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At the heart of general practice since 1960

How to improve consultation skills

From Dr Chris Manning

CEO Primhe and adviser to the

NHS Alliance

GPs have always been good at piping up, so I guess the call to 'become plumbers' is very apt (News, 30 March). It is also a highly appropriate metaphor for a profession that has become increasingly mechanistic, reductionist and organ-bound.

It is no wonder the Cartesian principles that attempt to pare our complexity down to fit a randomised controlled trial create the levels of illogical havoc that result. A fine example of this is the latest 'evidence' (or seeming lack of it) for screening for depression and diabetes.

The association is now well established (as both cause and effect). Further, people do not have to worry about whether the depression or the diabetes comes first ­ simply manage the whole person and address their brain-minds as well as their pancreases while doing so.

People are often in predicaments anyway before they acquire a diagnosis, so problem-oriented and solution-focused approaches have a lot going for them in most consultations. Primhe calls it 'predicamental' health care.

These people with depression, diabetes and IHD (or a combination thereof) are the same people who have always 'swamped' general practice. GPs who feel swamped are having that feeling because they have lost their ability to see the whole person, having had them converted into a whole raft of targets and matching organs.

It may be time to learn some skills that will assist you in every consultation.

Form a good therapeutic alliance with your patients, offer them hope, place high value on your person-centred practice and make sure your consultation skills blowlamp is up to soldering effective connections.

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