General Practice Flashcards
Name 5 specialities other than General practice
Surgery Paeds Obs and gynae Histopathology Radiology Opthamolagy Emergency medicine Psychiatry Anaesthetics Neurosurgery Sexual Health
What does it mean by Holistic approach within medicine
Treatment of the whole person
mental, social as well as illness
being able to manage risks and deal with uncertainty and complexity
What are the personal qualities required in general practice? State 5
- 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
What is a GP practice?
- There is no longer a typical Practice.
- Practices are responsive to local health needs and vary considerably.
- The Practice or building might be owned by the G.P.’s themselves, or by the local NHS organisation.
What are the three elements when referring to body language
Gaze behaviour
Posture
Specific gestures
What is gaze behaviour?
Eye contact is important in communication, and indicates interest. During communication a speaker holds eye contact 30% of the time, the listener holds eye contact the majority of the time.
How is posture an important element of body language?
Posture provides further information. A depressed person often looks literally depressed - head bowed, slumped posture; the anxious person is often restless and fidgety. Hands placed behind the head can suggest a confident or superior attitude. Fidgitting and moving around in the seat can indicate anxiety (or extrapyramidal symptoms).
How are specific gestures an important element of body language?
Body language can tell you if the patient is comfortable about the topic or not.
What are the common barrier positions?
Common barrier positions include folded arms, legs or feet crossed and ankle lock gestures. Holding a handbag or fiddling with a cufflink may indicate unease.
Hand to face actions form the basis of what? types of gesture?
What can they indicate?
Give some examples of these gestures
human deceit gestures indicate doubt, uncertainty, lying or exaggeration. examples include: - mouth guard - the nose touch - the eye rub - the ear rub - the neck scratch.
Cheek and chin gestures indicate
interest and evaluation
What 4 points is it important to consider when interpreting body language?
culture
context
gesture clusters
congruence
why is culture important to consider?
Body language differs between cultures, and care must be taken not to misinterpret it.
why is context important to consider?
Body language interpretation depends on the context (eg, the posture the patient adopts may be because of the discomfort of back pain or because of poor vision or hearing and not because of the non-verbal message).
why is gesture clusters important to consider?
A single gesture may easily be misinterpreted by the body language reader. It is therefore important that the interpretation is based on gesture clusters. The cluster of gestures re-inforces the message.
why is congruence important to consider?
A lack of congruence can imply omission, inaccuracy or even suppression of information.
Name the different forms of question styles?
Open-ended question Direct question Closed question Leading question Reflected question
Describe three styles of doctor/patient relationships in medical interviewing
Authoritarian or paternalistic relationship
Guidance/co-operation
Mutual participation relationship
What does it mean by authoritarian or paternalistic relationship
The physician uses all of the authority inherent in his status and the patient feels no autonomy. Pt does not actively participate in own treatment
What does it mean by guidance
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 does it mean by mutual participation relationship?
- This is the most desirable for the more complex diagnostic interview
- patient feels some responsibility for a successful outcome which involves both active participation and a feeling of relatively greater personal autonomy
What 3 activities does a medical consultation typically involve?
- Talking together (always)
- Doctor examining the patient (often)
- Performing procedures (sometimes)
What are the essential interview techniques
open ended question
listening and silence
facilitation (gestures, manner or words that encourage further communication)
In what way can non verbal communication be identified?
- Instinctive e.g. crying
- Learned from life experiences or training
- Through clinical observation e.g. discomfort
What factors influence the consultation?
Physical and Personal factors
Identify the physical factors that influence the consultation
Site and environment
Patient status
Adequacy of medical records
Time constraints
Identify the personal factors that influence the consultation
Age Sex Backgrounds and origins Knowledge and Skills Beliefs The illness
What are the three broad types of skills that are needed for successful medical interviewing?
Content skills
Perceptual skills
Process skills
What is meant by content skills?
What doctors communicate
- substance of their questions and responses,
- the information they gather and give;
- the treatments
What is meant by perceptual skills?
What doctors are thinking and feeling. Their;
- internal decision making
- clinical reasoning
- awareness of own biases, attitudes and distractions
What is meant by process skills?
How doctors do it;
- the way they communicate with pts
- how they go about history taking or providing info
- non verbal and verbal skills they use
- structure and organisation of communication
What skill is central to clinical practice?
Doctor patient communication
GP is the main interface between what?
NHS and the community
Who makes up the practice team?
Manager It/Admin staff Secretarial staff Nurses - junior and senior Advanced nurses/PAs Phlebotomists/HCAs
How do GPs sustain ongoing learning and reflections?
Revalidated every 5 years (prepared by reading literature, attending courses, and performing audits)
Ongoing reflections of patients
yearly appraisals
How do GPs maintain an adequate work life balance?
GPs can choose their pattern of work as many take on other roles e.g. teach.
They can choose the number of sessions worked in a week with one being half day.
How are IT systems used in the practice? State at least 5
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 do GPs referred to as running a business?
- Most GPs are independent contractors either owning or in partnership with others
- They are required to provide adequate premises and infrastructure to ensure pt safety and employ and train practice staff
What skills are needed for clinical competence?
- Knowledge
- Communication skills
- Examination
- Problem solving
what is a salaried GP
NHS contracted GP
What is a GP partner?
- Self-employed
- Responsible for running the “business” including the premises, infrastructure, patient services, staff employing/training
What is the role of a GP?
Caring for the whole person (often life long)
- Promotion of healthy lifestyle
- First point of contact for healthcare
- Responsiveness to local community needs
% are there of GPs?
47%
