- What is the problem?
There may be more than one! If so, make sure both you and the patient share a common list, then let the patient define which is the most important for her, and tackle this one first. Sometimes the patient will choose one that is more easily solved than the others and you can use this to help her gain confidence.
- Where does it arise?
- When does it arise?
- Why does it arise?
- Who is affected by it?
- How important is it?
- Who agrees that it is a problem?
- What mechanisms exist for finding a solution to the problem?
Get the patient's ideas - these are more important than your own. If you have to help out, suggest ideas rather than presenting "the" solution: "Have you thought about..." or "I wonder if..."
- What solutions have been proposed?
And by who? What does she think about these solutions?
- Can you now create a list of aims?
This list can then be discussed with the patient, creating an agenda to work with, so that all the patient's needs are met.
Patients are not the only ones to have needs. What about your needs? ...and the needs of the primary health care team, or the practice? This needs-based model can be used for finding the solution to problems in places other than the consulting room.