'Previous authors have spoken of doctor-centred medicine, and sought to replace it with patient-centred medicine. I have argued for the authority of the consultation to be earned so that the imperatives of the illness, the patient and the doctor are all served. The management plans that emerge from this approach have a better chance of matching the reality of the situation in which the consultation takes place. Patients are astonished at being listened to in this way, doctors recover their vocations and illnesses are managed better.'
Peter Bailey, author
The consultation is endlessly varied and humans are very difficult to understand. Each of us lives our life in the centre of our own private universe of thought and feeling. Reaching out from that privacy and connecting with others is what gives our lives meaning. Our lives are rich when we communicate and impoverished when we are unable to do so…Patients’ stories are infinitely varied, complex, chaotic, recursive and mysterious. Stories emerge in fits and starts, and it is the physician’s task to work with the narrative in order to manage the issue that has been presented in a way that does justice to the complexity of the individual…
This inspirational guide provides an innovative framework for understanding the consultation. It is concise, easy-to-read and highly accessible, presenting a simple and easily remembered non-linear diagram which facilitates the understanding of this richly complex process.
Inspired by the work of Balint, it beautifully reflects the narrative of the consultation in its tone, with examples and anecdotes illustrating key concepts.
It is highly effective as a primary teaching aid for undergraduate medical students, as a refresher for those in practice, an aide memoire to good consulting, a template for case analysis and reflection, and a diagnostic aid when consultations have gone wrong. The approach is recommended for all GP trainees, nurse practitioners and pharmacists where it has proven to be an immense help at all levels of experience and skill.
Foreword • Preface • About the author • Part one: The synoptic view of the consultation • Introduction • The puzzle and the picture: introducing the synoptic view • The doctor • The patient • The illness • The patient’s story of the illness: fractals • The patient’s story of the illness: narrative • The patient’s story of the illness: somatisation • The doctor’s story of the illness • The doctor–patient relationship • The three golden questions • Working with children • The social context of the doctor • The social context of the illness • The social context of the patient • The authority of the consultation • Part two: Consultations that go wrong: using the synoptic view as a diagnostic aid • Introduction • Dysfunction: the doctor • Dysfunction: the patient • Dysfunction: the illness • Dysfunction: the patient’s story of the illness • Dysfunction: the doctor’s story of the illness • Dysfunction: the doctor-patient relationship • Dysfunction: the social context of the doctor • Dysfunction: the social context of the illness • Dysfunction: the social context of the patient • Part three: Personal reflections on other models of the consultation • Models of the consultation • References • Index