Title Page

  • Document No.

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Client & Patient Details

  • Client Surname

  • Patient Name

Doctor Details

  • Doctor Surname

Medical Content

Problem Type Selection

  • What is the Problem Type?

  • Which body system is predominately affected?

Consultation Structure

  • Did the doctor initiate the welcome!

  • Did the doctor introduce themselves?

  • Did the doctor shake hands during the welcome?

  • Did the doctor seek an appropriate medical history?

  • Did the doctor conduct a physical examination, describing what they were doing?

  • Did the doctor describe their findings, in a narrative, relevant to the presenting complaint?

  • Did the doctor describe a medically appropriate diagnostic and therapeutic plan?

  • Did the doctor seek understanding of the findings and the plan by the use of reflective listening, and good questions?

Consultation Room Delivery

  • Was the doctor's pace of speech ...

  • How did you hear the doctor's tone?

  • Was the doctor's body language...

  • Blocking words
  • Did the doctor use any blocking words?<br>e.g. "See how it goes". "Wait and see". "Probably be okay.." " it could wait".

  • Which phrases were used?

  • Did the doctor use the word " NEEDS" rather than "recommend" in discussing the plan?

Plans and Estimates

  • Did the doctor provide a plan in detail BEFORE providing an estimate?

  • Did the doctor seek agreement to a medical plan BEFORE providing an estimate?

  • Did the client raise any objections to the plan BEFORE an estimate was provided?

  • How well did the doctor respond to any objections?

  • Did the doctor deliver the estimate and healthcare plan?

  • Did the client raise any objections to the plan AFTER an estimate was provided?

  • How well did the doctor respond to any objections?

  • How well did the nurse respond to any objections?

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