ABSTRACT

Pendleton published his short book on the consultation in 1984 when the video taping of consultations was the norm in training GPs. He approached the consultation in a task-orientated way, defining a number of objectives for the doctor to achieved. Central to achieving these was the need to identify the patient’s ideas, concerns and expectations as, once identified, they could hopefully be satisfied. Pendleton’s tasks 1 To define the reason for the patients attending 2 To consider other problems (continuing problems, at risk factors) 3 With the patient, to choose an appropriate action for each problem 4 To achieve shared understanding of the problems with the patient 5 To involve the patient in the management and to encourage him to accept

appropriate responsibility 6 To use time and resources appropriately 7 To establish and maintain a relationship which helps to achieve the other

tasks This approach was taken forward by others who sought to extend the

consultation from the superficial and obvious and include health promotion activities in order to strive for better heath – a concept that has become very fashionable in the 1990s. Stott and Davies tasks 1 Management of the presenting problem 2 Modification of help seeking behaviour 3 Management of continuing problems 4 Opportunistic health promotion

Pendleton described in detail the use of videoed consultations, in particular the need to feedback criticism in a safe way (first the trainee discusses the good points, then the trainer follows with a description of what he or she thought good, then the trainee is asked what he might have done better before lastly the trainer discusses what might have been done better in a constructive manner – the order being rigid and essential).