However, the use of the computer detracts the doctor's attention away from the patient, compromising these essential elements of the consultation.
Such strategies include providing "scripts" for PNs to use when offering tests with examples demonstrated for the PNs via DVD [ 39], checklists to ensure essential elements of the consultation are covered and educational resources for patients to take away.
To our knowledge this study is original in its design and will contribute to understanding what goes on during a consultation between patients and GPs, and identify what elements of the consultation could contribute to generating health inequalities.
[ 18- 20] These conclude that longer consultation length includes more key elements of the consultation, particularly health promotion, health education, preventive measures, improved recognition and handling of psychosocial problems, fewer prescriptions, improved chronic disease management, and better patient enablement.
The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i) assessment of chronic joint pain, ii) patient's ideas and concerns, iii) exclusion of red flags, iv) examination, v) provision of the diagnosis and written information, vi) promotion of exercise and weight loss, vii) initial pain management and viii) arranging a follow-up appointment.
The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: assessment of chronic joint pain, patient's ideas and concerns, exclusion of red flags, examination, provision of the diagnosis and written information, promotion of exercise and weight loss, initial pain management, and arranging a follow-up appointment.
The GPs seem to question the validity of diagnostic tools [ 28] and also questionnaires are doubted as the use of these kinds of instruments might impede the human element of the consultation [ 29].
Time was treated as a fixed constant of the patient/practitioner interaction such that SDM could be cast, problematically, as an additional element of the consultation (Table 7 2 & 7 3).
To observe quality and completeness of each consultation the researchers recorded on a check list which elements of the standard consultation protocol were covered, such as specific questions to be asked during history taking and elements to be covered in physical examination.
26 Well intentioned efforts to automate use of evidence through computerised decision support systems, structured templates, and point of care prompts can crowd out the local, individualised, and patient initiated elements of the clinical consultation.
A key element of that consultation and uptake was the establishment of a Steering Committee with management and industry stakeholders to oversee the project.
