About Two Houses GP
Two Houses GP is the home of the Two Houses Consultation Model, a new way of thinking about the GP Consultation devised by Dr Martin Brunet and described in his book:
The GP Consultation Reimagined: A Tale of Two Houses
published in 2020 by Scion Publishing.
Martin is a GP and GP Trainer near Guildford and was a Training Programme Director on the Guildford GP Training scheme from 2009-2019. Having taught on the consultation over these 10 years, and developed the model over that time, he stepped down from his TPD role in order to write the book.
Martin can be found on twitter @docmartin68
This book will not teach you to improve your consultations. That is its great merit. Instead, it will encourage you to learn how to consult better
From the Foreword by Roger Neighbour
An extraordinarily persuasive new way of imagining the consultation and the relationship between doctor and patient that sustains it. This book makes me feel as if I'd like to start my career all over again
Iona Heath, retired GP, essayist and former RCGP President
Written with beautiful clarity, and with compelling examples. This is one of the most comprehensive accounts of GP tradecraft that I have ever read. It is also endearingly personal, and as such I hope it will become a classic of our profession
John Launer, GP, medical educator and author
The House of Discovery
The House of Discovery is where doctor and patient work together on the first major objective of the consultation:
WORKING OUT WHAT MATTERS
This part of the consultation can be envisaged as though the doctor is visiting the patient's home, where the problem the patient brings is explored in the context of their unique situation, beliefs, preferences and priorities. This House of Discovery is visited repeatedly, with each consultation building on the last. Different skills are required for exploring regular areas of the house, compared with heading down to the hidden depths of the basement, or the unruly nature of the garden.
The House of Decision
The House of Discovery is where doctor and patient work together on the second major objective of the consultation:
DECIDING TOGETHER WHAT TO DO ABOUT IT
This second part of the consultation is imagined as the doctor taking the patient on a tour of a medical house where every room contains a possible action that could be taken, whether it is an explanation of the problem, a test to arrange or a treatment to consider. Some of the rooms are simple to navigate, while others pose significant challenges. The model explores the nature of specific rooms including Empty, Locked and Hidden Rooms as well as the dreaded Room 101.
Key Concepts in the House of Discovery
Working out what matters
Key to the House of Discovery is to work out What Matters. This involves listening to and valuing the patient story, as well as thinking like a detective.
Filling the GP Toolbox
Developing skills as a GP involves filling your toolbox with communication skills - words, phrases and actions that you find effective and benefit the patient.
Popping the Bubble
Sometimes the consultation starts with tension, we need to learn how to pop this tension before it gets out of hand
Exploring the Basement
Hidden down in the Basement of the patient's life may be areas of privacy and shame. It is essential that the doctor knows when to consider a trip to the Basement, and how to approach it with sensitivity and care.
Tending the Garden
The Garden is all about the patient's approach to lifestyle choices, and the location for chronic disease management. It requires regular tending, but only with the patient in charge as chief gardener.
Finding Dry Rot
When we explore the House of Discovery, we may roll back the carpet of our patient's story and find something worrying. Helping the patient to face such bad news is an essential skill to acquire.
A key objective in the consultation is to achieve a Shared Understanding with the patient.
The patient needs to understand what the doctor thinks about the problem, but, just as importantly, the doctor must understand what matters to the patient.
Shared Understanding is crucial to ensure a smooth transition from the House of Discovery to the House of Decision.
Rooms to look out for in the House of Decision
The High Tech Room
The High Tech Room is often the first room to be visited in the House of Discovery, since it involves giving medical explanations of what the doctor is thinking. The challenge is to give this information in an accessible way that empowers the patient.
Most rooms in the House of Discovery are Optional; they can be entered and explored, or quickly bypassed. The trick is to decide with the patient which to enter and which to leave.
Empty rooms are encountered when the patient expects a test to be helpful or a treatment to be effective, when in reality the room has nothing to offer. The challenge is to come to a shared understanding about the nature of these rooms.
Hidden Rooms are the opposite of Empty and Locked Rooms in that they contain a potentially useful plan of action that the patient was not previously aware of. They can be very useful to counter the disappointment of an Empty or Locked Room.
Locked Rooms are encountered when a possibly useful treatment or test is not available to the patient, due to something like a contraindication or a lack of funding. The challenge is to share the inevitable disappointment and help the patient to find an alternative way forward.
The defining features of Room 101 are that it contains an important treatment or test and the patient could come to harm if they do not enter, but they are reluctant to do so. The doctor needs to try to help the patient across the threshold, and to be prepared to continue to work with the patient even if the room cannot be successfully navigated.