General Practice Flashcards
What is general practice?
Caring for the whole person as well as their illness
The promotion of healthy lifestyles
First point of contact
What are some personal qualities to be a good GP?
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
Who owns the practice or building that GPs work in?
GPs themselves or the local NHS organisation
What kind of employment do most GPs have?
Self emplyed, either owning or running a business of their own in partership with others
What are responsibilities of GPs as a partner?
Running the business affairs
Providing adequate premises and infrastructure to provide care
Employ and train people
What aspect of the NHS is at the cutting edge of information technology?
General practice
Why is general practice considered to be at the cutting edge of information technology?
Leads the way for the move from paper to digital
What are advantages of moving from paper to digital?
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
What are the main information systems that GPs use?
Vision
EMIS
What does the use of vision or EMIS allow?
Store appointments
Assist in consultations
Support prescribing
Allow GPs to manage hospital letters and blood results electronically
What is a massive advantage of being a GP, in terms of work-life balance?
Ability to work flexibly
What other roles can GPs take on?
Working at a university as a lecturer
Why do GPs no longer have to provide out of hours services?
It was removed from the national GP contract in 2004
Why would GP practices provide out of hours services?
They get paid extra for doing so
What are GPs required to display in terms of learning?
Life long learning
What must GPs do to show they are still learning and adapting?
Undertake 5 year cycle in order to be revalidated
Meeting held with professional colleague and annual appraisal work is assessed
How do GPs prepare for revalidation?
Reading literature
Attending courses
Performing audits
What does the BMA recommend in regards to revalidation?
Salaried GP contract has time negotiated as protected for appraisal work
Who does the practice team consist of?
Manager
IT/admin staff
Secretarial staff
Reception staff
Nurses
Advanced nurse practitioner
Physician assistants
Health care assistants
General practitioners
GPs can choose a wide variety of career paths, what are some of these?
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
Why are GP practices well placed to be able to adapt to their communities?
Run by doctors
What is longitudinal care?
Holistic, dynamic and integrated plan that documents important disease prevention and treatment goals and plans
What does longitudinal care mean it is possible to do?
Assist with the neonatal care of a baby at the start of your career and still be looking after them when they turn 40
What are the advantages of getting to know families and them trusting you?
Consultations are quicker and easier
They have confidence in your knowledge and guidance
What is an emotional advantage, and disadvantage of looking after people with chronic conditions?
You get to watch them improve and deteriorate
How many consultations do GPs perform in a professional lifetime?
200,000
What do major problems with communication lead to?
Complaints such as “my doctor wont listen to me”
Misdiagnosis
What does effective communication improve?
Patient satisfaction
Patient recall
Patient understanding
Patient concordance
Outcomes of care
What are the 4 essential components of clinical competence?
Knowledge
Communication skills
Physical examination
Problem solving
What are 3 broad types of skills need for effective communication?
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 doctors are thinking and feeling, internal decision making, clinical reasoning, awareness of own bias, attitudes and distractions
What are process skills?
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
What are 2 categories of factors that influence the consultation?
Physical factors
Personal factors (doctor and patient)
What are examples of physical factors that affect the consultation?
Site and environment
Adequacy of medical records
Time constraints
Patient status (old vs new)
What are personal factors that influence the consultation?
Age
Sex
Backgrounds and origins
Beliefs
The illness
Who are the publics health beliefs mainly influenced by?
The media
What is the general rule for age impacting a consultation?
Young patients prefer young doctors
Old patients prefer old doctors
What is the general rule for sex affecting a consultation?
Patients prefer same sex doctors
What are the 3 styles of doctor-patient relationships?
Authoritarian or paternalistic relationship
Guidance/co-operation
Mutual participation relationship
What is an authoritarian or paternalistic relationship?
Patient feels no autonomy
Tries hard to please the doctor
Does not actively participate in their own treatment
What kind of relationship does the patient feel no autonomy?
Authoritarian or paternalistic
What is a guidance/co-operation relationship?
Doctor exercises much authority and the patient is obedient
But has greater feeling of autonomy and participates more in the relationship
What kinds of relationship does the doctor exercise authority but the patient has a greater feeling of autonomy than others?
Guidance/co-operation
What is a mutal participation relationship?
Most desirable and complex
Patient feels responsible for treatment by participating
What kind of relationship does the patient feel responsible for treatment by participating?
Mutual participation relationship
What are the 3 seperate activites involved in the medical consultation?
Talking together (always)
Doctor examining patient (often)
Performing procedures (sometimes)
What are some different interviewing techniques?
Open ended questions
Listening and silence
Facilitation
What is an example of an open ended question?
“What kind of troubles have you been having”
What skill does listening and silence interviewing technique require?
Active listening
What is the facilitation interviewing technique?
Encourages communication by using manner, gesture or words that do not specify the kind of information that is sought
What are some examples of different kinds of questions?
Open ended questions
Direct questions
Closed questions
Leading questions
Reflected questions
What are open ended questions?
Not seeking any particular answer but simply signals to the patient to tell their story
What are direct questions?
Asks the patient about specific item
What are closed questions?
Can only be answered with yes or no
What are leading questions?
Presumes the answer
What are reflected questions?
Allows the doctor to avoid answering a direct question
What kind of questions should be avoided?
Leading question
What does the use of questions too early in the interview do?
Restricts the amount of information recieved
What is non-verbal communication also known as?
Body language
What are the 3 categories of non-verbal communication?
Instinctive
Learned
Clinical observation
What is an example of instinctive non verbal communication?
Crying
Expression of pain
Laughter
What are different kinds of learned non-verbal communication?
From life experience
From training
What is learned non-verbal communication for life experiences dependent on?
Family experiences and culture
What is an example of clinical observation non-verbal communication?
Being aware of the patients pain
What are 4 important points to be considered before interpreting body language?
Culture
Context
Gesture clusters
Congruence
What should be remembered about body language and cultures?
Body language differs between cultures
What should be remembered about body language and context?
Interpretation depends on context, such as is the patient’s posture due to pain or poor hearing
Why are gesture clusters advantageous?
Single gesture can be misinterpreted, cluster of gestures re-enforces the message
What is more reliable, non-verbal communication or words?
Non-verbal communication
What can lack of congruence imply?
Omission
Inaccuracy
Suppresion of information
What is congruence?
Agreement or harmony
What is autonomy?
Patient makes decisions about their care
What are some different examples of body language?
Gaze behaviour
Posture
Specific gestures (such as hand to face)
What does eye contact indicate?
Interest
What does fidgeting and moving around indicate?
Anxiety
What does lack of eye contact indicate?
Person is being dishonest
What do specific gestures tell you?
If the patient is comfortable with the topic or not
What are examples of barrier specific gestures?
Folding arms, legs
Feet cross and ankle lock
What does hand to face gestures indicate?
Doubt, uncertainty, lying or exaggeration
What does holistic care refer to?
Healing the mind, body and soul of our patients
