Five cards: a simple guide to beginning the consultation

摘要

Although it is widely accepted that the doctor should allow the patient to speak freely at the start of the consultation, many doctors find it difficult not to interrupt, and tend to medicalise the patient’s presentation prematurely. To help overcome these tendencies we use a simple description of the consultation as consisting of three parts, according to who should be leading the dialogue at the time (Figure 1).1–3 The consultation begins with the ‘Patient’s part’, during which the patient has the freedom to express their pre-consultation experience (symptoms, problems) and thoughts (ideas, concerns, and expectations [ICE]). Next comes the ‘Doctor’s part’, when the doctor selectively gathers information relevant to the task of translating the patient’s narrative from ‘lay’ language into ‘medical’ constructs. Finally, in the ‘Shared part’, doctor and patient cooperate to arrive at plans and decisions acceptable to both of them.