Consultation Models for the MRCGP – At a Glance

The consultation is the foundation of general practice and the MRCGP expects you to know the major consultation models.

 

 

Balint (1957) – The Doctor, His Patient, and the Illness

 

Introduced the bio-psychosocial model of patient care.

Emphasised active listening to uncover the patient’s hidden agenda.

Key ideas:

• ‘Ticket of entry’ (the presented complaint) often hides deeper issues.
• The doctor acts as a drug — the relationship itself can heal.
• Doctor’s beliefs influence patient interactions (‘apostolic function’).

 

 

Berne (1964) – Games People Play

Developed Transactional Analysis: every interaction stems from one of three ego states:

• Parent, Adult, or Child.

 

Consultations often reflect a Parent–Child dynamic — but the ideal is an Adult–Adult interaction.

Promotes awareness of emotional tone and role during consultations.

 

 

Byrne and Long (1976) – Doctors Talking to Patients

 

Analysed thousands of real consultations and identified six phases:

1. Establish relationship
2. Discover reasons for attendance
3. Examination
4. Consider the condition
5. Plan treatment/investigation
6. Close the consultation

 

 

Stott and Davis (1979) – Exceptional Potential in Every Consultation

 

Identified four key areas to address in every consultation:

1. Management of presenting problem
2. Modification of help-seeking behaviour
3. Management of continuing problems
4. Opportunistic health promotion

 

 

Helman (1984) – Culture, Health and Illness

 

Patients seek answers to seven questions during illness:

1. What has happened?
2. Why has it happened?
3. Why me?
4. Why now?
5. What happens if nothing is done?
6. How does it affect others?
7. What should I do about it?

 

 

Pendleton et al. (1984) – The Consultation: Learning and Teaching

 

Set out seven tasks for every consultation:

1. Define reasons for attendance
2. Consider other problems
3. Choose appropriate actions
4. Achieve shared understanding
5. Involve the patient in management
6. Use time and resources appropriately
7. Build and maintain the relationship

 

 

Neighbour (1987) – The Inner Consultation

 

Easy-to-remember five-stage model:

1. Connecting
2. Summarising
3. Handing over
4. Safety netting
5. Housekeeping (doctor looks after themselves emotionally)

 

Emphasised goal setting, skill building, and bringing it all together.

 

 

Calgary-Cambridge Model (1996) – The Medical Interview

 

Widely used patient-centred model with five stages:

1. Initiating the session
2. Gathering information
3. Building the relationship
4. Explanation and planning
5. Closing the session

 

Focuses on collaborative partnership with the patient.

 

 

Consultation Models Memory Grid

Model	Year	Core Concept
Balint	1957	Doctor-patient relationship matters; hidden agendas are common; doctor acts like a drug.
Berne	1964	Parent–Adult–Child ego states; aim for Adult–Adult communication.
Byrne and Long	1976	Six phases of consultation flow from building rapport to closing.
Stott and Davis	1979	Every consultation is a chance: manage problem, modify behaviour, promote health.
Helman	1984	Patients seek seven answers about their illness — not just diagnosis.
Pendleton et al.	1984	Seven practical tasks to structure a consultation.
Neighbour	1987	Five steps: Connect, Summarise, Handover, Safety Net, Self-care.
Calgary-Cambridge	1996	Structured, patient-centred communication; build partnership throughout.

 

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Thank you to the joint editorial team of MRCGP Exam Prep for this exam tips post.