FPC1 Tutorial 1 General Practice - A Groups - 1A

Question 1

list some specialties

Answer 1

GP- 47%
medicine- 14%
anaesthetics- 7%
surgery- 6%
peadiatrics- 6%
psychiatry- 4%
emergency medicine- 4%
obstetrics and gynae- 4%
radiology
histopathology
ophthalmology 
public health
oncology
microbiology
neurosurgery
sexual health

Question 2

what are the roles of General practitioners?

Answer 2

Caring for the whole person as well as their illnesses.

The promotion of healthy life styles.

The first point of contact.

Question 3

what are the skills that GPs utilise throughout their career?

Answer 3

Problem-solving and managing Risk and

Uncertainty (Tutorial 4 Year 1).

Evidence-based medicine (Tutorial 2 Year 2).

Wide ranging clinical skills. (Tutorial 4 Year 1)

A holistic approach aimed at managing risk, and dealing with uncertainty and complexity. (Tutorial 2 Year 2)

Question 4

what are the personal qualities required to be a good GP?

Answer 4

Ability to care about patients and their relatives

A commitment to providing high quality care

An awareness of one’s own limitations

An ability to seek help when appropriate

Commitment to keeping up to date and improving quality of one’s own performance

Appreciation of the value of team work

Good interpersonal and communication skills

Clinical competence

Organisational ability

Ability to manage oneself

Ability to work with others

Maintaining good practice

Relating to the public

Ability to deal with uncertainty

Question 5

is there a typical GP practice?

Answer 5

no

Question 6

what do practices respond to localy?

Answer 6

the local health in which they vary considerably

Question 7

Do General practices tend to be larger practices now?

Answer 7

there are still a few small ones rurally but these are less common

there are trends to larger practices

Question 8

what is the practice owned by?

Answer 8

could be owned by the GPs themselves or by the local NHS organisation

Question 9

what are GPs responsible for when running their buisness affairs to the practice?

Answer 9

providing adequate premises and infrastructure to provide safe patient services and employ and train practice staff

Question 10

Are GPs advanced in IT?

Answer 10

yes

GP practices have led the way in the move from paper to digital record-keeping and are now well on the way to offering online transactions, such as appointment bookings and repeat prescriptions.

Question 11

what does using IT enable the practice to do?

Answer 11

This means that patient data can be easily accessed by any approved member of staff at any time, and sometimes any place when working remotely.

Patient data can be listed, graphed and searched easily, enabling GP’s to convey and track information in a more effective manner than perhaps any other area of the NHS

Question 12

what are the main systems for GP IT? and what do they store?

Answer 12

Locally the main systems are Vision and EMIS.

They store appointments, assist in consultations, support prescribing, and allow GP’s to manage hospital letters and blood results electronically.

Question 13

what are the uses of practice IT systems?

Answer 13

Store appointments

Book appointments

Assist in consultations (patient records)

Support prescribing

Electronic management of
hospital letters

Electronic management of blood/other results

Use in audit

E-consultations

Chronic disease management and recall

Patient leaflets/resources

Public health information

Identify patients for screening programmes

Question 14

how is the work-life balance for GPs?

Answer 14

very flexible,

GP is able to make decisions about the priorities of the practice. They also have opportunities to decide their pattern of work, with many taking on other roles, such as working in another hospital department, or at the University for example.

Question 15

can GPs chose what their shifts are like?

Answer 15

yes

Question 16

what might taking another interest whilst being a GP do for them?

Answer 16

increase their job satisfaction in the longer term

Question 17

when was the out of hours care removed from thee national GP contract?

Answer 17

2004

Question 18

can GPs still get paid for the night or weekend if they chose to do it?

Answer 18

yes £££££

Question 19

how often do GPs have to undergo revalidation?

Answer 19

every 5 years

Question 20

how do GPs prepare for appraisal?

Answer 20

each year they read literature, attend courses and perform audits.

Question 21

what do the BMA recommend for a GP undergoing appraisal

Answer 21

time negotiated as protected for appraisal, and most partnerships accommodate GP partners learning needs with allocated study leave

Question 22

who is involved in the practice team?

Answer 22

Manager
IT/Admin Staff
Secretarial Staff
Reception Staff
Nurses – Junior/Senior
Advanced Nurse Practitioners/Physicians Assistants
Phlebotomists/Health Care Assistants

Question 23

what is the main interface between NHS and the community?

Answer 23

GP

Question 24

what are the four essential components of clinical competence?

Answer 24

knowledge, communication skills, physical examination and problem solving

Question 25

what are the three broad types of skills needed for successful medical interviewing?

Answer 25

content skills
perceptual skills
process skills

Question 26

what are ‘content skills,?

Answer 26

What doctors communicate - the substance of their questions and responses, the information they gather and give; the treatments

Question 27

what are ‘perceptual skills’?

Answer 27

What they are thinking and feeling - their internal decision making, clinical reasoning; their awareness of their own biases, attitudes and distractions.

Question 28

what are ‘process skills’?

Answer 28

How they do it - the ways doctors communicate with patients; how they go about discovering the history or providing information; the verbal and non-verbal skills they use; the way they structure and organise communication.

Question 29

what are factors influencing the consultation?

Answer 29

Physical factors

Personal factors - doctor and patient

Question 30

what are the physical factors effecting consultation?

Answer 30

Site and environment

Adequacy of medical records

Time constraints

Patient status-new patient, new problem

Question 31

what are personal factors influencing consultations?

Answer 31

age
sex
background and origins in
knowlegde and skils
belief
the illness

Question 32

what are the three styles of doctor/patient relationship?

Answer 32

authoritarian or paternalistic relationship

guidance/co operation

mutual participation relationship

Question 33

what is Authoritarian or paternalistic relationship

Answer 33

The physician uses all of the authority inherent in his status and the patient feels no autonomy. He tries hard to please the doctor and does not actively participate in his own treatment.

Question 34

what is guidance/co-operation relationship?

Answer 34

The physician still exercises much authority and the patient is obedient, but has a greater feeling of autonomy and participates somewhat more actively in the relationship.

Question 35

what is a mutual parcipitation relationship?

Answer 35

This is the most desirable for the more complex diagnostic interview, as it is for the management of patients suffering from a chronic illness. Here the patient feels some responsibility for a successful outcome which involves both active participation and a feeling of relatively greater personal autonomy. This is created by appropriate moderation of the doctor’s use of his authority. In such a relationship, the widest range of relevant diagnostic information tends to emerge and the most successful outcome of treatment is likely to occur.

Question 36

what 3 seperate activities does a medical consultation typically involve?

Answer 36

talking together - always

doctor examining the patient- often

performing procedures- sometimes

Question 37

what are the three types of communication that can be seen by the doctor whilst taking a history of a patient?

Answer 37

open ended questions

listening and silence

facilitation

Question 38

what are open ended questions?

Answer 38

The open-ended question is essential in initiating the interview. A question such as, “what kind of troubles have you been having?” may start to elicit an account of the problems and worries that a patient has.

Question 39

what is listening and silence?

Answer 39

Vital to the quality of communication are active listening skills. This means asking questions that follow on logically from what the patient has told you, encouraging them to talk by nodding, making eye contact, etc, plus picking up on the patient’s body language (ie, nervousness, eyes filling with tears).

Silence is a means of encouraging communication. While the patient is communicating freely, the doctor’s behaviour of choice is an interested attentive and relaxed silence. An attentive facial expression and posture tells the patient non-verbally that s/he has an interested listener.

Silence can also encourage communication. If the patient falls silent the interviewer should consider being silent him- or herself for at least a brief time (a few seconds - not a long uncomfortable gap!). If one senses that the patient is holding back and that his/her non-verbal behaviour reflects tension or discomfort, one’s silence is likely to be appropriate.

Question 40

what is facilitation?

Answer 40

Facilitation encourages communication by using manner, gesture or words that do not specify the kind of information that is sought. It suggests that the doctor is interested, and encourages the patient to continue. Silence and facilitation tend to go hand in hand
- an interested, attentive manner is of course facilitating. Change of facial expression or posture displaying greater interest or attention is a facilitation.

Question 41

what are the type of questions?

Answer 41

Open-ended question
Direct question            
Closed question
Leading question
Reflected question

Question 42

what are examples of instrinctive non verbal communication?

Answer 42

crying, expressions of pain, laughter

Question 43

what are different ways of misinterpreting body language?

Answer 43

culture
context
gesture clusters
congruence