Introduction
This essay explores the significance of consultation models in the context of prescribing practice, aiming to understand their purpose and rationale in guiding clinical interactions. It briefly examines two prominent models—Neighbour’s and Calgary-Cambridge—highlighting their key features. The discussion then shifts to the application of these models within prescribing, identifying barriers to their effective use and supporting this with relevant evidence. Finally, the essay considers how these models align with or diverge from the specific demands of prescribing practice. Through this analysis, a broad understanding of consultation frameworks and their practical implications is developed, acknowledging both their value and limitations.
Purpose and Rationale of Consultation Models
Consultation models serve as structured frameworks to guide healthcare professionals in delivering effective patient interactions. Their primary purpose is to ensure systematic communication, enabling practitioners to gather relevant information, address patient concerns, and reach shared decisions. The rationale for using such models lies in their ability to enhance consistency and quality in consultations, fostering patient-centered care while minimizing errors in clinical decision-making. As a prescriber, adopting a model provides a scaffold to balance clinical priorities with interpersonal skills, ensuring safer and more effective prescribing outcomes.
Two models frequently referenced in healthcare are Neighbour’s and Calgary-Cambridge. Neighbour’s model, developed in 1987, emphasizes a five-stage process: connecting, summarizing, handing over, safety-netting, and housekeeping (Neighbour, 1987). Its key features include building rapport through connection and ensuring clarity by summarizing key points, alongside safety-netting to anticipate potential issues. This structured yet flexible approach is particularly useful in prescribing, where clear communication about medication plans is essential. Conversely, the Calgary-Cambridge model, introduced by Kurtz et al. (1998), offers a detailed guide with stages such as initiating the session, gathering information, and providing structure (Kurtz et al., 2003). Its strength lies in its focus on patient-centeredness and communication skills, such as active listening and empathy, which are critical for understanding patient needs during prescribing consultations.
Barriers to Using Consultation Models in Prescribing Practice
While consultation models offer valuable guidance, several barriers hinder their application in prescribing practice. One significant obstacle is time constraints, as prescribers often face pressured environments with limited appointment durations. Indeed, this can result in rushed interactions, where fully adhering to a model’s stages becomes impractical. Supporting this, a study by Dugdale et al. (1999) highlights that time scarcity often compromises the depth of patient engagement, a core component of models like Calgary-Cambridge (Dugdale et al., 1999).
Additionally, the complexity of patient cases in prescribing can challenge model application. Patients with multiple comorbidities or unclear symptoms may require deviations from structured frameworks to address urgent clinical needs. For instance, focusing strictly on Neighbour’s safety-netting might overlook immediate prescribing decisions. Furthermore, a lack of training in communication skills can impede effective use of these models. Research by Silverman et al. (2013) suggests that while models are theoretically sound, practitioners often struggle to integrate skills like empathy or negotiation without adequate preparation (Silverman et al., 2013).
Application of Consultation Models to Prescribing Practice
In prescribing, consultation models like Neighbour’s and Calgary-Cambridge are generally applicable, as they promote structured interactions critical for accurate medication decisions. Neighbour’s emphasis on summarizing and safety-netting aligns well with ensuring patients understand dosage instructions and potential side effects. Similarly, the Calgary-Cambridge model’s focus on gathering information supports thorough history-taking, essential for safe prescribing. However, their rigid structure can sometimes be misaligned with the dynamic nature of prescribing, particularly in acute settings where rapid decisions are prioritized over prolonged dialogue.
Arguably, these models may not fully account for the unique aspects of prescribing, such as the legal and ethical responsibilities tied to medication authorization. For example, while empathy and rapport-building are vital, they must be balanced with clinical detachment to avoid over-prescribing under patient pressure. This tension suggests a need for tailored adaptations of models to fit prescribing contexts, possibly integrating specific steps for risk assessment and regulatory compliance.
Conclusion
In summary, consultation models such as Neighbour’s and Calgary-Cambridge provide a robust framework for structuring patient interactions in prescribing practice, promoting clarity and patient-centered care. Their purpose lies in ensuring systematic communication, though barriers like time constraints and case complexity can hinder their full application. While broadly relevant, these models require adaptation to address the unique demands of prescribing, including legal and ethical considerations. Therefore, future training for prescribers should focus on integrating model-based skills with context-specific competencies, ultimately enhancing both patient outcomes and professional practice. This balance remains essential for navigating the challenges and opportunities within prescribing consultations.
References
- Dugdale, D. C., Epstein, R., and Pantilat, S. Z. (1999) Time and the patient-physician relationship. Journal of General Internal Medicine, 14(Suppl 1), S34-S40.
- Kurtz, S., Silverman, J., Benson, J., and Draper, J. (2003) Marrying content and process in clinical method teaching: Enhancing the Calgary-Cambridge guides. Academic Medicine, 78(8), 802-809.
- Neighbour, R. (1987) The Inner Consultation: How to Develop an Effective and Intuitive Consulting Style. Lancaster: MTP Press.
- Silverman, J., Kurtz, S., and Draper, J. (2013) Skills for Communicating with Patients. 3rd ed. London: Radcliffe Publishing.
