Consultation Structures: What Each One Is For

Illustrative private consultation showing attentive clinician–patient communication

Before we begin

“Two clinicians see Richard on the same day. One finishes in 10 minutes with a plan he never follows. The other takes 12 minutes and he books the follow-up. Same advice. What differed?”

The teaching

A consultation model is a map, not a script. Different maps answer different questions.

Model	Origin	What it is best for	What to watch
Pendleton's seven tasks	Pendleton et al., 1984	Reviewing a consultation: did we define the reason for attending, consider other problems, choose action together, share understanding, involve the patient, use time well, keep the relationship? Includes ICE (ideas, concerns, expectations) inside task 1.	A checklist of tasks, not a sequence; easy to tick and still miss the person
Neighbour's five checkpoints	Neighbour, 1987	Pacing and safety: Connecting, Summarising, Handing over, Safety-netting, Housekeeping	Written for short appointments; in private, longer-form practice it becomes a way to use the extra time deliberately. The "housekeeping" step (look after yourself) is the one most often dropped
Calgary-Cambridge guide	Kurtz & Silverman, 1996	Teaching and observing skills: initiating, gathering information, physical examination, explanation and planning, closing, with building the relationship and providing structure running through every stage	Detailed; best as a teaching framework rather than something to recite

Calgary-Cambridge's useful idea for this course is the two-thread structure: a content thread (what is covered) and a process thread (how it is covered). Most poor consultations have good content and poor process.

Rogers' core conditions

(Carl Rogers, person-centred approach): empathy, unconditional positive regard (acceptance), and congruence (genuineness). These come from counselling, not consultation. They are not a structure and they have no time limit. They are the attitude that makes any of the structures work. For a coach, they are often the most directly applicable idea in the whole module.

What transfers, what does not (translation box)

Practitioner	Coach
Use a structure to hold history, examination, differential, and plan together	Use the relationship and process threads; do not replicate history-taking for diagnosis
Neighbour's safety-netting is a clinical duty	Safety-netting becomes "know your referral triggers" (links to Lesson 3.2 Scope & Referral)
ICE is used to uncover the reason for attending and expectations of tests/treatment	ICE is used to uncover what the person wants, believes about their health, and fears

Where this sits in the HSI Method

Assess (gather information with process skills) → Integrate (summarise back, check understanding) → Prioritise (agree what matters first, with them) → Personalise (shared plan) → Measure (agree follow-up).

Myth vs Reality

Myth

A consultation model is a rigid script that makes you sound robotic.

Reality

Models are for learning and review. Experienced clinicians stop reciting them and keep the habits.

Dr Haq’s 30 Seconds

A short personal take from your course director

Recording to come — 20–40 seconds in Dr Haq’s own words.

A note on the evidence

These are teaching frameworks, not interventions with outcome trials of their own. The honest claim is that structured communication training is a standard part of medical education and that these models are widely used for it, not that using Model X improves outcome Y.

Patient Journey — Checkpoint 13

Continuing case

Richard Okafor46 yearsFinance director

Richard returns for his follow-up. Before, he said "all my bloods are normal, so there's nothing to work on." Now he says: "I just want you to tell me what to take." Using Pendleton task 1 and ICE, write three questions that would uncover what "tell me what to take" is really asking for.

How would you apply the lesson to this conversation?

Mini case

Priya, 38, arrives wanting a "longevity panel" she saw on social media. Using ICE, what are her idea, concern and expectation? What happens to your plan if her concern is a parent's recent dementia diagnosis rather than a wish to optimise?

Reflect before you move on

Which of the five Neighbour checkpoints do you most often skip when you are short of time, and what does that cost the person in front of you?

Short video (Dr Haq) · model comparison table · translation box · case exercise.

References

Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: An Approach to Learning and Teaching. Oxford University Press, 1984. (Seven tasks incl. ICE in task 1; via GPnotebook.)
Neighbour R. The Inner Consultation. MTP Press, 1987. (Five checkpoints; via GPnotebook.)
Kurtz SM, Silverman JD. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ 1996;30:83–89. (Task list and two-thread structure.)
Rogers CR. On Becoming a Person. 1961. Core conditions summarised in StatPearls, NBK589708.
Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005;55:305–312. (via NCBI DARE NBK71656.)
Cahill K, Lancaster T, Green N. Stage-based interventions for smoking cessation. Cochrane Database Syst Rev. 2010;(11):CD004492. https://www.cochrane.org/evidence/CD004492_are-stage-based-interventions-more-effective-non-stage-based-ones-helping-smokers-quit
Gigerenzer G, Edwards A. Simple tools for understanding risks: from innumeracy to insight. BMJ 2003;327:741–744.
West M. Compassionate leadership: attending, understanding, empathising, helping (via FMLM materials).
Elwyn G et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891. https://www.bmj.com/content/359/bmj.j4891
Rubak et al. Full review: https://bjgp.org/content/55/513/305
Gigerenzer & Edwards: https://www.bmj.com/content/327/7417/741

Consultation resources

Revisit Lesson 3.2: scope and referral

Key Points

Pick one structure and use it deliberately for a week.
Ask ICE in every first appointment.
Give every number a meaning and a next step; use natural frequencies.
Reflect before you advise.
Name your scope and your referral route in one sentence.

Module 4 overview Building the Relationship: Person-Centred Communication

Curriculum contents