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Scripts for Formulating a Management Plan

Dr. Ramesh Mehay, Programme Director (Bradford VTS), 2010

Key points
There are six parts to formulating a management plan and we will look at these in turn.
Signpost
Discuss treatment package or treatment options
Involve the patient
Facilitate decision making/the process
Reassure where necessary
Summarise periodically
In general, seek permission rather than being directive e.g. ‘Is it okay if we...’ or ‘How would you feel if I suggested xxxx?’ rather than
‘You must do xxx and yyy and zzz.’
Reassure where necessary (and sometimes you might need to do this several times): ‘I know you're worried about the chest pains
coming from your heart but let me reassure you again that....’ or ‘I sense that you’re still worried about the pains coming from your
heart. Can you give me an idea of what would reassure you?’
Remember, as the patient is the main one affected by the management plan, you must share, discuss and negotiate it with them.
Otherwise they won't engage. Clearly, sometime you, as the doctor, do need to take charge (e.g. Medical emgencies) but other than
that, most situations and their management plans should be done jointly with the patient.

Look at the next page for the scripts.

Learn these scripts ‘off by heart’. Practise saying them with patients. You will eventually add your own flavour to them in time.
1. Signpost: that you're going to move onto this stage. Use words like ‘shall we’, ‘can we’ or ‘is it okay if we...’.

2a. When there is a ‘treatment package’ 2b. When there are ‘treatment options’

• If you’ve said there are three things which can be done to make your
(headaches) better but then remember a fourth, simply say 'Actually, I've just
thought of another thing we/you can do’.
3a. Involve the patient 3b. Involve the patient

What you say next depends on how they respond.


5. Facilitate decision making process
 Help the patient by facilitating decision making especially if there is some difficulty coming to a decision.
 First, detail each option
 Then discuss the pros and cons of each
 Now see what they prefer and don't prefer
 Offer your professional opinion e.g. 'In my professional opinion, I think it would be best if...'

6. Reassure where necessary


 And that doesn't just mean doing it once. If the patient still seems worried, you need to do it again at the point where you spot that anxiety (i.e.
through their verbals and non-verbals).
 e.g. ‘Let me reassure you that I don't think your chest pains are a heart attack because...’

7. Summarise periodically
 Especially if you end up having a long discussion.
 ‘Okay, just to recap, what we've agreed to do is.... Are you still happy with that?’

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