The Calgary Cambridge Guide to structuring a patient consultation suggests the following approach:

1. Initiating the session

Build rapport and a climate of mutual trust and respect:

• Introduce yourself and say, “Hello, my name is… and I am the… [your role]”
• Confirm the patient’s identity then ask. “How would you like to be addressed?”
• Explain your reason for the consultation – “I am here to...[review your medicines and ensure you are getting the best from them or address any concerns or issues you have regarding your new medicines/condition or check you have the information you need or want to use your medicines]. Is this a good time to speak about this?”

Negotiate a shared agenda

• “What do you want to discuss in this consultation?”

2. Gathering information

Explore the patient’s perspective and identify adherence issues

• “What do you know about your medicine/condition” or “What would you like to know?”
• “What concerns, if any, do you have about your medicines/condition?”
• “What improvements are you expecting from your medicines?”
• “Patients often miss doses of their medicine. How many doses of your medicine, if any, have you missed in the last week/month? What were the reasons?”

3. Explanation and planning

Educate the patient in response to:

• Information or advice they’ve asked for at stage 2 above
• Misunderstandings or misconceptions they may have revealed about their medicine/condition when questioned about what they know at stage 2
• Essential safety advice about a medicine – i.e. don’t tell them everything at once. You may have established what they already know and can target essential information, according to their need or re-emphasise key safety information, e.g. “Rinse your mouth with water after using your [steroid] inhaler to remove any traces and reduce the risk of thrush."

Empower the patient to come up with options and enable them to fit medicines taking into their routine or lifestyle to help with adherence issues

• Ask the patient, “What can you do to remember to take your medicines?” or “What do you do in your daily routine that you can combine with taking your medicine so that you remember, e.g. keeping your medicine next to the alarm, with the toothpaste, coffee mug, cereal box, etc?”
• “What would be most helpful – to discuss alternative drugs, the benefits and risks of taking/not taking your medicine or alternative options?”
• “What do you want to do about your medicines now?”
• Refer or seek alternatives if their decision is not to take a medicine or to stop taking it.

4. Closing the session

Provide guidance on what to do if they experience issues after the consultation and who they can contact (safety netting) and check their commitment to agreed actions

• Say, “This is how to contact me should you have further queries or you experience issues with your medicines...”
• “If you experience symptoms such as… you should return to the [GP or prescriber]”
• “To summarise, what you have decided to do is…”
• “To check that I’ve understood what you want to do about your medicines/condition, please explain the steps you have decided to make”
• “Would you like to discuss your progress and if so, when?”