Synopsis
Conduct safe, person-centred primary-care consultations that establish the patient’s agenda, assess risk, reason transparently, reach a shared plan and create dependable follow-up.
- Begin by confirming identity, preferred name, communication needs, who else is present and whether the setting offers privacy; in remote care also confirm the patient’s location and a callback route.
- Open with the patient’s account and agenda before narrowing the history, because the first symptom mentioned may not be the main concern and late-arising agendas can change risk.
- Elicit ideas, concerns, expectations, functional impact and the outcome the person hopes for; do not use these as a ritual checklist detached from the clinical story.
Reasoning priorities
Identify the problems and outcomes requiring attention today.
Repeat a summary and ask what has been missed; negotiate priorities explicitly rather than silently dropping later concerns.
Worked reasoning
A 46-year-old reports a new headache for ten days during a telephone appointment, wants antibiotics and must collect a child soon.
- Confirm identity, current location, callback number and privacy; establish onset, trajectory, systemic symptoms, neurological symptoms, pregnancy possibility, immune status, trauma, medicines and what the patient fears.
- Form an ordered assessment: sudden onset, new focal deficit, altered consciousness, meningism, temporal symptoms or severe systemic illness would demand urgent action; a remote call cannot provide fundoscopy, blood pressure or neurological examination.
- Acknowledge the antibiotic expectation, explain that the cause remains uncertain and that direct observations and examination are needed today; agree a face-to-face assessment rather than prescribing without adequate information.
- Document the reasoning and verify the plan by asking the patient to repeat where and when they will attend, arranging a feasible time, and giving explicit emergency actions for sudden severe pain, weakness, confusion, collapse or visual loss.