FPC1 Tutorial 1 General Practice - A Groups - 1A Flashcards
list some specialties
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
what are the roles of General practitioners?
Caring for the whole person as well as their illnesses.
The promotion of healthy life styles.
The first point of contact.
what are the skills that GPs utilise throughout their career?
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)
what are the personal qualities required to be a good GP?
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
is there a typical GP practice?
no
what do practices respond to localy?
the local health in which they vary considerably
Do General practices tend to be larger practices now?
there are still a few small ones rurally but these are less common
there are trends to larger practices
what is the practice owned by?
could be owned by the GPs themselves or by the local NHS organisation
what are GPs responsible for when running their buisness affairs to the practice?
providing adequate premises and infrastructure to provide safe patient services and employ and train practice staff
Are GPs advanced in IT?
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.
what does using IT enable the practice to do?
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
what are the main systems for GP IT? and what do they store?
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.
what are the uses of practice IT systems?
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
how is the work-life balance for GPs?
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.
can GPs chose what their shifts are like?
yes
what might taking another interest whilst being a GP do for them?
increase their job satisfaction in the longer term
when was the out of hours care removed from thee national GP contract?
2004
can GPs still get paid for the night or weekend if they chose to do it?
yes £££££
how often do GPs have to undergo revalidation?
every 5 years
how do GPs prepare for appraisal?
each year they read literature, attend courses and perform audits.
what do the BMA recommend for a GP undergoing appraisal
time negotiated as protected for appraisal, and most partnerships accommodate GP partners learning needs with allocated study leave
who is involved in the practice team?
Manager IT/Admin Staff Secretarial Staff Reception Staff Nurses – Junior/Senior Advanced Nurse Practitioners/Physicians Assistants Phlebotomists/Health Care Assistants
what is the main interface between NHS and the community?
GP
what are the four essential components of clinical competence?
knowledge, communication skills, physical examination and problem solving
what are the three broad types of skills needed for successful medical interviewing?
content skills
perceptual skills
process skills
what are ‘content skills,?
What doctors communicate - the substance of their questions and responses, the information they gather and give; the treatments
what are ‘perceptual skills’?
What they are thinking and feeling - their internal decision making, clinical reasoning; their awareness of their own biases, attitudes and distractions.
what are ‘process skills’?
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.
what are factors influencing the consultation?
Physical factors
Personal factors - doctor and patient
what are the physical factors effecting consultation?
Site and environment
Adequacy of medical records
Time constraints
Patient status-new patient, new problem
what are personal factors influencing consultations?
age sex background and origins in knowlegde and skils belief the illness
what are the three styles of doctor/patient relationship?
authoritarian or paternalistic relationship
guidance/co operation
mutual participation relationship
what is Authoritarian or paternalistic relationship
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.
what is guidance/co-operation relationship?
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.
what is a mutual parcipitation relationship?
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.
what 3 seperate activities does a medical consultation typically involve?
talking together - always
doctor examining the patient- often
performing procedures- sometimes
what are the three types of communication that can be seen by the doctor whilst taking a history of a patient?
open ended questions
listening and silence
facilitation
what are open ended questions?
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.
what is listening and silence?
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.
what is facilitation?
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.
what are the type of questions?
Open-ended question Direct question Closed question Leading question Reflected question
what are examples of instrinctive non verbal communication?
crying, expressions of pain, laughter
what are different ways of misinterpreting body language?
culture
context
gesture clusters
congruence
