The Choosing Wisely initiative promotes conversations between patients and clinicians, to choose care that is supported by evidence, and truly necessary. The consultation is an efficient diagnostic tool, as 60-90% of conditions are correctly diagnosed based only on medical history.¹Patient centered consultations and shared decision-making reduces overutilization.² The importance of the second half of the consultation to avoid unnecessary care was stressed by Elwyn et al already in 1999.³

There is broad consensus that patient centered consultations and shared decision-making should be practiced and taught. A variety of models are used in teaching, all aiming to set common ground for wise clinical choices, and shared decision-making. Although commonly advocated, there is no uniform definition of Shared Decision Making.⁴

In this workshop we present - and offer practice in - the model used at medical universities, in training of postgraduate residents and specialists in general practice throughout Sweden. Common features with other models are the elicitation of the patient’s ideas, concerns and expectations, and the division of the consultation into three parts; the patients’, the doctors’ and the shared closing part.^{5 6}

One feature of this model is the wrapping up of the consultation, metaphorically described as a parcel, which this workshop is focusing on. The closing part contains four steps; a) Summary of the patient’s ideas, concerns and expectations, b) Medical assessment and recommendations c) Shared decision making d) Check for understanding. It has been developed by Charlotte Hedberg, from her work with graduate and postgraduate consultation teaching.⁷

References

1. Sackett DL, Haynes RB, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. Little, Brown and Company; 1985.

2. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on outcomes. J Fam Pr. 2000;49:796–804.

3. Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999;49:477–82.

4. Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006;60(3):301–12.

5. Larsen JH, Neighbour R. Five cards: a simple guide to beginning the consultation. Br J Gen Pract J R Coll Gen Pract. 2014;64(620):150–1.

6. Van Dalen J, Bartholomeus P, Kerkhofs E, Lulofs R, Van Thiel J, Rethans JJ, et al. Teaching and assessing communication skills in Maastricht: the first twenty years. Med Teach. 2001;23(3):245–51.

7. Hedberg C. Patient centered consultation - good for both patient and doctor. Three step model may prevent common misunderstandings. Läkartidningen. 2020(42).

Objectives To practice the prevention of overdiagnosis through a model of patient centered consultation.

Method Theoretical introduction of the model. Inventory of clinical situations with a risk of overdiagnosis. Role-play and feedback in small groups under guidance of the facilitators, both experienced consultation educators and general practitioners.

Results Increased understanding of the mechanisms at play in clinical interaction, and how the attention to the closing part of the consultation may help clinicians and patients to choose wisely and prevent overdiagnostic activities.

Conclusions This workshop invites primarily clinically active professionals to a practically focused workshop on patient centered consultations and shared decision-making. It provides an opportunity to practice consultation skills to wrap up consultations and prevent overdiagnostic activities.