title: Effective follow-up consultations: the importance of patient-centered communication and shared decision making.
abstract: Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice.
authors: Consultant paediatrician for respiratory and allergic disease, Princess Amalia Children's Clinic, Isala klinieken, Zwolle, the Netherlands, and Professor of Clinical Medical Education, UMCG Postgraduate School of Medicine, University Medical Center Groningen and University of Groningen, the Netherlands. Electronic address: p.l.p.brand@isala.nl.
authors: Paul L P
authors: PL
authors: Brand
authors: Anne M
authors: AM
authors: Stiggelbout
mesh_terms: D002648:Child; D003142:Communication; D003657:Decision Making; D005500:Follow-Up Studies; D006801:Humans; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000592:standards / Q000639:trends*
keywords: Communication; Follow-up consultations; Patient-centered care; Shared decision making