.

Did the clinician take basic observations during the consultation? Were there any particular that might have been useful?

No they did not, they only asked the patient if they had checked their temperature and they didn’t ask what type of thermometer they used to determine level of accuracy. The clinician could have checked to see whether the patient has any observation equipment such as pulse oximeter and a blood pressure machine. In this case, they could have carried out:

  • Blood pressure check
  • Oxygen saturation
  • Pulse rate check
  • Respiratory rate check

Could the clinician have made use of any risk stratification tools whilst in the consultation? If so, which ones?

NEWS2 score could be employed based on the observations in the event that the patient had the equipment (e.g BP machine and pulse oximeter) and was capable of measuring them. Risk assessment of their asthma could have been carried out e.g. are they wheezing, are they able to complete sentence in one breath.

Did you pick up on any safeguarding issues during the consultation? What were they?

Potentially there may be issues with the parent struggling to cope with being able to look after herself and her son. There maybe financial pressures where the patient is struggling to buy food for her son. The patient is concerned for her son, so there are no concerns over purposeful neglect, but it appears the patient does need more support.

Did you pick up on any red flags during the consultation? What were they?

The patient presented with:

  • Unexplained weight loss
  • Changes in taste
  • Reduced appetite
  • Childhood asthma

Did the clinician close the consultation appropriately?

The clinician has clear structured plan with the patient and invites to share her thoughts. This follows the ‘handing over’ step of the Neighbour model.

Did the clinician safety net the patient appropriately?

The patient has been given safety netting advice, but the information is vague in some places. For example, how long should she expect to see improvements in her symptoms once she starts the antibiotics, what kind of symptoms would need for her to go to hospital.

As the patient is a single parent and is unwell with potential risk of sepsis or acute attack of asthma it is important to ensure they have some support in case of an emergency.

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This article is from the free online course:

Conducting Remote Consultations and Triage

UCL (University College London)