Challenges in practice
Unintentional impact of language
The GP would justify putting Mr Patel as her first concern here, but this results in dismissing the family context that influences his decision for what would be in Parvati's best interests. She is trying to be his advocate, using the phrase "but it's not really about the family, it's about you" which closes down the opportunity to understand their views; the language used towards the conclusion is very definite and directive- meet with the family to explain what's needed.
This wasn't a judgemental or dismissive approach, yet the cultural preferences were insufficiently responded to here. Just like another of the alternate endings, no definitive decision is reached yet the outcome and plan here feels different due to the phrases adopted by the GP.
The circumstances relevant cultural differences and or preferences of those involved were insufficiently responded to
Examiners felt that you might not have made full use of the information given by the patient to you during the consultation. You may not have sufficiently demonstrated the ability to work in partnership with your patient to develop a shared management plan. It is important to take account of the patient’s agenda, health beliefs or preferences in the development of a management plan.
For example, a coughing patient whose neighbour has lung cancer may need particular reassurance or investigation to assuage their fear. Another patient who is vaccine hesitant due to health beliefs which are understandable and strongly held in their community might be receptive to signposting of resources produced by community leaders and a non-pressurising approach.
Patient-centred doctors are responsive to patient preferences about their health. This does not mean you can/should always be patient led. But the information about their unique situation and preferences should inform how you proceed and what you do next.
Suggestions
Practice responding appropriately to your patients’ agenda and preferences, incorporating these where possible into your plans and explanations. Try to involve patients in making decisions wherever possible.
There are many educational resources about consulting skills (both in print and online) that will help.
The examiners felt the consultation was insufficiently person-centred.
It is important to understand the context of the illness; and attach importance to the subjective aspects of medicine. This means always seeing the patient as a unique person and being curious; then valuing patient preferences and expectations.
For example, a patient whose neighbour has lung cancer may have fears about their own cough. Another patient may be vaccine hesitant due to health beliefs which are understandable and strongly held in their community.
Suggestion
Ensure you explore the person's ideas, concerns and expectations; also consider the impact the situation has had on their life.