The FRAYED consultation model for doctors dealing with unreasonable demands from difficult patients

The FRAYED consultation model for doctors dealing with unreasonable demands from difficult patients: A communication skills guide for stressed GPs on how to survive doctor-patient conflict


This book is by Dr Deen Mirza, a self-help author and coach for GPs, who runs courses on ‘Survival Skills for General Practice’ ( It is a revolutionary re-framing of the GP consultation for the family doctor of the 21st century.
General practitioners today are overwhelmed by a huge workload and increasing patient demand. All of the communication skills teaching GPs receive during training pushes doctors to become more intuitive, more sensitive and more understanding. But how does this work when a GP is already worn out himself?

This groundbreaking book works on a completely different premise: that the doctor simply needs to survive rather than be a superhuman. It recognises that stress and confrontation wear out the family physician, who cannot afford to compromise his function in this way.

Dr Mirza analyses one of the most dysfunctional types of doctor-patient encounter- when a difficult patient makes an unreasonable demand. He acknowledges the potential for this type of consultation to spiral out of control, consuming the GP’s clinic time and emotional health. By then breaking down the encounter into different phases, he outlines a method for engaging, negotiating and in some cases, submitting gracefully to the patient.

The author writes: ‘If you get yourself entrenched in a downward negative spiral with a difficult patient, then I hope that this model helps you to deal with it positively and move on emotionally intact.’

The mnemonic presented – FRAYED- is memorable and easy to apply. The reader is guided smoothly through the different stages of Fact-Finding, Refuse Request, Acceptable Alternative, Yield or don’t Yield, End Encounter and Document Diligently.

New and unique concepts included here are: the idea of ‘Loop-holing’; making a strategic decision to Yield to an unreasonable request; and feeling ‘OK’ about it afterwards.

This book lies in stark contrast to previous paradigms of the consultation in that the emphasis is on the doctor’s psychological health. No longer is the doctor automatically expected to sacrifice his well being to protect the NHS, appease those who are monitoring his performance or persist in empathising with someone who is shouting at him. By describing a situation that can contribute to physician burnout, and then providing a simple exit strategy, Dr Mirza shows a way to manoeuvre around challenging patients.

With forewords by Dr Nigel Giam and Dr Hamed Khan, two well known figureheads of the next generation of general practitioners, this approach has received credible endorsement by those in the front line of primary care today.

Other self help guides in this series will include: ‘Ten Diagnostic Mistakes That Doctors Make’; ‘A GP’s Guide to Consulting Efficiently Within Ten Minutes (And Not Running Late)’, and ‘The Golden Minute – What To Document After The Patient Has Left The Room (So As Not to Get Sued)’. With these titles the author heralds a new wave of literature fit for the family doctor practicing in the 21st century.

From the Foreword by Nigel Giam

‘…in a time when the medical profession is being stretched in all directions, there is a necessity for reactive, resilient and flexible consultation styles. Recognising that you may need to adopt a FRAYED model early on in a consultation will enhance self-awareness, ensure that you utilise ‘ego states’ in a functional manner and facilitate a balance between you and the patient. We don’t go looking for battles, but unfortunately as GPs we cannot control what comes in through the door. Being FRAYED alert will help avoid being FRAZZLED and I think we can all agree that burn out is an end point we would all rather avoid. A great read and I am now actually looking forward to that next challenge in the consultation room!’

Click here to buy this book on Amazon