Table 1 The SOFIA scheme

Welcome

The patient and general practitioner (GP) agree on the aim of the consultation. Information about the study and participation is repeated. It is orally confirmed that informed consent for study participation has been given.

SOcial clinical space: The “patient part” of the consultation

This opening part of the consultation aims to establish a positive relationship between the patient and the GP. The patient has the opportunity to present his or her complaints and through clarifying the patient’s thoughts, feelings, and notions regarding these complaints, the GP sets an agenda for the consultation. Suggestions for open questions the GP could ask are:

“How are you? Is there anything that you would like to focus on today? Are there any other concerns that I should be aware of? Is there anything in particular that you hope to gain from today’s meeting and is there anything that you hope that I can help you with?”

Dependent on the study arm the patient is allocated to, results from the surveys about the quality of life may be discussed. The GP is instructed to probe for areas that need attention and needs that should be focused on, especially if the patient’s sum score on any of the six scales indicates poor quality of life in the construct measured by the scale. The GPs are instructed to ask whether the patient experiences suicidal thoughts (if so general practitioners are instructed to follow the SOFIA handbooks’ guide on talking about suicide). If not already known, GPs ask about possible substance abuse and self-harm (if yes, see the SOFIA handbook for referrals).

FInd any symptoms for undiagnosed or undertreated somatic diseases: The “GPs’ part” of the consultation

The middle section of the consultation aims to collect information on current diagnoses and their treatments and to detect possible, unrecognized, and undertreated disorders or overdiagnosed and/or overtreated conditions. The GPs are instructed to ask about known diseases and current treatments and any symptoms that the patient may experience. The GPs will perform a focused physical somatic diagnostic interview, based on any somatic concerns that the patient and GP agree upon. The patient must be physically examined, even if they have no physical complaints, because of the delayed and altered bodily experience often accompanying SMI. The GPs conclude this part of the consultation with a brief review of current medication and, if relevant, make a plan to optimize pharmacological treatment. The GPs discuss adherence challenges related to treatment, possible side effects, and any possible considerations or wishes for medication changes with the patient. If required, a pharmacologist can be consulted by email. If required, a follow-up consultation focusing on medications will be scheduled.

Agree on individual care plan (final step of the SOFIA scheme)

During the final part of the consultation, an individual care plan is made. The GP and the patient will discuss current treatment with the patient, i.e. is the patient adequately treated for his/her current conditions. The GP and patient assess whether treatment adjustments are needed. The GP explores if anything discussed during the consultation requires follow-up, i.e. referrals to the municipality, a psychologist, “institutional care facility” or other services listed by the SOFIA handbook. The GP creates a safety-net – by emphasizing that the patient is always welcome to contact the practice. If medically indicated, paraclinical tests and follow-up consultations will be scheduled.