Opportunistic health promotion

The classic model by Stott and Davis ( Table 3.1 ) highlights the opportunities for health promotion in each consultation. 3 Since the consultation is patient-initiated, it is the doctor who needs to be the initiator of preventive health care. The potential in the consultation involves reactive and proactive behaviour by the doctor ( Fig 10.1 ). 4

Reactive professional behaviour deals only with the presenting complaint. It may be performed with skill but if the practitioner is only trained to perform reactively then the opportunity for preventive and promotive health care will be lost.

Proactive behaviour is defined as professional behaviour that is necessary for the patient's wellbeing, but it is performed not merely as a response to the presenting problem and it is initiated by the doctor. 4 It includes health promotion, preventive care and screening and the early detection of disease before it becomes symptomatic. Other aspects of proactive care are seen in Fig 10.1 .

Rcadi ve

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Professional behaviour

Fig. 10.1 The potential in every general practice consultation

Proactive behaviour also includes: 4

• continuing care of a previously treated problem, e.g. rechecking blood pressure, checking diabetic control, follow-up bereavement counselling

• co-ordination of care by organising referral to appropriate agencies or specialists and maintaining adequate medical records

• The modification of abnormal or inappropriate help-seeking behaviour: e.g. the person who never attends is at risk from 'silent disease'; the too frequent attender wastes resources and serious illness may be overlooked

This mix of reactive and proactive behaviour is not appropriate in every consultation. It requires counselling skills and training in the delivery of quality general practice.

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