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The Flipped Consultation

Seeking to deal with distress through social and psychological approaches, exploring opportunities for change, before biomedicalising.
When people are faced by demands in their daily life which outstrip the resources they can draw on to manage them, this can lead to exhaustion and burnout. A consequential stress response by the body can lead to new symptoms, for instance, fatigue, palpitations, or swallowing problems. Addressing underlying social or psychological triggers and contributors to this imbalance can help to break the exhaustion cycle, which can otherwise perpetuate some medically unexplained symptoms. We’ve discussed how we suspect Omar’s swallowing problems to be due to stress and anxiety. Here I’m going to introduce to you the flipped consultation, a different approach we can take to help develop an explanation for Omar’s symptoms and support him to manage better day-to-day.
The flipped consultation is a socio-psycho-bio assessment. It was originally developed by a team of GPs working with a mental health charity to understand how we can offer whole person healthcare to people presenting with distress. This approach seeks to deal with distress through social and psychological approaches, exploring opportunities for change, before biomedicalising. A biomedical risk assessment would still be required, for example, to rule out psychosis in someone presenting with distress, but the outward appearance to the patient would be of a socio-psycho-bio assessment. By using the flipped consultation, we focus on Omar’s illness in the context of his daily life; his whole lived experience.
We work with Omar to co-construct a personalised narrative or explanation of his illness; one which can help Omar be part of the solution to making sense of and dealing with the problem. In other words, mobilising potentially the most valuable asset we have in a consultation – the creative capacity of the patient themselves. The flipped consultation recognises and uses the resources of not only individuals such as Omar, but also their community, for example, through the use of a social prescriber and access to local support groups. It also allows an opportunity for use of time as a diagnostic tool, with continuity of care through shared ongoing reassessment of symptoms.
Taking this alternative approach can be difficult with patients whose care has already been medicalised. Asking open questions and being curious about a patient and their symptoms can be a great starting point. In the next sections, we’ll discuss in more detail how we can harness Omar’s creative self and how the flipped consultation might be applied to help him

In this video, Dr Annabelle Machin will introduce the flipped consultation, a socio-psycho-bio assessment. She will talk about situations when we might consider this alternative approach and how it could help us to involve patients in making sense of their symptoms.

Video references

Reeve J, Cooper L, Harrington S, Rosbottom P, Watkins J. Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention. BMC Health Serv Res. 2016; 16:470. DOI: 10.1186/s12913-016-1726-6

Lucassen P, Reeve J, Postma S, Hartman TO, van Ravesteijn H, Linssen M et al. Feeling blue, sad, or depressed: how to manage these patients. BJGP. 2018; 68 (672): 330-331. DOI:

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