The Three Ring Model is a teaching model of the consultation whose goal is the application of the biopsychosocial model of medicine, in real-time, in consultations having a defined time framework. In short, it aims to support the practice of medicine that is both humanistic and efficient.
In its barest outline The Three Ring Model views the physician as having three cardinal tasks that are valid ubiquitously throughout each consultation. Because these tasks often compete with one another for the doctor’s attention the model views doctors as being forced, throughout the consultation, to make conscious choices about which cardinal task to attend to and with what tools.
In this model the three cardinal tasks are named “problem-solving”, “connecting” and “managing”.
Problem-solving refers to the classic biomedical tasks of diagnosis and treatment in all their stages and for all medical conditions (including for example physical and psychological conditions and preventative medicine).
Connecting refers to establishing and maintaining a therapeutic relationship with the patient. This task entails “humanistic” aspects whereby the doctor interacts with the patient as a complex, unique and valued human being. It also entails professional aspects whereby the doctor acts, as it were, as a member of a guild according to the professional standards and the ethos of that guild.
Managing refers to that set of organization tasks that control the flow and content of the consultation, that manage the time element of the consultation and that control the balance of the attention given to the other two tasks. Managing may be likened to the “executive function” of the consultation.
Tool Kits The Three Ring Model also envisages a tool kit, or a set of concepts and skills, that can be used in the service of each of the three cardinal goals.
Regarding problem-solving Historically, the tools for problem-solving have dominated medical education and so most doctors are well-trained in their use. Problem –solving tools, therefore, are not emphasized in this model as much as the tools for connecting and managing – tools which are generally less familiar to practicing physicians.( Never the less, the Three Ring Model does offer a few concepts and tools for problem-solving that appear to benefit even the well trained.) Overall, the main contribution of the model to “problem- solving” is in placing that function in the context of a triad of functions that often compete with one another.
Regarding Connecting The task of “connecting” is best viewed as the developing of a supportive relationship with the patient’s metaphoric “inner patient”. The bulk of psychosocial parameters embedded in the inner patient are reflected in the mnemonic device called CASE:
C Concept refers to the health belief model of the patient: the way the patient understands the mechanism of his illness and its treatment
A Affect refers to the emotions inherent in the patient’s condition as revealed by the patient’s words or actions during the consultation.
S Significance refers to the unique significance of the patient’s problems to the patient, based upon his/her personal history, experience or and mind-set.
E Expectations refers to the patients’ expectations regarding how they will be treated by the treating physician and the health service provider regard their medical care and their rights as patients.
Doctors can engage the inner patient basically in two ways. On the one hand the doctor can initiate a discussion on one of the relevant aspects of the patient’s CASE. On the other hand, the doctor can respond to patient “cues” – words or actions of the patient which seem to invite such a discussion. How doctors can recognize and respond to cues is an important element in the Three Ring Model.
Regarding managing: The starting point of the model’s development of a tool kit for “managing” is the widely-held perception that time restraints in daily practice restrict the doctor’s freedom to connect with the patient. This attitude is summed up in the statement “ Bedside manner’s are important in theory, but in real practice we have to stick to the basics lest we open a Pandora’s box.”
The Three Ring Model provides doctors with one set of tools that enable them to skillfully open and close the feared psychosocial box. By helping doctors overcome Pandoraphobia the model frees them to balance humane connecting and practical problem-solving.
Another set of useful tool for “managing” is related to the use of a standard format for the consultation. That format entails a pre-determined sequence of subtasks, each marked by metaphorical “milestone”. These milestones provide direction and structure to the horizontal flow of the consultation is it moves forward through the ubiquitous force fields of connecting and problem-solving.
The Three Ring Model as a teaching device
The Three Ring Model serves as the source of the terminology and of the conceptual constructs used by Tedmed.org in both the catalog of the video collection and the short online course. This teaching model of the consultation is totally compatible with other commonly-used models of communication. It itself evolved over many years for use in courses that initially utilized various such models on their own. Therefore, much of the terminology and the conceptual framework in this model is similar to those in common usage. Furthermore, the idiosyncratic aspects of the Three Ring Model are mainly expressed as mnemonic devices which are entirely consistent with the other current models and are by-and-large self- explanatory. A definition of the key concepts of the model and their relationship to concepts in other models can be found in the glossary of terms.
This model can be used to help doctors (through demonstrations and exercises) to identify the cardinal goals of the consultation as they arise in each unique patient encounter. Training using this system, furthermore, can help doctors to consciously select appropriate tools for each recognized goal, and to find the balance in their response between the competing goals.
Tedmed.org invites you to learn more about the Three Ring Model and to participate in a short on-line training course on improving doctor-patient communication based on the model.
In addition, trainers in doctor-patient communication are invited to use our large annotated data base of simulated interviews and clips to select appropriate teaching material for their teaching.