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Life & Times

Finding meaning in the consultation: introducing the hermeneutic window

Rupal Shah, Robert Clarke, Sanjiv Ahluwalia and John Launer
British Journal of General Practice 2020; 70 (699): 502-503. DOI: https://doi.org/10.3399/bjgp20X712865
Rupal Shah
Education Lead Professional Development, Health Education England, London. Email:
Roles: Associate Dean
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  • For correspondence: rupal.shah@hee.nhs.uk
Robert Clarke
GP and independent medical educator, Hertfordshire.
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Sanjiv Ahluwalia
Health Education England, London.
Roles: Regional Postgraduate Dean
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John Launer
Health Education England, London.
Roles: Programme Director for Innovation
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INTRODUCTION

The ability to offer individualised care to patients remains a key component of general practice. This is more important now than ever, given that the care we provide as GPs is likely to involve less face-to-face contact even once the threat of COVID-19 has passed. Many consultation frameworks address only generic skills and largely ignore the extent to which the clinician is able to establish a human connection, to understand what an illness means to their patient and to help them navigate through it, particularly when there is uncertainty and complexity within the consultation. This person-centred approach is the bedrock upon which general practice was founded and deserves further analysis. In this article, we introduce a new four-domain model to describe the skills and approaches needed by clinicians in order to encourage consultations that are individualised and create meaning for both patient and clinician. This model could help to guide training, as well as validating these consultation skills for practising clinicians.

WHOLE-PERSON CARE

Iona Heath reminds us that ‘clinicians must see and hear each patient in the fullness of his or her humanity in order to minimise fear, to locate hope (however limited), to explain symptoms and diagnoses in language that makes sense to the particular patient, to witness courage and endurance, and to accompany suffering’.1

In an interview recorded before his death in 2011,2 Dr Kieran Sweeney, a retired GP and Professor of Primary Care, poignantly described what was missing in the outwardly …

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British Journal of General Practice: 70 (699)
British Journal of General Practice
Vol. 70, Issue 699
October 2020
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Finding meaning in the consultation: introducing the hermeneutic window
Rupal Shah, Robert Clarke, Sanjiv Ahluwalia, John Launer
British Journal of General Practice 2020; 70 (699): 502-503. DOI: 10.3399/bjgp20X712865

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Finding meaning in the consultation: introducing the hermeneutic window
Rupal Shah, Robert Clarke, Sanjiv Ahluwalia, John Launer
British Journal of General Practice 2020; 70 (699): 502-503. DOI: 10.3399/bjgp20X712865
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    • INTRODUCTION
    • WHOLE-PERSON CARE
    • INTRODUCING THE HERMENEUTIC WINDOW MODEL
    • IMPLICATIONS
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More in this TOC Section

  • Ambivalent sexism within medicine: reflections from four medical students
  • Books: long read: The Doctor Who Fooled The World. Andrew Wakefield’s War On Vaccines
  • Lady Pereira Gray: an appreciation
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