Mike Sheldon to write - on lines of research paper for the Bern conference

Two main processes –

Assessment and Therapy

Process of assessment – best to use 3 windows concept and divide history and examination into the three spheres or domains.

Rules of this assessment – involve patient, if using more than one therapist(which will probably be the norm)  must be integrated.

The patient must be part of the team

We have developed three models of doing this assessment

1 Full WPM clinic with 3 therapists

2 Doctor and counsellor working together

3 Doctor alone undertaking the assessment in a long appointments surgery session. In a normal practice this could happen once a week. It is best to see no more than 3 patients in such a session, and so if each patient needs 3 or 4 of these appointments to complete the assessment process, around 3 to 4 patients could through the assessment each month. This would amount to around 50 patients in a year, which should be sufficient to deal with the really complex patients (sometimes referred to as heartsink) in a single doctor’s practice.

The aim of this assessment process is to understand and agree together (doctor and patient) as to where the health problems lie and which need to be tackled and by whom. If the patient has a long term physical illness which causes a degree of disability he or she may need ongoing help and support from the likes of OTs to learn how to cope with these disabilities.

If there are anxieties and fears ten a period with a counsellor should be beneficial. If the patient has religious questions such as “Why did God let this happen to me” they can be pointed in the direction of a suitably qualified chaplain or minister.

As always part of the task of the GP is to coordinate and oversee this process to ensure that appropriate treatment is provided.

Description of the three assessment models

Outline of how the GP can oversee and monitor the therapy process.

Some principles –

• Copy the patient in to referral letters
• Encourage them to keep a health journal to monitor progress and highlight on-going issues.
• Insist on an integrated team approach, so with the patient’s permission case conferences are held with the major therapists involved in the patient’s care.
• See the patient at fixed intervals to monitor progress, these may need to be monthly or every three months at first, but in time can stretch out and eventually stop.
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