Consultation models and patient-centred communication — KFP-style written assessment

KFP 1 (10 marks)

A 58-year-old man books "a script renewal". You notice he has not attended for two years. As you print the script he says: "Actually... my brother died last month. I've been getting chest tightness when I walk." ^[3]

1. Name the consultation phenomenon and the skill that prevents it. (3) ^[3]
2. How should you restructure the consultation now? (4) ^[3][4]
3. Which evidence would you cite to a registrar for why the first two minutes matter? (3) ^[5]

Model answers

1. The doorknob presentation: the real agenda emerges at the end because it was never screened. Prevention is an agenda-screening question after the first story ("Is there anything else you wanted to cover today?") and explicit negotiation of what today covers when several problems exist. ^[3]
2. Acknowledge the disclosure and its importance; re-open the consultation with open questions about the chest tightness and the bereavement; elicit ICE for both problems; then negotiate the agenda honestly — chest symptoms today (possible cardiac cause, red-flag screening), script and bereavement follow-up booked. Calgary-Cambridge treats gathering information and understanding the patient's perspective as distinct tasks; both now apply. ^[3][4]
3. Henbest and Stewart's scoring method found the first two minutes of the consultation correlated highly with the whole consultation's patient-centredness (rs = 0.806). Interruptions and premature closure in the opening window lose information and trust for the entire encounter. ^[5]