Posted on Dec.05, 2009, under Tutorial
The purpose of medical consultation is to understand sickness in the context of someone’s life, drawing upon a broad range of approaches to awaken and support a person’s inner healing response. Health challenges impact many aspects of a person’s life, and many aspects of a person’s life can influence illness and the restoration of health. The success of any consultation depends on how well the patient and doctor communicate with each other. There is now firm evidence linking the quality of this communication to clinical outcomes. In the early 1980’s, Goldman, Lee and Rudd published the often-cited “10 Commandments of Consultation”, which effectively defined a practical standard for internal medicine consultation. Consultants were advised to:
- clarify the question
- determine the urgency of the consultation
- gather data independently rather than relying on that previously obtained
- be brief and succinct
- state the differential diagnosis concisely and be specific in recommendations
- anticipate potential problems and provide options
- honor the roles of other caregivers teach with tact
- maintain direct personal contact with the consulting physicians
- follow up with periodic notes and, where appropriate, recommendations.
Keep a good communication between doctor and patients is utmost importance, try to avoid whenever possible using a family member to translate. More often than not, you will be wasting your time; you will be unsure of the history and you will be unsure whether the doctor actually understands your problems. The phone translator services are usually quite good.
While all physicians have a duty to seek medical consultation when confronted with problems beyond their expertise, the acceptance of a consultation referral by the internist implies certain additional duties. The consultation and its documentation should be carefully constructed to meet these duties and to avoid misunderstandings.
Once the patient and doctor have agreed that psychological distress is an important factor in the patient’s illness, they can start to examine management options to address this. Even if the patient has significant physical disease, it is important to detect and manage psychological comorbidity.