Synopsis
Structure a complex general-practice consultation around risk, multimorbidity, the patient's agenda and feasible continuity, producing a prioritised plan rather than a hurried list.
- Surface the full agenda early, then agree priorities by combining immediate risk, patient importance and what can realistically be completed today.
- Use the record actively but verify it: diagnoses, medicines, monitoring, recent contacts and social context may interact, and copied problem lists may be stale.
- Build a unifying problem representation while allowing more than one condition; avoid forcing every symptom into one diagnosis or addressing each disease in isolation.
Reasoning priorities
Identify all intended topics and agree a safe order for the encounter.
Combine urgent risk and patient priorities, explicitly parking lower-priority work with a real follow-up arrangement rather than silent omission.
Worked reasoning
A fictional consultation supplies two recent falls, postural dizziness after a medicine change, missed diabetes monitoring, low mood and a daughter who reports difficulty managing appointments; there is no current injury or focal neurological deficit.
- Surface all concerns and check immediate consequences of falls, acute neurological or cardiac warning features, self-harm risk and current physiological stability before accepting a routine review frame.
- Represent the interaction: new falls and postural symptoms temporally associated with treatment change, alongside monitoring gaps, mood symptoms and reduced organisational support.
- Agree that falls risk and medicine review need same-day assessment, while diabetes monitoring and fuller mood work require staged but definite follow-up; ask the patient how and whether the daughter should be involved.
- Create an owned plan for observations, examination, medication reconciliation, support and booked review, with specific advice for syncope, injury, worsening mood or new neurological symptoms.
- Verify understanding and practical feasibility, document consent for information sharing, and seek feedback on prioritisation, multimorbidity integration and use of continuity.