Take Away messages

We took notes so you don't have to.

Explain the consultation process

  • Explain the process before you start.

  • “This is how I work out what's going on…”

  • “First, the young person will talk, uninterrupted…”

  • “Second, the parent will add their contribution…”

  • “Third, I'll speak to the young person alone…”

  • “Having listened to everyone, I will then explain what is going on to both of you.”

Relate the diagnosis to symptoms the young person is experiencing

  • Conversations that focus on the young person's life are more effective than conversations that focus on the disease.

  • Find out what's going on in the young person's life.

  • “What do you think is contributing to your condition?”

  • Make the diagnosis personal to relate to their life.

  • “X (symptoms) leads me to believe you have Y condition.”

  • For example: “Because you're breathless playing football and your mother hears you coughing at night, it leads me to believe you have…”

  • Find out what effect the illness is having on the young person's life, e.g. school, mood, sleep, relationships with peers.

Involve the young person in planning ‘what happens next’

  • Telling a young person what to do rarely changes their behaviour.

  • Let the young person set the goals: “What would ‘being well’ mean to you?”

  • Involve them in the problem solving.

  • “How can we work together to achieve this?”, and…

  • “What do we do if this doesn't work out?”

  • Kids are resourceful, help them tap into that.

Try these simple experiments for a week.
See what changes...

  • Start: Check at the beginning “what do you want to get out of this consultation?”

  • Individual: Break the ice by showing you see the young person as an individual not a person with X disease.

  • A life, not a disease: Talk to them about their life not their disease: “What's going well at school, what do you enjoy doing to relax at weekends?”

  • Resourcefulness: Explore with the young person what has been going well since their last consultation.

  • Eye contact: Try introducing and making eye contact with the young person first in your next consultation.

  • Alone: Speak to the child alone.

  • Silence: Let the young person break the silence, actively make an effort not to fill a silence and see if the young person fills it.

  • Normalise: Normalise subjects like alcohol and drugs. For example, “We know loads of young people smoke, do any of your friends smoke? … What about you?”

  • Wellness score: Use the wellness score: “Out of a 100, how well do you feel at the moment?”

  • Psychosocial screening tool: Use the ‘H.E.A.D.S.’ trick.

    • H is for home

    • E is for education

    • A is for activities

    • D is for drugs (and alcohol), and diet

    • S is for sleep, sexuality or suicide (which stands for mood)

  • Concordance: In exploring concordance/adherence with medication, ask ‘how often are you managing to remember to take your medication’ and acknowledge no-one is 100% compliant all the time.

  • Trial period: Negotiate a trial period, with a defined end point to an improvement in their life.

  • Set shared goals: Let the young person set the goals of what ‘getting better’ means to them.

  • Informed choices: Offer two different treatments, or offer the choice of not starting a treatment as an option.

  • Explain side effects: Explain the side effects and whom to contact if they do have side effects.

  • ‘Something else’: Ask “is there something else?” – when you ask: “Is there anything else?” it implies that you're trying to close the conversation down.

Useful resources

For further on reading on why everyone stands to benefit from re-examining the doctor-patient consultation, read this excellent report published by the health foundation:
When doctors and patients talk: making sense of the consultation

For further adolescent eLearning:
Adolescent Health Programme - RCPCH

A great example of a holistic approach to transition:
Transition Together – Walsall Healthcare NHS Trust

A website for teenagers with HIV and their families:
life, love & hiv – Body & Soul

A third sector organization that lobbies on behalf of young people to ensure they are consulted in matters that relate to their well-being:
National Children's Bureau

NHS London London Deanery