Undertaking consultations and clinical assessments at advanced level

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.