Sean Hanna

General Practitioner Ora Toa PHO

In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.

The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.

The practitioner is confronted with a choice. Shall he remain on the high ground where he can solve relatively unimportant problems according to his standards of rigor, or shall he descend to the swamp of important problems where he cannot be rigorous in any way he knows how to describe.

Donald Schon (1983)

• Mihi: initial greeting and engagement.• Application to clinical consultation: The main focus of the

first stage is to ensure clinicians clearly introduce themselves and describe their role (as the doctor) and the specific purpose of the consultation to the Māori patient and whānau.

• Whakawhānaungatanga: making a connection.• Application to clinical consultation: The primary focus of

this stage is connecting at a personal level with the patient and any whānau present. This process is based on a traditional format of engagement within Māori cultural protocol, and is often mistaken as ‘building rapport’.

• Kaupapa: Attending to the main purpose of the consultation

Lacey et al, NZMJ 2011

Feedback Informed Treatment• Borrowed from psychotherapeutic literature (Scott Miller,

International Center for Clinical Excellence)• At present we do anonymous patient satisfaction surveys,

we have anonymous suggestions boxes, we overhear people say “he’s a great GP”, sometimes we get a mention in the Deaths notices in the newspaper. Why don’t we just ask consumers directly if we are any good, and how we can be better???

• A reliable, valid, and objective way to measure our effectiveness, and to change our approach when what we are doing in consultations isn’t working.

Feedback on Therapeutic Alliance

• Therapeutic Relationship is one of the stronger factors that predicts response to treatment

• Clinicians are not good at predicting the therapeutic alliance

• The only way to get feedback on alliance is from patients/ clients/ consumers/ tangata whaiora