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The DESH model

Pulse's 'GP to be' Dr Deshani Shan has developed her own personal consultation model

My all-time favourite line from a film has to be 'Explain it to me like I'm a four-year old'.

Denzel Washington (playing homophobic personal injury lawyer Joe Miller) to Tom Hanks (AIDS patient and victim of unfair dismissal, Andrew Beckett) – Philadelphia, 1993. It's a film that changed the way we thought about HIV and it's a line that has stuck with me since.

Simplification is a much underrated talent. It's a form of translation. A kidney for vocabulary - filtering out irrelevancies while conserving meaning. In few professions is this skill required as relentlessly as in general practice, and I'm glad that it's given its due status in the CSA. It's a great shame that there is a pervading tendency in science and medicine for us to feel that simplistic thinking is unintelligent thinking. It's unfortunate too, but no doubt telling, that the very word 'simple' has such negative lay connotations in this respect.

With this in mind I have been exploring the vast minefield of consultation models that has cropped up since they first became fashionable in the 1960s, in an attempt to find one that resonates and feels wearable. With so many out there I soon experienced choice paralysis (a very real phenomenon, check out 'The Paradox of Choice: Why More Is Less', Barry Schwartz).

Like most of you, I imagine, I found a few concepts from many different models helpful, found some deeply unhelpful and found all a struggle to remember. So in an attempt to console myself and to finally draw a line under my quest for the holy grail of models, I have decided that if I can't beat them, I will join them.

Please find below my simplistic and unashamedly narcissitically titled (well, it worked for Apgar) but very usable model. Bear with me while I explain it to you like you're a four-year-old.

The DESH Model

D – Dig - look for clues for your puzzle and work out the answer

E - Explain – tell them your answer, show them how you worked it out, and talk to them about whether they had worked out the same answer or came to a different answer by themself

S - Shoulds – tell them what they should do now and if things get worse, what should happen next and when they should see you again

H – Handshake – stand up and shake their hand so they know their time is up. Give them all their bits of paper (prescription, PILS, Choose & Book forms etc) and remind them of when they should see you again.

So there you have it. The DESH model. Use it and abuse it.

I hope it gets you through your CSA and helps you run to time.

And remember, 'make everything as simple as possible, but not simpler.' That was Albert Einstein. He was a clever chap.

Dr Deshani Shan is a GP registrar at Concordia Parkside, a BMA committee member for Greater London GP Trainees and Lead Group Secretary for Kings College VTS.

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