Table 1 The SOFIA scheme

Welcome

Patient and general practitioner agree on the aim of 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 general practitioner. 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 general practitioner sets an agenda for the consultations. Suggestions for open questions the general practitioner 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 MMQ1 may be discussed. The general practitioner is instructed to probe for areas that need attention and needs that should be focused on, especially if the patient’s sum score in any of the six scales indicates poor quality of life in the construct measured by the scale. The general practitioners 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, general practitioners ask about possible substance abuse, self-harm (if yes, see the SOFIA handbook for referrals).

FInd any symptoms for undiagnosed or undertreated somatic diseases: The “general practitioners’ 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 general practitioners are instructed to ask about known diseases and current treatments and any symptoms that the patient may experience. The general practitioners will perform a focused physical somatic diagnostic interview, based on any somatic concerns that the patient and general practitioner agree upon. The patient must be physically examined, even if the patients have no physical complaints, because of the delayed and altered bodily experience often accompanying SMI. The general practitioners conclude this part of the consultation with a brief review of current medication and, if relevant, make a plan to optimize pharmacological treatment. The general practitioners 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 consultation)

During the final part of the consultations, an individual care plan is made. The general practitioner and the patient will discuss current treatment with the patient, i.e., is the patient adequately treated for his/her current conditions. The general practitioner and patient assess whether treatment adjustments are needed. The general practitioner explores if anything discussed during the consultation requires follow-up, i.e., referrals to municipality or psychologist, or referral to “institutional care facility” or other services as provided by the SOFIA handbook. The general practitioner 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.