Consultation refers to the process and method of collecting various clinical data necessary for diagnosing diseases and identifying problems through questioning and conversation. It is also a process of interaction and communication between doctors and patients, establishing a positive doctor-patient relationship, and promoting cooperation. The quality of the consultation not only affects the completeness and accuracy of the collected data but also impacts the scientific and effective nature of diagnosis and treatment, patient satisfaction, and even the rational use of healthcare resources.
General practitioners must not only inquire about the illness but also about the person, their background, relationships, and influences. Therefore, they must master consultation skills that differ from traditional methods.
1. Pay Attention to the Consultation Context
The consultation takes place in various settings, such as clinics, hospital wards, homes, or workplaces. The requirements for the consultation environment include: no noise, maintaining quietness and cleanliness, relative soundproofing, patient satisfaction with confidentiality, bright yet soft lighting, appropriate temperature, comfortable facilities, and good hygiene.
Participants should be appropriate, respecting the patient’s privacy and not affecting the consultation’s effectiveness. Elderly patients, children, those with hearing or speech impairments, extremely weak or confused patients, and those with mental health issues should have someone accompany them. Generally, it is best for only the doctor and patient to participate, as this facilitates communication and understanding, protects the patient’s privacy, and encourages them to provide accurate medical history.
General practitioners should also pay attention to their appearance, including hairstyle, glasses, grooming, makeup, clothing, facial expressions, behavior, body posture, language skills, and non-verbal communication (tone, speed, pitch, and intonation). They should also be aware of how their age, gender, education, title, technical level, knowledge, concepts, attitudes, and interpersonal skills affect the consultation.
General practitioners should observe the individual characteristics of patients. Different patients and needs require different consultation methods and procedures. First, assess if it is an emergency; if so, address the pain and life-threatening issues before delving deeper into the patient’s health problems. Additionally, understanding the patient’s age, gender, appearance, who accompanies them, how they enter and sit down, their facial expressions, and their non-verbal communication are all important clinical data that help the general practitioner assess the patient’s characteristics, the nature of health issues, and the patient’s needs and expectations. Furthermore, understanding the patient’s education level, occupation, economic status, family situation, and religious beliefs directly influences their expectations regarding the consultation outcome. Success can only be achieved by aligning with the patient’s expectations.
General practitioners should be mindful of their position, posture, and distance from the patient. The patient should sit on the doctor’s right side, with the doctor slightly angled towards the right, facilitating face-to-face communication. This positioning allows the doctor to examine and interact with the patient more naturally while taking notes and maintaining direct eye contact, which helps adjust the distance between the doctor and patient. If the patient sits on the left, it becomes awkward for the doctor to examine and interact, making the patient uncomfortable. The doctor should lean slightly forward, maintaining eye contact to convey attention, encouragement, empathy, resonance, and care, while avoiding unrelated activities such as answering phones during the consultation. The distance between the doctor and patient should be about half a meter; too close can be uncomfortable, while too far hinders communication.
2. Arrange a Reasonable Consultation Procedure
Different patients require different consultation procedures, generally falling into three categories:
(1) Chronic patients with first-time contact. The consultation procedure should be: guided inquiry – ask about the main issue for this visit (including chief complaint, current medical history, and brief past health history) – inquire about the patient and their background – ask about the patient’s medical history – explore the connection between the patient and health issues – finally, clarify the issues further.
(2) Emergency patients. Start with direct questions about the illness or health issues, then refer them promptly or wait until their condition stabilizes before inquiring about their background – ask about their medical history – explore the connection between the patient and health issues – finally, clarify the issues further.
(3) Recurrent patients with established health records. Spend a few minutes reviewing the patient’s health records (understanding the patient and their background, past health status) – ask about the current issues and objectives of the visit – inquire about the background of this visit – explore the connection between the current issues and the patient and their background – finally, clarify the issues further.
3. Use Appropriate Inquiry Methods
(1) Closed inquiry: Questions provide options for answers, such as yes/no, pain/no pain, present/absent, etc. This method is often used to inquire about symptoms, signs, and past health status, and can also clarify related issues. The advantage of closed inquiry is that it gets straight to the point, directly addressing the necessary information, yielding precise answers, and saving time, especially suitable for emergency patients. However, the downside is that it narrows the scope of inquiry, potentially leading to fixed thinking in patients and misguiding them, making it difficult to obtain comprehensive and detailed information, and not easily understanding the patient’s true feelings. Closed inquiry corresponds to focused thinking, often centered on the disease and aimed at gathering disease-related information.
(2) Open inquiry: Questions do not provide options for answers but guide the patient to recall certain aspects, allowing them to narrate in their own time sequence, language, and concepts, unrestricted by the doctor’s thought patterns. The advantage of open inquiry is that it is unrestricted and free from fixed thinking, allowing patients to express themselves, which can uncover issues the doctor may not have considered. However, the downside is that patients may struggle to focus, not know where to start, or distinguish between relevant and irrelevant issues, which can waste time. Open inquiry corresponds to radiating thinking, often centered on the patient and aimed at gathering patient-related information.
4. Clarify the Content of the Inquiry
(1) Guided inquiry: This includes the opening remarks, such as standing to greet the patient, saying hello, introducing oneself, inviting the patient to sit down, and inquiring about the patient’s general situation, while finding common ground to alleviate the patient’s anxiety, improve the doctor-patient relationship, and gain the patient’s trust. For example, a doctor might say: “Oh! We are from the same hometown!” “You were in the army? I also served!” “I had a similar illness before; I understand how you feel.” A successful doctor can often predict the patient’s issues and emotions through observing their physical and behavioral characteristics, addressing the patient’s most pressing concerns with a single question, making the patient feel that the doctor is empathetic and experienced, capable of identifying the core issues and effectively helping them resolve their problems. The doctor’s appearance, qualities, charisma, interpersonal skills, communication techniques, service attitude, and philosophy all influence the quality of the consultation.
(2) Ask about health issues related to this visit: For example, “What main issue do you want to address today?” “What is the primary reason for your visit?” “What problem do you hope I can help you with?” “What do you think is wrong with you?” These inquiries are open-ended; once the patient states the main issue, the doctor should follow up with closed inquiries based on diagnostic hypotheses to gain a comprehensive understanding of the problem in a short time. For instance, if the main issue is sleep disturbance, the doctor should thoroughly inquire about the sleep status and the nature of the disturbance, when it started, how long it has lasted, possible causes, what happened at the time, factors affecting sleep, patterns, experiences, past health issues, and their connection to the sleep disturbance, etc. Generally, inquiries should cover the main symptoms, signs, feelings or experiences, onset time, duration, nature and characteristics of the problem, occurrence, development, and changes, treatment history, and past medical history, including a systematic review. The systematic review can be conducted through questionnaires, which are more comprehensive and save time.
(3) Inquire about the patient and their background: Start with social background, such as: “How is your work situation?” “Are you satisfied with your job?” “What is your economic status?” “Are you interested in religion?” “How are your interpersonal relationships?” “What aspects of society do you think affect your health or relate to your issues?”
Ask about community background, such as: “Do you think there are factors in your living and working environment that affect your health?” “Do people around you have similar issues?”
Ask about family background, such as: “How do you feel about your family life?” “What aspects of family are particularly important to you?” “What regrets do you have regarding your family?” “Do you think your issues are related to your family?”
Ask about personal background, such as: “Can you talk about your upbringing?” “What is the most memorable thing for you?” “Is it related to your current issues?” “How do you perceive your personality?” “What personality traits have the most significant impact on your life?” “Do you think they are related to your current issues?” “Are there any stressful situations in your life? How do you cope?”
Ask about disease background, such as: “How has your health been over time?” “When did changes occur?” “What health issues have impacted you the most?” “How have they affected you, in what ways?”
Ask about the patient’s overall characteristics, such as: “What is your greatest pursuit?” “What are your views on life and existence?” “What supports you emotionally?” “Why or for whom are you striving?” “What do you see as the main meaning or value of life?” “What are your life goals or plans?” “Has your current health issue affected your life plans?”
(4) Inquire about the medical background: Ask the patient about their expectations for the consultation, such as: “Why did you come to see me instead of going to another hospital or doctor?” “What issues do you hope I can help you with? How do you want them resolved?”
Ask about the reasons for the visit, such as: “Why today, rather than yesterday or tomorrow?” “Why emphasize this issue over others?” “What prompted you to seek medical attention?”
Ask about the patient’s needs, such as: “Do you think relieving physical pain is more important than alleviating mental stress?” “What are your biggest concerns?” “Do you feel your sense of security is threatened?” “Are you comfortable with my services?” “Are you satisfied with our relationship?” “Do you want to understand your issues better?” “Do you wish to be more involved in the treatment process?”
Ask about the patient’s beliefs regarding the causes of their illness, such as: “What do you think is going on with your issues?” “What do you believe caused your current problems?” “Are you clear about the origins of your health issues?”
Ask about the patient’s health belief model, such as: “Do you usually pay attention to your health?” “How important do you think health is?” “Under what circumstances do you typically seek medical attention?” “Do you often take preventive measures against diseases?” “Do you think it’s necessary to quit smoking or drinking?” “Do you consider your health issues serious?” “Are you currently worried or afraid about your health status?”
Ask about the impact and significance of the illness on life, such as: “How do you think being ill has affected your life?” “Do you wish to recover your health quickly?” “Do you see any benefits from being ill?”
(4) Explore the connection between the patient and health issues: We have discussed many aspects; please think carefully about which aspects your issues are mainly related to, especially in your life.
(5) Clarify the issues: What do you now believe the real problem is? What is the true cause? Who is your issue related to? Let’s sort through the origins of the problem together.
(6) Farewell remarks before the patient leaves: The doctor can say: “Since you came to me, we are good friends. I will take responsibility for you as I would for my family. If I cannot solve your problem, that’s okay; I will help you find a hospital or doctor who can. Regardless, I will not abandon you.”
5. Utilize Unique Consultation Techniques
(1) Pay attention to your appearance: The doctor’s appearance should be serious, tidy, and hygienic, making the patient feel that they are in good hands, safe, and approachable, facilitating communication.
(2) Use language skills: Tailor your questions to different patients, addressing their concerns directly, making them feel understood. The tone should be deep and resonant, maintaining a moderate speed, with a pitch that is not too high, creating a sense of calm, trust, and respect. A high-pitched, fast-paced voice may convey impatience, restlessness, carelessness, and disrespect.
(3) Enhance quality charisma: Qualities that patients appreciate in doctors include enthusiasm, sincerity, equality, respect, approachability, understanding, and empathy.
(4) Questioning techniques: Use simple language, avoiding medical jargon; ask one aspect at a time, making it easier to answer; follow a logical sequence to help the patient clarify their thoughts; avoid interrupting the patient’s recollections; and arrange light breaks to adjust the patient’s emotions.
(5) Listening techniques: The focus of the consultation is not on questioning but on listening. Lean slightly forward, maintain eye contact, avoid unrelated actions, and provide timely feedback, such as nodding, raising eyebrows, and encouragement. The doctor can say earnestly: “Ah! Really, that’s very important, please continue, take your time, don’t rush.” Sometimes, repeating what the patient has said can help clarify issues. If the patient struggles to understand something, provide explanations, analogies, and discussions to reach a consensus. When patients have difficulty expressing themselves, offer examples or analogies for them to choose from, such as: “You feel a lump that is very hard; how hard is it? Like a rock or like the tip of your nose?” When patients are emotionally agitated, show understanding and redirect their attention; sharing personal experiences can help. If a patient becomes too emotional to continue, assist them in adjusting their breathing rate, encouraging slow breaths. When patients are overly tense, introduce light-hearted topics to help them relax. For depressed or slow-thinking patients, the doctor should be patient, gently guiding them when they are silent. When patients are angry, learn to take responsibility, even to the point where the patient feels embarrassed, as their anger is often not directly related to the doctor. Also, learn to express gratitude, thanking the patient for their trust, for sharing important matters, for their cooperation, and for returning for consultations. The quality of the consultation largely depends on the doctor’s mindset; viewing the patient as a bother or reducing medical service to mere diagnosis and prescriptions will not ensure quality. Treating the patient as a relative or friend, with a grateful attitude, will lead to success.
(6) Persuasion techniques: Use personal experiences to persuade patients, present facts, use everyday reasoning, and motivate them. Human potential is limitless; often, the factors limiting potential are subjective attitudes, views, and beliefs. Provide patients with more knowledge, correct misconceptions, change negative beliefs, and adjust their mindset to build confidence, unleash potential, and promote active recovery.
