Recognition, explanation, action, learning: Teaching and delivery of a consultation model for persistent physical symptoms

Abstract

Objective: To describe the teaching and delivery of an extended consultation model designed for clinicians to use with patients with persistent physical symptoms and functional disorders. The model is underpinned by current scientific knowledge about persistent physical symptoms and the communication problems that arise in dealing with them.

Methods: Process evaluation of training and delivery of the Recognition, Explanation, Action, Learning (REAL) model within the Multiple Symptoms Study 3: a randomised controlled trial of an extended-role GP "Symptoms Clinic". Evaluation used clinician and patient interviews and consultation transcripts.

Results: 7 GPs were trained in the intervention and 6 of them went on to deliver the REAL model in Symptoms Clinics either face-to-face or online. The Symptoms Clinic provided a set of 4 extended consultations to approximately 170 patients. Evaluation of training indicated that there was a considerable load in terms of new knowledge and skills. Evaluation of delivery found clinicians could adapt the model to individual patients while maintaining a high level of fidelity to its core components.

Conclusion: REAL is a teachable consultation model addressing specific clinical communication issues for people with persistent physical symptoms.

Practice implications: REAL enables clinicians to explain persistent physical symptoms in a beneficial way.

Keywords: Consultation; Explanation; Functional disorders; Medically unexplained symptoms; Persistent physical symptoms; Physician-patient communication.