FOPC 1 Flashcards
Who is involved in community care
- GP
- Dietician
- Psycologist
- Pharmacists
- Nurses (school and midwifes)
- Health educators
- Physiotherapist
- Councellor
Who else makes up the GP team
- Locum GP
- Nurses including nurse practitioners
- Phlebotomists
- Managers
- IT staff- in charge of repeat prescriptions
- Receptionists- booking appointments
- Secretary
Which specialties are available
- GP
- Environmental medicine
- Public health
What other events can be covered by GPS
- Out of hours responsabilities
- BASICS- british association for Immediate care
- Events coverage
- Portfolio careers: short time roles
Definition of Gp as a gatekeeper
They are involved in co-ordinating the health care of the patient: in charge of all their referrals and their transition into secondary/ specialist care
Advantages of being a gatekeeper
- continuity of care
- makes sure the patient is sent to the right place
- reduces costs and wating times in secondary/specialist care
- Stregthens the dr-patient relationship
- reduces exposure to dangers such as MRI radiation
- Puts dr in charge of patient education
Disadvantages of being a gatekeeper
- GPs need to be more knowledgeable in certain areas
- Could strain relationship if things go wrong
- Patient has less control over whole health care
- More stress on GP
Skills which are used by a GP
- Holistic approach
- Assess risk and uncertainty
- Problem solving- hypothetical deductive reasoning
- A variety of clinical skills
- Evidence based medicine
Skills which medical students need to acquire in order to become good doctors
- Awareness of self limitations
- Ability to ask for help when required
- Good team work
- Ability to keep up to date and improve self-performance
- Good interpersonal skills and ability to communicate with others
- The ability to deal with risk and uncertainty
- Good organizational skills
- Ability to care for patients AND THEIR RELATIVES
- A commitment to deliver high quality of care
Factors which allow a dr to provide best quality of care
- Awareness of patients current and past medical history
- Awareness of patients social circumstances
- Local so readily available
- Tend to follow patients for a long period of time so develop a relationship with them-ARE TRUSTED
- GP has a huge variety of skills and knowledge
- Holistic approach: involved not only in diagnosing but also in preventing
Perks of being a GP
- good work-life balance
- A GP is an independent contractor so can choose how many sessions to work
- One session is ½ days work
- Since out of hours contract GPs no longer have to cover weekends and night hours
GP learning
- Continuos process
- Revalidation every 5 years
- GP must prepare for appraisals by reading literature, attending audits
- Audits are held with other medical professionals
Running a GP clinic
- Like running a business
- In charge of making sure both infrastructure and medical practice meets the standards to provide safe medical practice
What is IT in Gps used for
- Store and book appointments
- Electronic management of hospital referral letters
- Electronic management of blood tests and results
- Keep a copy of patient records which helps during consultations
- Can be used in audits
- To manage chronic diseases and recall for immunisations
- repeat prescriptions
- to identify patients for screening programmes
Meaning of longitudinal care
Care of patient from baby to age of 40
4 essential components of clinical competence:
- Communication skills
- knowledge
- Physical examination
- Problem solving
Skills which a GP must have when conducting a medical interview
- Content skills- What they communicate and what they gather
- Perceptual skills- What the doctors Is feeling. Awareness of own bias, attitudes and thoughts
- Process skills: How the doctors goes about gathering and giving information. Combination of verbal and non-verbal reasoning. Ability to provide structure to the way they conduct their interview
Factors which affect a consultation
Physical
- Environment : Safe space of a GP clinic/ED rather than in a caotic environment such as a car crash
- State of medical records
- Time constraints of consultations
- Patient status e.g. new patients/old patients with known conditions or unknown conditions
Personal factors:
- Age
- Gender
- Ethicity/background
- Knowledge/skill: Drs may feel more pressured if they are consulting someone else in the profession as they feel they might have more experience than them
- The illness: more difficult to conduct a consultation in which you are informing the patient they have a terminal illness
Types of DR-patient relationship
Authoritarian/paternalistic: DR in charge of care. Patient has no autonomy- is not actively involved in their treatment
Guidance/Co-operation: Dr still has more autonomy but patient is more involved- has some say in their treatment
Mutual participation: Active participation of both dr and patient. Patient feels some responsibility for a successful outcome.
The consultation is made up of three separate activities:
- Talking together: always
- Examination: often
- Procedures: sometimes
Skilled interviewer qualities
Will communicate their treatment plan to the patient in a clear way they understand without frightening them
- Will involve the patient in their own care
- Build a relationship which will ensure that relevant issues are made clear early on
Question types
- open ended questions
- closed questions -YES/NO
- Reflective questions-
- Direct questions – asks about a specific facor
- Leading questions- presumes the answer
Non verbal communication
-Instinctive : crying, laughing
-Learned:
From life experience
From training
-Clinical observation
Body language
Study of body language helps observation and communication and therefore patient care:
Culture- certain body languages must be taken into consideration
Gestures clusters- re-inforce information
Context- body language due to pain which is not related to non-verbal messages
Congruence: Lack of congruence (agreement) may be a sign of omission. Non-verbal language carries more significance in these circumstances than verbal language
Gaze behavior:
Lack of eye contact can indicate patient is holding back information/ is being dishonest
Posture:
Depressed patients are usually slouched
Nervous patients are usually restless
Specific gestures
Crossed arms/clutching a handbag may be signs of distress
Hand to face gestures: can indicate doubt/ uncertainty
- holding face to hand- indicates boredom
- clenched hand- patient is holding back negative attitude
- chin, cheek- indicate interest
- Index finger indicated negative thoughts
Role of GP?
- promoting healthy life style
- Caring for whole person and not just their illness
- Main interface between community and NHS
- First point of contact
