adherence and health outcomes. Consequently, the success and cost-effectiveness of
health care services depends critically on consultation management. Use of good
communication skills in consultations has been found to affect a range of health
outcomes from emotional well-being to blood pressure and blood sugar concentration
(Stewart, 1995). Yet it is all too easy for consultations to go wrong. The Toronto
Consensus Statement on Doctor–Patient Communication (Simpson et al., 1991)
noted that 54 per cent of patient complaints and 45 per cent of patient concerns were
not elicited by doctors and that in up to 50 per cent of consultations the patient and
the doctor did not agree on the nature of the main presenting problem. This may be
because patients are sometimes interrupted too quickly by health care professionals who
want to identify and resolve patients’ problems as efficiently as possible. Consultations
serve different purposes and involve different groups of patients but key principles
underlying effectiveness have been identified.
Many models of successful doctor–patient consultations have been developed. For
example, after analysing 2,500 taped consultations, Byrne and Long (1976) identified six
phases, which form the structure of successful consultations. They suggested that the doctor
(1) establishes a relationship with the patient; (2) attempts to discover the reason for the
patient’s visit; (3) conducts a verbal and/or physical examination; (4) considers the diagnosis
with the patient; (5) describes further treatment or investigation; and, finally (6) ends the
consultation. Byrne and Long (1976) noted that consultations can go wrong in phase two
238 RELATING TO PATIENTS
FIGURE 10.2Doctor–patient interaction is crucial to patient satisfaction, patient
adherence and health outcomes.
Source: © Joho/cultura/Corbis.