General Practice Flashcards
Describe the career pathways of graduates
- Foundation years (FY1/2) - end with full GMC registration
2. Training pathways: uncoupled and run-through
What is uncoupled training?
Core training for 2-3yrs then speciality training to completion
I.e. core medical, anaesthetics, psychiatry, surgical
What is run-through training?
Progression automatic as long as meets required standards
3yrs for GP and 5-7yrs other specialties
Broad overview then specialise
What is holistic care?
Care for whole person as well as illness - manage problem physical, mental, social in management and prevention of disease
What is the role of a GP?
Care for whole person, as well as illness
Promotion of healthy lifestyles
First point of contact
Out of hospital care
What are task carried out by GPs around 7.30-9am?
Admin:
Looking through correspondence, discharge summaries and test results
Hospital letter might require specific GP action (i.e. forwarding results or arranging further tests)
What are task carried out by GPs around 9am-1pm?
Morning surgery:
See ~18 patients
After, do paperwork and make phone calls to patients hospitals doctors
What are task carried out by GPs around 2-3pm?
Home visits: homes or care homes
After, write referrals, prescriptions to sign and check lab results
What are task carried out by GPs around 3-5.30pm?
Afternoon surgery
What other staff do GPs work with?
Practice nurses Advanced nurse practitioners Phlebotomists/healthcare assistants Practice managers IT/Admin staff Reception staff Secretarial staff
What are the challenges of the 10 minute consultation?
Risk of short consult after GP trying to make up time Less psychosocial problems recognised Long term problems dealt with less Less health promotion More GP stress
What are the personal qualities required in general practice?
Care about patients and relatives Provide high quality care Awareness of own limitations Know when to seek help Keeping up to date and improving quality of own performance Team work Good interpersonal and communication skills Clinical competence Organisational ability Relating to the public Ability to deal with uncertainty
How can different G practices vary?
Responsive to local health needs
Rural practices less common
Practice owned by GPs or by local NHS
What are GPs responsible for if they are independent contractors?
Buy adequate and safe premises
Business affairs i.e. equipment, stock
Make sure all equipment and furniture safe to use
Employ and train staff
What is the role of the practice manager?
Business manager; provide financial and business advise
Amin manager: manage practice staff and daily operations
What is the role of practice nurses?
Management of long-term conditions and running clinics: asthma, diabetes, HPT, family planning, smoking cessation, vaccinations etc
What is the benefit of digital record-keeping as opposed to paper?
Allows patient data to be easily access (by approved member) at any time and sometimes any place when working remotely
Patient data, listed, graphed and searched easily - conveys more info more efficiently
What are the two many systems for digital record-keeping?
Vision and EMIA
They store appointment, assist in consults, support prescribing and allow GP to manage letter and blood results electronically
What do IT systems enable GPs to do?
Store and book appointments Assist in consults Support prescribing Manages test results Manages hospital letters Identify patients for screening programs
What does being an independent contractor allow the GP to do?
Decide pattern of work:
Can take on other roles like teaching
Balances home and work life issues
What was removed from GP Contracts in 2004?
Out of Hours care:
GP no longers has to cover night and weekend, they can opt in or out (better work-life balance)
Describe the ongoing learning
Mandatory 5 year revalidation - each year GP prepares by reading literature, attending courses and performing audits
Appraisal assessed by professional colleague
What is the role of the IT/admin staff?
Know computer system to manage and recall patients for clinics and immunisations
Discuss longitudinal care in GP
Treat same patient as the grow older
GP gain trust of patient and families, making consult quicker and easier
See patient with long-term conditions improve or deteriorate (acutely or chronically)
Why is effective communication essential?
Improves: Patient satisfaction Recall Understanding Concordance Outcomes of care
What are 4 essential components of clinical competence?
Knowledge
Communication skills
Physical examination
Problem solving
What are 3 broad types of skills needed for effective communication?
Content skills
Perceptual skills
Process skills
What are content skills?
What GPs say - the substance of their questions and responses
What are perceptual skills?
GPs internal decision making and clinical reasoning - awareness of own biases, attitudes and distractions
What are process skills?
Way of communication (how they go about discovering info) and the verbal and non-verbal skills used and the structure and organisation of communication
What are 2 factors that will influence the consultation?
Physical factors Personal factors (of GP and patient)
What are physical factors that will influence consultation?
Site and environment (RTA in dark, cold, rain different to doctor managing same problem in emergency) Adequacy of med records Time constraints Patient status (new patient or known and new/old problem)
What are personal factors that will influence the consultation?
Age - patient might want older/younger GP
Sex - gender barrier
Backgrounds and origins - language or religion barrier
Knowledge and skills
Beliefs - patients influenced by medical training, media, past experiences
Illness - consult harder for terminal illnesses than minor
What are the 3 different doctor/patient relationship styles?
Authoritarian or paternalistic relationship
Guidance/co-operation
Mutual participation
Describe the Authoritarian doctor/patient relationship
GP uses authority of status and patient feels no autonomy
Tries to please GP and no active participation in treatment
Describe the guidance/co-op relationship
GP has authority and patient obedient, but has greater feeling of autonomy and participates more actively
Describe the mutual participation relationship
Best - patient feels some responsibility for treatment which involves both active participation and feeling of greater autonomy
What are 3 different interviewing techniques?
Open ended question
Listening and silence
Facilitation (encourage communication by using manner, gesture or words)
What are the 5 different types of questions?
Open ended Direct Closed - yes or no answer Leading - presumes answer avoid) Reflected - GP can avoid answering a direct question
What are 3 different forms on non-verbal communication?
Instinctive - crying, laughter, pain expression
Learned: life experiences or from training
Clinical observation - doctor can recognise clinical syndrome
What 4 points are important to consider with body language?
Culture
Context - posture due to discomfort
Gesture clusters - reinforces message as single gesture can be misinterpreted
Congruence - lack of it between nonverbal messages and words indicates omission, inaccuracy or info suppression
What are other forms of body language?
Gaze behaviour
Posture - i.e. depressed: sunken head, anxious: fidgety
Specific gestures - indicated patient comfort (barrier positions: folded arms, legs or feet)
