The language the GP uses here is from a perspective of seeking permission- after clarifying the concern about combining Ibuprofen with Prednisolone, the GP uses signposting to suggest the topics for discussion, and introduces the wider issues of Jane re-engaging with her long term condition monitoring alongside support for her and George "If that's ok with you" to which Jane is receptive from her tone and approvals.

Notice the body language of the GP, softening her posture, making herself smaller and segmenting each suggestion to check for ongoing agreement.

While it doesn't occur, there's an opportunity in each of the GP's frequent pauses to respond should Jane raise an objection or indicate a problem through her facial expression. 

Shared Decision Making hasn't been facilitated by simply doing these techniques in the management phase of a consultation. It begins from the first seconds of the consultation, and when the GP decides to make the first interruption. In this consultation the patient needed further prompting early in the first minute, but minimal encouragers to keep the patient talking show that the Patient is in control of what they want to say about their probem- they've rehearsed how they'd like to introduce their issue before coming into the room!

The GP's responsibility is how they deal with the opening line, in terms of tone, eye contact, whether to ask an open or closed question, body posture, whether they interact with the computer and so on. 

What did Jane do in her opening gambit?

She tentatively apologised for taking so long to get into the consulting room.  

The GP's response was to validate her without need for apprehension, and this gave Jane the impression that she could proceed at the pace she needed to without being judged or needing to offer an apology. Responding to Jane's cue in this way set up the tone of the rest of the consultation, and GPs choose whether they respond to such cues at the time, or whether to pick this up further into a consultation so as not to disturb the flow of the patient in their part of the consultation. 

Jane hadn't planned on discussing her other issues by coming in, but she reflects that the Doctor 'broached it in the right sort of manner'

When exploring the support needed to facilitate the attendance for the investigations, the GP floated the idea of someone from the Church group, but Jane found her own solution of the neighbour, although we later find out about adult children who live further away, so the negotiation of solutions help to raise further choices and what's the most workable way forward. This plants the seed for future consultations to address the other health conditions Jane should be paying attention to in order to keep her in the best shape for long-term functioning and being there for George. 

GP consultations are often designed to find the solution that the patient already had at their disposal, and Shared Decision Making enables this discovery by being curious about what matters most. The Generated Possibilities include family, members of the Church group, Jane's Neighbour, the Carers Group at the practice and charitable organisation support. What systems are in place for Carers at your surgery?