Middleton’s model consists of reconciling the patient’s and doctor’s agendas and drawing up a negotiated plan. The two agendas are not always compatible and it is well known that compliance is poor if the patient does not wholeheartedly back the plan of campaign. The days of giving out authoritarian, prescriptive advice are long since over. However, patients should be given up-to-date information on the different methods available and method teaching should be carried out.
Nearly one-half of all information given in general practice consultations is forgotten (Ley, 1982). Advice can be given in ways which increase the likelihood of the patient remembering it
(Fowler, 1985a). It is useful to stress important pieces of advice, using short words and sentences, giving specific rather than general advice and repeating advice. Countering myths is also important. The use of leaflets to supplement advice is vital (Fowler, 1985b). The Family Planning Information Service sets a very high standard with its set of family planning leaflets.
Included in this section is Neighbour’s handing-over phase under which heading he includes negotiating with the patient, influencing the patient and how the plan is presented. Before moving on, it is necessary to check that the patient is happy with the plan. The patient should be encouraged to accept an appropriate degree of responsibility.