77 Helping With Psychosocial Problems: The Five-Consultation Method

Moderator Marijke VAN DER BURG, Department of Family Medicine, University Medical Centre Utrecht, The Netherlands, p.vanhasselt@med.uu.nl
Quite often doctors see patients with physical complaints for which no physical cause can be detected. Some of these patients can be effectively reassured by their doctor, some however insist on further investigation and medical treatment, and some are quite prepared to accept their doctor's suggestion that their complaints are the physical expression of some kind of emotional distress. In the third year of the vocational training of family doctors in Utrecht we pay much attention to the treatment of these patients. After some training most students are quite proficient and successful. They feel more capable, more in charge and less helpless, which amongst other factors is important in reducing their risk for burnout. Today a workshop focuses on the use of counselling skills with the second and third group of patients just mentioned. On the basis of his knowledge of the patient the doctor chooses one of the two following procedures: A. The patient is invited to make an exact registration of the context of his physical complaints, i.e., when and where the complaints occur, in what situation, and what changes (in the situation, in other people's behaviour or in the patient's behaviour) take place when the complaints arise. Then this registration is analysed to find a common topic in the field of the patient's emotional/relational/behavioural functioning, which seems to make too high demands on the patient's coping skills. B. The patient is invited to a 30-minute consultation to explore any psychosocial problems, whether or not in relation to the physical complaints. After this the doctor may invite the patient to additional consultations, five at most, of 30 minutes each, focused on a specific emotional/relational/behavioural topic with the aim of improving the patient's psychosocial functioning. In the workshop method A will be briefly explained. The major part of our attention will be directed at method B. We will carefully go into the necessary consultation skills and into the conditions that are important for the method to be successful, including
selection of patients
defining a circumscriptive focus of attention
limitation of the help to live fixed consultations of 30 minutes each, which is an essential element of the method. In the workshop cases wilt be presented, so that participants can practice defining a specific and clear focus of attention, which is realistic and positively formulated (Maximum amount of participants: 20).