The 7-step consultation: what we learned and how to improve it?

Abstract

In 2008, the book, "A Consulta em 7 passos" (Consultation in 7 steps), was published in Portugal. This work proposes, for training and learning purposes, the structuring of medical consultations into three stages and seven steps: preparation; first minutes; exploration; evaluation; plan; closure; and final reflection. This article aims to briefly assess "what we have learned and what we believe can be improved". Over the years, the authors have gathered new ideas, criticisms, and suggestions on the application of the method in dozens of meetings and training sessions with interns and residents. The most important points include: the method should be applied with flexibly; the consultation should be considered to be only one piece of the broader and more complex mosaic that is health care for each person; it is important to emphasize the perspective of the meeting of people, agendas, and objectives; the existence of a personal, unified, and integrative clinical record; the optimal use of information and communication technologies; the need to develop a "personal/individual care plan" and the concept of "personal self-management of health"; the inclusion of the person-centered clinical method in a more comprehensive systemic model; and the development of collaborative intelligence and action in multidisciplinary teams dedicated to caring for each person and family.