P-R-A-C-T-I-C-A-L: a step-by-step model for conducting the consultation in general practice

It has been shown that when patients are unable to express all their major concerns, they are less likely to follow the physician's prescribed treatment plan and they are less satisfied. On the other hand, the GP has a limited amount of time to elicit all the appropriate information and must ask certain questions about the biological aspects of the illness in order to carry out her professional responsibilities. By acting in a patient-centred way, first enabling the patient to express himself, the GP can make maximum use of patients' ability for problem formulation and solution.

We describe a model, for which the mnemonic, P-R-A-C-T-I-C-A-L, will help the practitioner to remember its nine steps. The model uses a chronological succession of strategies during the consultation that balances the voices of medicine and the lifeworld. In overview, the GP takes the patient, step by step, first through an exploration and clarification of his views of the illness, then expands the problem by further examination (e.g. the physical examination), a negotiation about the final model of the illness that includes both diagnosis and management, a discussion of the treatment plan, and finally a moment of reflection to prepare for the next visit.