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The Naked Consultation


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Table of Contents

Deconstructing the Consultation
Consultations: the Good, the Bad, and the Difficult
Models and Milestones
In the Beginning
Building Rapport
Speaking the Patient's Language
Managing Feelings: Your Own and the Patient's
Getting Patients to Tell You What's Wrong
Summarising and Reflecting
Giving Information to Patients
Safety-Netting and Ending
Managing Time
Transactions in Consultations
You, the Patient, and the Computer
Looking After Yourself Tools and Techniques for Learning and Improving Consultation Skills
Knowing Where to Start and What to Learn
How Adults Learn
Working with Colleagues to Improve Your Consultation Skills
Case Discussion
Getting and Giving Effective Feedback
Using Role Play to Help with Consultation Techniques
Consultation Skills and the RCGP
Making a Personal Learning Plan
Conclusion Appendix 1: Jargon Buster
Appendix 2: Some Useful Resources

About the Author

Liz Moulton is a freelance general practitioner (GP) in West Yorkshire and a GP appraiser and advisor to the Royal College of General Practitioners (RCGP) Practice Support Unit. She graduated from Leeds University and was a GP registrar on the Airedale Training Scheme. She then worked in the Academic Primary Care teaching practice at the University of Dundee before settling in Yorkshire, working in two different GP training practices. Liz was a GP trainer for more than 20 years. She has been course organiser for the Leeds Vocational Training Scheme for general practice, served as associate and deputy director at Health Education Yorkshire and the Humber, worked in primary care development for Leeds Health Authority, and acted as a GP advisor to the UK Department of Health. Liz has also run many courses on consultation skills for GPs, GP registrars, nurses, and nurse practitioners, and was recently appointed to lead "The Consultation" and "Teaching the Consultation" modules for the University of Leeds' masters' level course for medical teachers. She was absolutely delighted to be awarded an MBE in 2005 for services to medicine and healthcare in Yorkshire.


"It offers a very clear summary of consultation skills theory with lots of practical tips... This is a helpful and easy-to-read using summaries and linking to the current RCGP CSA. It is very helpful for GP trainees."
- (Highly Commended, Primary Health Care, BMA Medical Book Awards 2016)

"Our health service is facing unprecedented changes and the pace of change seems to increase year on year. ... Still one thing remains constant: the helping nature of the human contact between clinician and patient that empowers the patient. This is the subject of Liz's book, a book that I would advise those new to general practice to read and those experienced in our art to re-read. ... This book will, I believe, enable you to understand your interactions with patients better and, amidst the ever-changing context and environment, ensure you have the skills you need for effective consultations."
-From the Foreword by Dr. Mark Purvis, Director of Postgraduate General Practice Education, Health Education Yorkshire and the Humber, University of Leeds, UK

Praise for the Previous Edition

"I am not much given to fan mail, but I feel compelled to let you know that I am tearing my way through The Naked Consultation and consider it the most practical and useful work on the matter ever produced in the UK. It is some time since I have read a book that has given me more than a single new insight-yours has brought me a bucketfull. Thanks. Well done."
-Dr. Malcolm Thomas, Medical Director, Effective Professional Interactions, Ltd, Morpeth, UK

"This practical guide to consultation skills is written by a GP. However, practice, specialist and consultant nurses will find that its focus on consultation processes, skills and the use of counselling will help them enhance their work with patients. There is an excellent 'jargon buster' defining and describing a comprehensive list of terms and a selection of useful document templates. Many chapters are short, focusing attention on basic but important skills. Excellent!"
-Nursing Standard

"Liz Moulton-a GP and trainer-has come up with a practical vade mecum for any doctors interested in buffing up their rusty consulting skills, adding a few new tools to their consulting toolkit, or even diagnosing what went wrong in their latest consultation from hell. What I like about it is that it breaks the consultation down into key phases that GPs will recognise (for example, the beginning, getting patients to tell you what's wrong, safety netting, and ending), and then draws on whichever models might be relevant to that bit. This is a readable book with plenty of case studies and action points to try. Unlike some books I've reviewed, The Naked Consultation won't be filed in my loft-it'll sit right next to the Oxford Handbook on my consulting desk."
-BMJ Careers

"A must for anyone who wishes to improve their consultation skills or aims to better understand the process of making a cup of tea! Particularly good for the beginner (medical student, ST1 registrar) or the time-pushed, as the author gives clearly presented, readable summaries of the key theories in this field. I am a clinical teaching fellow in primary care and currently recommend this book to all our students."

"This charming book has a contemporary style which sets it apart from other consultation books. This is a must read for those aiming to pass the CSA exam comfortably. Its charm is in its easy-to-read pages with chapters listed as buzz words that are used in marking schemes for COT and CSA assessments. It consists of two parts: 'Part 1: Deconstructing the Consultation' and 'Part 2: Tools and Techniques for Learning and Improving Consultation Skills,' with an appendix 'jargon buster' at the end. This book was showcased by the recent RCGP Consultation Skills and Reducing Risk Workshop, and with good reason, in my opinion."
-Dr. Shazia Mahmud, GP, Health Sciences Library, Frimley Park Hospital NHS Foundation Trust, UK

"A useful addition to the consultation literature. The audience includes any type of primary health care practitioner, and teachers and clinical trainers would also find this useful. The author has addressed the intricacies of the consultation process with an improvement focus that engages readers and keeps them turning the pages."
Doody Enterprises, Inc.

"Has a relevance to anyone who has an interest and involvement with practical and clinical patient assessment. It will also be a useful aid for lecturers and trainers who teach communication skills. A learned text that is also light and likeable."
-Cancer Care News

"[This] book is exactly what it says on the tin: 'a practical guide to consultation skills for any health professional working in primary care.' ... In the first part of this book, Liz Moulton presents in her own approachable style the key features of most of the established consultation literature. The second part, of as much interest to teachers and trainers as to clinicians in training, reviews a wide array of current teaching and learning methods. She covers PUNs and DENs, working with colleagues, case discussion, role play, and video in eminently practical ways. The Naked Consultation is a practical and readable vade mecum for the would-be skilled consulter."
-From the Foreword to the First Edition by Roger Neighbour, MA, DSc, FRCP, FRCGP, Bedmond, UK

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