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The purpose: Training of carrying out of effective consultation of
teenagers as important practical skill of the general practitioner on 10 monthly
courses in a course «Retraining and improvements of professional skill GPs» at
the deportment of «Ambulatory Medicine» TashPMI.
Materials and methods: For the last year 2015-2016, 58 GPs from SVP
and city polyclinics were trained in the course. Тhere are many kinds of
consultations of teen patients on practice and all of them are suitable on the
certain cases.
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We worked on clinical cases of different teen patients. Students worked on
pair and done role plays. But during the same time doctors should give more
concrete information concerning consultation, for example, how to collect the
analysis. Trainees were taught methods of consultation of teen patients and role
plays were recorded. That video was evaluated by evaluation list and
consultation card.
Students were given the list of questions to get history of smoking. Three of
these questions are open and gives more freedom to the patient to express the
thoughts and fears.
1. What do you think about smoking? (That has imparted you?)
2.
Tell me more about your experience of smoking or being on the
company of smoking peers. (About a problem)
3.
Specifying questions. (what you have done, how you filed, if you
have an experience of smoking how much you smoke …)
4.
What did you do?
5.
Do your parents smoking?
6.
Your position about smoking.
For the answer to the first question the teenager should be given more time.
There can tell much about illness, about excitements and expectations. It is
important do not interrupt the patient that he has not lost a thread of the
thoughts. The second open question can be set about the biggest problem of the
patient that it is better to see a picture. And for this purpose it is possible to set
special questions – what disturbs you more. It is possible to ask about an
important things of his life, when the patient complains of acne or about a diet
when he complains of loss or gain of weight. This question help a doctor to
collect more and correct information and in the same time to show the teen his
interest on the problem of him.
Practically all teens have their own opinion about smoking. In many cases
those opinions erroneous – any time they can quite smoking, smoking electron
or fruity cigarettes, ones or twice a week do not bring to addiction. Ignoring
opinion of the patient the doctor loses his trust.
Time – they should consult longer than usual patients. If the average doctor
have 1- 2 teen patients a day, 20-30 minute consultation quite probably [4]. Do
not hurrying up is a basis of the consultation. Teenagers see that the doctor does
not hurry up so they believe that he and his problems are important for doctor. In
the end of consultation it is possible to give time to the patient that he could
think and ask questions. It is possible to ask «do you still have questions», «all
are clear for you?».
Problem definition is important part of consultation. It is not always
patients come to the doctor for treatment; often they search for support,
approval, and understanding or simply want to talk [7]. Open and special
questions help with such cases.
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Questions –the teen patients need to be set and differentiate. Questions
show that the doctor not only hears you, but also listens; he is ready to help.
Questions should be set directly, clearly. Having asked it is necessary to listen
and key things to write down. So it is possible to be insured against that to ask
the same question two or more times. Patients notice and it tells them about
incompetence of the doctor. And in the end it is possible to read records and will
make sure that all was written correctly.
Teens can, simply lie sometimes specially and sometimes without having
on it the weighty reasons. It can be questions concerning smoking, alcohol,
diets, playing sports or concerning recover. In such cases the doctor himself
should do a conclusion. If the question very important for diagnostics and
treatment tactics it is possible to formulate so that a question was clear as much
as possible and objective.
Assumptions of patients – need careful studying for the several reasons. In
the first ignoring them we ignore opinion of the patient and him. Also it is a
good occasion to insult misunderstanding [11]. The answer should be begun
with a positive word and to explain the present disease or its reason.
On the other hand, respecting assumptions of teens the doctor gains the
confidence of the teen. Many teens think that no one may understand their body
better than them, even doctors. If teen confirms that without cigarettes he cannot
survive it is necessary to choose one from two harms – or the patient will leave
and will continue smoking or you will be less aggressive about smoking in the
first and second consultations.
Explanation – is an important part of consultation of the smoker teens,
especially on difficult patients. Explaining to the patient, you take control over
consultation on your hands. It is more important at the consultation of teen
patients which like to dominate. It is necessary to explain calm, lower tone and it
forcing the patient will calm down. The teen who wanted to receive the answer
to a question «why it should take so long to wait on turn» or «why all doctors
ask me about my smoking, please concentrate on my knee, I have got a pain
after soccer match» you can solve the problem first and then explain an etiology
and pathogenesis of smoking of sigarettes. This explanation will cause less
indignation.
At an explanation it is possible to use a sheet of paper for record of
keywords and drawing and in the end of consultation it is possible to give this
paper to the patient. Surgeons use drawings for an explanation of forthcoming
operation. It is possible to draw a daily diet of them, their body parts involved
on smoking or leisure time spending and many other things.
Some kinds of supervision have been applied to consultation discussion –
direct supervision, a consultation audio record, consultation video recording. All
these kinds of consultations have the advantages and down sides, but video
supervision can be the most advanced variant. At video recordin possible to
estimate verbal and nonverbal skills of the doctor. For an estimation of skills of
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consultation it was used a card of consultation and a scale of an estimation of
consultation.
We gave to the students questioner to fill out, which show their satisfaction
by their job have done. They evaluated their skills by themselves.
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