General Practice

Question 1

What is general practice?

Answer 1

Caring for the whole person as well as their illness

The promotion of healthy lifestyles

First point of contact

Question 2

What are some personal qualities to be a good GP?

Answer 2

Ability to care about people and relatives

Commitment to providing high quality care

Awareness of ones own limitations

Clinical competence

Organisational ability

Ability to work with others

Question 3

Who owns the practice or building that GPs work in?

Answer 3

GPs themselves or the local NHS organisation

Question 4

What kind of employment do most GPs have?

Answer 4

Self emplyed, either owning or running a business of their own in partership with others

Question 5

What are responsibilities of GPs as a partner?

Answer 5

Running the business affairs

Providing adequate premises and infrastructure to provide care

Employ and train people

Question 6

What aspect of the NHS is at the cutting edge of information technology?

Answer 6

General practice

Question 7

Why is general practice considered to be at the cutting edge of information technology?

Answer 7

Leads the way for the move from paper to digital

Question 8

What are advantages of moving from paper to digital?

Answer 8

Patient date easily accessed by approved members of staff

Can possibly be accessed remotely

Patient data can be listed, graphed and easily searched

Identify patients for screening programmes

Question 10

What are the main information systems that GPs use?

Answer 10

Vision

EMIS

Question 11

What does the use of vision or EMIS allow?

Answer 11

Store appointments

Assist in consultations

Support prescribing

Allow GPs to manage hospital letters and blood results electronically

Question 12

What is a massive advantage of being a GP, in terms of work-life balance?

Answer 12

Ability to work flexibly

Question 13

What other roles can GPs take on?

Answer 13

Working at a university as a lecturer

Question 14

Why do GPs no longer have to provide out of hours services?

Answer 14

It was removed from the national GP contract in 2004

Question 15

Why would GP practices provide out of hours services?

Answer 15

They get paid extra for doing so

Question 16

What are GPs required to display in terms of learning?

Answer 16

Life long learning

Question 17

What must GPs do to show they are still learning and adapting?

Answer 17

Undertake 5 year cycle in order to be revalidated

Meeting held with professional colleague and annual appraisal work is assessed

Question 18

How do GPs prepare for revalidation?

Answer 18

Reading literature

Attending courses

Performing audits

Question 19

What does the BMA recommend in regards to revalidation?

Answer 19

Salaried GP contract has time negotiated as protected for appraisal work

Question 20

Who does the practice team consist of?

Answer 20

Manager

IT/admin staff

Secretarial staff

Reception staff

Nurses

Advanced nurse practitioner

Physician assistants

Health care assistants

General practitioners

Question 21

GPs can choose a wide variety of career paths, what are some of these?

Answer 21

Parter

Take a special interest such as diabetes

Salaried GP to have better work life balance

Interest in education as a lecturer

Sports doctor for local football team

Question 22

Why are GP practices well placed to be able to adapt to their communities?

Answer 22

Run by doctors

Question 23

What is longitudinal care?

Answer 23

Holistic, dynamic and integrated plan that documents important disease prevention and treatment goals and plans

Question 24

What does longitudinal care mean it is possible to do?

Answer 24

Assist with the neonatal care of a baby at the start of your career and still be looking after them when they turn 40

Question 25

What are the advantages of getting to know families and them trusting you?

Answer 25

Consultations are quicker and easier They have confidence in your knowledge and guidance

Question 26

What is an emotional advantage, and disadvantage of looking after people with chronic conditions?

Answer 26

You get to watch them improve and deteriorate

Question 27

How many consultations do GPs perform in a professional lifetime?

Answer 27

200,000

Question 28

What do major problems with communication lead to?

Answer 28

Complaints such as "my doctor wont listen to me" Misdiagnosis

Question 29

What does effective communication improve?

Answer 29

Patient satisfaction Patient recall Patient understanding Patient concordance Outcomes of care

Question 30

What are the 4 essential components of clinical competence?

Answer 30

Knowledge Communication skills Physical examination Problem solving

Question 31

What are 3 broad types of skills need for effective communication?

Answer 31

Content skills Perceptual skills Process skills

Question 32

What are content skills?

Answer 32

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

Question 33

What are perceptual skills?

Answer 33

What doctors are thinking and feeling, internal decision making, clinical reasoning, awareness of own bias, attitudes and distractions

Question 34

What are process skills?

Answer 34

How doctors do it, the way they communicate with patients, how they go about discovering the history or providing information, verban and nonverbal skills they use, the way they structure and organise communication

Question 35

What are 2 categories of factors that influence the consultation?

Answer 35

Physical factors Personal factors (doctor and patient)

Question 36

What are examples of physical factors that affect the consultation?

Answer 36

Site and environment Adequacy of medical records Time constraints Patient status (old vs new)

Question 37

What are personal factors that influence the consultation?

Answer 37

Age Sex Backgrounds and origins Beliefs The illness

Question 38

Who are the publics health beliefs mainly influenced by?

Answer 38

The media

Question 39

What is the general rule for age impacting a consultation?

Answer 39

Young patients prefer young doctors Old patients prefer old doctors

Question 40

What is the general rule for sex affecting a consultation?

Answer 40

Patients prefer same sex doctors

Question 41

What are the 3 styles of doctor-patient relationships?

Answer 41

Authoritarian or paternalistic relationship Guidance/co-operation Mutual participation relationship

Question 42

What is an authoritarian or paternalistic relationship?

Answer 42

Patient feels no autonomy Tries hard to please the doctor Does not actively participate in their own treatment

Question 43

What kind of relationship does the patient feel no autonomy?

Answer 43

Authoritarian or paternalistic

Question 44

What is a guidance/co-operation relationship?

Answer 44

Doctor exercises much authority and the patient is obedient But has greater feeling of autonomy and participates more in the relationship

Question 45

What kinds of relationship does the doctor exercise authority but the patient has a greater feeling of autonomy than others?

Answer 45

Guidance/co-operation

Question 46

What is a mutal participation relationship?

Answer 46

Most desirable and complex Patient feels responsible for treatment by participating

Question 47

What kind of relationship does the patient feel responsible for treatment by participating?

Answer 47

Mutual participation relationship

Question 48

What are the 3 seperate activites involved in the medical consultation?

Answer 48

Talking together (always) Doctor examining patient (often) Performing procedures (sometimes)

Question 49

What are some different interviewing techniques?

Answer 49

Open ended questions Listening and silence Facilitation

Question 50

What is an example of an open ended question?

Answer 50

"What kind of troubles have you been having"

Question 51

What skill does listening and silence interviewing technique require?

Answer 51

Active listening

Question 52

What is the facilitation interviewing technique?

Answer 52

Encourages communication by using manner, gesture or words that do not specify the kind of information that is sought

Question 53

What are some examples of different kinds of questions?

Answer 53

Open ended questions Direct questions Closed questions Leading questions Reflected questions

Question 54

What are open ended questions?

Answer 54

Not seeking any particular answer but simply signals to the patient to tell their story

Question 55

What are direct questions?

Answer 55

Asks the patient about specific item

Question 56

What are closed questions?

Answer 56

Can only be answered with yes or no

Question 57

What are leading questions?

Answer 57

Presumes the answer

Question 58

What are reflected questions?

Answer 58

Allows the doctor to avoid answering a direct question

Question 59

What kind of questions should be avoided?

Answer 59

Leading question

Question 60

What does the use of questions too early in the interview do?

Answer 60

Restricts the amount of information recieved

Question 61

What is non-verbal communication also known as?

Answer 61

Body language

Question 62

What are the 3 categories of non-verbal communication?

Answer 62

Instinctive Learned Clinical observation

Question 63

What is an example of instinctive non verbal communication?

Answer 63

Crying Expression of pain Laughter

Question 64

What are different kinds of learned non-verbal communication?

Answer 64

From life experience From training

Question 65

What is learned non-verbal communication for life experiences dependent on?

Answer 65

Family experiences and culture

Question 66

What is an example of clinical observation non-verbal communication?

Answer 66

Being aware of the patients pain

Question 67

What are 4 important points to be considered before interpreting body language?

Answer 67

Culture Context Gesture clusters Congruence

Question 68

What should be remembered about body language and cultures?

Answer 68

Body language differs between cultures

Question 69

What should be remembered about body language and context?

Answer 69

Interpretation depends on context, such as is the patient's posture due to pain or poor hearing

Question 70

Why are gesture clusters advantageous?

Answer 70

Single gesture can be misinterpreted, cluster of gestures re-enforces the message

Question 71

What is more reliable, non-verbal communication or words?

Answer 71

Non-verbal communication

Question 72

What can lack of congruence imply?

Answer 72

Omission Inaccuracy Suppresion of information

Question 73

What is congruence?

Answer 73

Agreement or harmony

Question 74

What is autonomy?

Answer 74

Patient makes decisions about their care

Question 75

What are some different examples of body language?

Answer 75

Gaze behaviour Posture Specific gestures (such as hand to face)

Question 76

What does eye contact indicate?

Answer 76

Interest

Question 77

What does fidgeting and moving around indicate?

Answer 77

Anxiety

Question 78

What does lack of eye contact indicate?

Answer 78

Person is being dishonest

Question 79

What do specific gestures tell you?

Answer 79

If the patient is comfortable with the topic or not

Question 80

What are examples of barrier specific gestures?

Answer 80

Folding arms, legs Feet cross and ankle lock

Question 81

What does hand to face gestures indicate?

Answer 81

Doubt, uncertainty, lying or exaggeration

Question 82

What does holistic care refer to?

Answer 82

Healing the mind, body and soul of our patients