The Expert Clinician

What Are the Reasons for a Consultation and the Aims of the Consultation?

Patients seek a consultation with a health care practitioner (HCP) for various reasons and may be referred through different routes and at different stages of their care pathway.

When the patient meets the HCP, it is important to establish the aims of the consultation early because they determine the initial focus and format, the questions to ask, and the signs to look for.

Types of Referrals and Reasons

The types of referrals and examples of the reasons for referrals include:

Self-referral. This occurs when the consultation is initiated by the patient, the patient’s family or carers, or the emergency services.

The reasons for self-referral include:

• For help with a new problem.
• A change in a pre-existing problem.
• To discuss their risks and plan management when a close relative has been diagnosed with a heritable condition.
• For reassurance.
• For treatment, such as a travel vaccination.
• For a report, such as a disability assessment.
• To access a service, such as an open-access endoscopy service or a “one-stop” clinic, or to perform a minor surgical procedure.

A referral from another healthcare professional (HCP). This typically follows an initial assessment by that HCP.

Patients are usually referred from another HCP for various reasons, including:

• For help in formulating a diagnosis.
• To plan management.
• When emergency care is needed.
• To provide treatment.
• For reassurance.
• For a second opinion.

Referrals following a screening investigation. These are increasingly common. For example, after a cervical smear, a faecal occult blood test, a mammogram, or a “well-person screening”.

Further appointments within an ongoing care pathway. Examples include:

• To discuss the results of an investigation and plan management actions.
• When an ongoing problem has changed.
• To check for change.
• To monitor response to treatment.
• For assessment, such as a pacemaker check, blood pressure check, or diabetes control.

What are the Aims?

The Core Aims of the Consultation

A core aim of the consultation is to exchange information. A meaningful exchange of information depends on a good working relationship, and a good working relationship depends on the information exchanged.

A good working relationship not only benefits the consultation but also helps build a reservoir of “goodwill” for the future. 

Although information exchange and the establishment of a good working relationship are core aims of the consultation, they are enablers. This is because they are almost always undertaken to formulate a diagnosis and a management plan.

For many consultations, formulating a diagnosis is a core aim. However, a clinical diagnosis is a proposition, an opinion, until the cause of the problem is proven. Frequently, the underlying cause is uncertain, and the diagnosis remains descriptive or serves as a working diagnosis within a list of possible diagnoses.

Management planning is the process of determining and agreeing with the patient the care to be provided after the consultation. The ultimate aim is to help the patient, but how this is best achieved will vary between patients, between consultations, at different stages in the pathway of care, and may differ for different problems. Management may be as simple as providing treatment at the end of the consultation, or it may involve a complex series of investigations to formulate a diagnosis.

The Specific Aims of the Consultation

The core aims — information exchange, establishing a working relationship, formulating a diagnosis, and planning management — apply to most consultations, but the detail and emphasis will vary both between consultations and within a single consultation.

1. Establish a working relationship:

• To help the patient relax
• To build trust
• To ensure the patient feels they are being treated as an individual and that they are valued and respected
• To show the clinician cares and wants to help
• To enable information exchange
• To plan management
• To increase the likelihood of adherence and compliance with future care

2. Information exchange

• To formulate a diagnosis
• To plan management
• To learn and understand available information
• To document available information
• To build a working relationship
• To inform the patient
  • To explain symptoms or signs
  • To suggest a cause, diagnosis or list of diagnoses
  • About matters relevant to them. For example, lifestyle, risks and benefits
  • The implications, risks and benefits, prognosis
  • What to expect and what is expected of them
  • As part of informed consent

3. Formulate a diagnosis

• To confirm a diagnosis
• To make a definitive diagnosis
• To make a descriptive diagnosis
• To make a working diagnosis
• To exclude a diagnosis
• To understand the problem
  • To determine the location of the abnormality causing the problem
  • To determine the type of problem
  • To determine the cause
• To make a list of possible diagnoses
• To screen
  • For another abnormality
  • For a secondary abnormality
  • For a complication
• For assessment
  • Of severity
  • The impact on the patient
  • Of function
  • Of change, including to provide a baseline
  • Future risk or prognosis

4. Plan management

• To formulate a diagnosis
• To provide treatment
  • Definitive treatment.
  • To alleviate symptoms.
  • To help the patient.
  • To help function.
  • To slow the rate of disease progression.
  • To reduce the risk of a future problem.
  • To prevent a future problem.
  • As a trial to formulate a diagnosis.
• To inform treatment
• To learn more about the problem
  • To determine the location of the abnormality causing the problem
  • To determine the type of problem
  • To determine the cause
• To learn more about the patient
• To screen
  • For another abnormality
  • For a secondary abnormality
  • For a complication
• To assess
  • Severity
  • The impact on the patient
  • Function
  • Change, including providing a baseline.
• Future risk or prognosis
• To reassure the patient

By keeping these core aims and specific objectives clearly in mind, healthcare practitioners can ensure every consultation remains focused, patient-centred, and effective.