Finding meaning in the consultation: introducing the hermeneutic window

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.