Dr Chris Barker, is a general practitioner with a special interest in pain and Associate Specialist in Pain Medicine, Merseyside. He is an honorary lecturer at Cardiff University and is a key opinion leader in primary care pain management. In the second of a series of three consultations, Chris encounters an aggressive, distressed patient demanding a scan. He demonstrates some of the difficulties encountered and how a change in consultation style may be indicated to diffuse a difficult situation.

Points to note from the consultation:

* Poor eye contact from patient initially, disrespectful towards colleagues and on a rant
* Wait & see approach initially adopted
* Aggressive & distressed; frustrated
* Got into assessment eventually by biding time
* GP feeling vulnerable & risk of losing consultation
* Used examination to break up deadlock
* Carried on with history after calmed with examination
* Avoiding confrontation difficult with this patient
* BPS assessment completed in a disordered way but information intact
* Ongoing negotiation
* Focus upon real life – main issues are pain, work & family related.

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