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Undertaking consultations and clinical assessments at advanced level

25 February 2021
9 min read
Volume 30 · Issue 4

Abstract

Once deemed the reserve of doctors, ‘the medical interview’ has since transitioned across professional boundaries and is now a key part of the advanced clinical practitioner (ACP) role. Much of the literature surrounding this topic focuses on a purely medical model; however, the ACPs' use of consultation and clinical assessment of complex patient caseloads with undifferentiated and undiagnosed diseases is now a regular feature in healthcare practice. This article explores how knowledge of the fundamental principles surrounding ACP–patient communications, along with the use of appropriate consultation frameworks and examination skills, can provide a deeper insight and enhance the existing skills of the ACP. A comprehensive guide to undertaking patient consultations, physical examination and diagnostic reasoning on a body systems basis is explored in future issues of this Advanced Clinical Practice series.

The process of conducting a patient consultation and performing a subsequent clinical assessment has historically been termed ‘the most powerful and sensitive and most versatile instrument available to the physician’ (Engel, 1973). Despite the rapid growth of healthcare technology, this remains the case today. A skilled advanced clinical practitioner (ACP) in this area has the potential to make a significant contribution to several fundamental outcomes: patient satisfaction, patient concordance with prescribed therapies/interventions, overall diagnostic accuracy and overall patient outcomes. Evidence suggests that, by conducting a high-quality medical history alone, 60-80% of the relevant information to form a diagnosis can be ascertained (Peterson et al, 1992; Roshan, 2000). The overall aim is to identify symptoms and physical manifestations that represent a final common pathway of a wide range of pathologies, which may be highly suggestive or even pathognomonic of one such pathology, or multiple concurrent pathologies.

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