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
CONSULTATION AND COUNSELING
BUDI UTOMO

Department of Public Health and Preventive Medicine

Faculty of Medicine, Universitas Airlangga
Surabaya

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Satisfied patients are less likely to file

formal or initiate malpractice
complaints. (Fong Ha, 2010)
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OUTLINE
 Effective Communication

 Doctor ‘s Communication

 Consultation

 Counseling

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
EFFECTIVE COMMUNICATION
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LINEAR MODEL of COMMUNICATION

Noise

SourceEncoding Message Decoding Receiver

Noise

Shannon and Weaver’s model of communication (1949)

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INTERACTIONAL MODEL of COMMUNICATION

Feedback

SourceEncoding Message Decoding Receiver

Schramm's Model of Communication (1954)

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HUMAN COMMUNICATION
 A social process in which individuals employ symbols to
establish and interpret meaning in their environment.

Richard West, 2010

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EFFECTIVE COMMUNICATION
identified as paramount in communication among individuals from
various parts of the globe (Rudd, 2007)

EFFECTIVE COMMUNICATOR
selects the correct organizational format for its presentation to an audience, a format that
is logical for the subject and that will naturally appeal to people’s minds. (Rowan, 2003)

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Communicator Audience

Persuasive

Theory of Discursive Aims (Kinneavy, 1971)

Theory of Informative and Explanatory Discourse (Rowan, 2003)

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“Communication works for those who work at it.”

John Powell

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
DOCTOR’S COMMUNICATION

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DOCTOR AS A COMMUNICATOR

 Patients

 Public

 Colleagues

 Other Professionals

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DOCTOR – PATIENT COMMUNICATION

 Purposes:

Good interpersonal relationship

Information exchange

Treatment decision making

 Goals (Discursive Aims):

Self Expressive

Reference

Persuasive

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DOCTOR – PATIENT COMMUNICATION

 Consultation

 Counseling

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
CONSULTATION
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DEFINITION

 The consultation is a situation when a patient seeks

medical information, advice and treatment from a
doctor

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THE STEPS OF CONSULTATION

 Initiating the meeting

 Problem Analysis

 Management Options

 Decision Making Process

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INITIATING THE MEETING

 Remember the first purpose!

 Make your patient feel welcomed and comfortable
 Give impressive opening remarks
 Be ware of non-verbal communication

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PROBLEM ANALYSIS

 CLUE: The second purpose!

 Seek out the reason for encounter of the patients
 Decide the need of RFE, Symptoms or Treatment
 Determine the type of treatment (continuous or
emergency)
 Beware of psychological reasons of RFE
 Conduct appropriate history taking and physical
analysis

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MANAGEMENT OPTIONS

 To treat or to refer

 Therapeutic interventions

 Patient education

 Follow-up and staggered consultations

 Family as resource

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REFERRAL
 A situation when a family physician refers his patient to a
specialist for his expert opinion, treatment or both.
 The consultant specialist takes over the management of this
referred patient and subsequently refers the patient back to
the family physician after the treatment has been completed.

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DECISION MAKING PROCESS

 The third purpose!

 Type of Decision Making Process

 Paternalistic
 Informative
 Interpretive
 Deliberative (Shared Decision Making)

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SHARED DECISION MAKING

 decisions that are shared by doctors and patients,

informed by the best evidence available and
weighted according to the specific characteristics
and values of the patient.
 For specific audience.

Brooks, 2007l

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Why SDM?

 Relationship: paternalistic deliberative

 Increasing patient autonomy and personal value

 Broader access to information

 Expanding clinical options

 Rising costs

 Ascendancy of chronic illness

 Complex tradeoffs
 Woolf, AIM, 2005
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What Kind of Decision?

 Uncertain or no clear evidence supporting one

testing, screening or treatment option over another
 Options have different inherent benefits/risks

 Patient values important in optimizing decision

Brooks, 2007l

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Steps in an Ideal Decision Making Process

 Define the problem.

 Identify the decision criteria.

 Allocate weights to the criteria.

 Develop the alternatives.

 Evaluate the alternatives.

 Select the best alternative.

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Barriers to SDM
 Clinicians
Challenge to physician autonomy
Don’t recognize preference sensitive decisions
Evidence difficult to extract, interpret, communicate
 Practice
Logistics Lack of time
Lack of reimbursement
 Patients
“Patients don’t want to participate”
Variation in role preference
Literacy, numeracy challenges
 Resources
Need portfolio of appropriate decision aids 06/13/2020
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Impact of SDM

 Increase Patient Involvement

 Improve Patient Knowledge balance, accuracy, consistency of

information
 Clarify Patient Values

 Improve concordance between values and choices

 Reduce Patient Decisional Conflict, Regret

 Improve realistic expectations

 Lower decisional conflict

Decrease number who are undecided
O’Connor, Cochrane Collaboration, 2006
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COUNSELING 

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 Counseling Principals
 The physician’s role is important for educating and assisting patients to
make behavioral changes.

 Counseling occurs along a continuum from very directive to very non-

directive.

 Behavior change is a process and not a one-time event.

 Patient-centered counseling reflects the values of the patient and physician

and medical evidence.

 Active participation by patients is an important part of the change process.

 Office systems are necessary to remind/prompt physicians to intervene.

Courtesy of Ockene on:
http://www.bu.edu/pace/conference/Conference%20Slides/Ockene.ppt
 Brief 5A Intervention Model
 ASK about tobacco use at every visit

 ADVISE all tobacco users to quit

 ASSESS willingness to quit

 ASSIST the patient in quitting

 ARRANGE follow-up contact

Primary Care Physicians Counseling
are Important for
for Health Enhancement (PPS)

Prevention and Intervention

 Provide continuity of care

 80% of adults visit an MD/year
 Credible information source
 People are aware of their health when visiting an
MD
 They are effective!
 Can refer to other providers
 Counseling for Health Enhancement (PPS)
Physician-Based Interventions: Criteria


Evidence-based; demonstrated to be effective

Brief; fit in context of regular medical visit
 Patient-Centered Counseling Model

Six general principles:


Accept patient where she/he is;
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Use medical evidence;
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Acknowledge patient autonomy and that he/she has the
answers;
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Build self-efficacy;
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Set realistic expectations for self & patient; and

Share responsibility.
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REFERENCES:
West RL, Turner LH. Introducing communication theory : analysis and application. Boston:
McGraw-Hill; 2007.

Parvanta CF. Essentials of public health communication. Sudbury, Mass.: Jones & Bartlett
Learning; 2011.

Adler RB, Rodman G. Understanding human communication. New York, N.Y.: Oxford University
Press; 2006.

Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: a review of the
literature. Social science & medicine (1982) 1995;40(7):903-18.

Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J 2010;10(1):38-43.

Clarke, G., Hall, R. T., & Rosencrance, G. (2004). Physician-patient relations: no more models.
The American Journal of Bioethics: AJOB, 4(2), W16–19. doi:10.1162/152651604323097934

Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and
implementation of public health interventions. Annual Review of Public Health, 31, 399–418.
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doi:10.1146/annurev.publhealth.012809.103604
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THANK YOU…
budiutom@gmail.com

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