questions from case study Flashcards
Lisa has been having some “stomach aches”. Jill advises her to go and see her GP. What three broad types of skill might you, as the GP, use during the consultation?
Content skills
Perceptual skills
Process skills
Different factors can affect the consultation. One such factor may be Personal Factors. Can you think of another factor and give four examples of it?
Site and environment
Adequacy of medical records
Time constraints
Patient status
You take a history and examine Lisa. You do not find anything on examination, but you feel that you are not getting the whole story from Lisa. What kind of questions might you use to elicit more information?
Open-ended question Direct question Closed question Leading question Reflected question
You allow time and ask some open ended questions. This allows Lisa to talk and she eventually discloses that she is worried that she might be pregnant. She has been having unprotected intercourse with her boyfriend Martin. She has had a positive pregnancy test but doesn’t yet know if she wishes to continue the pregnancy. She is also worried you will tell her Mum Jill.
You are also Jill’s GP and see her quite regularly. In fact she has an appointment with you booked for later in the week.
Can you disclose Lisa’s pregnancy to her mother?
What oath guides you about this?
No (patient confidentiality)
The Hippocratic Oath.
There are a number of personal qualities that enable some students to become effective and valued General Practitioners. Can you list 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 are the aims of a GP consultation according to the Calgary Cambridge model?
Initiating the Session Gathering Information Providing Structure Building Relationship Explanation and Planning Closing the Session
As part of your awareness of your learning opportunities, are there any issues in having done the majority of undergraduate training in hospital specialties when considering, for example, a child presenting with abdominal pain?
The hospital is the tip of the iceberg of care. You will see a narrow spectrum of presentations in hospital and may gain a distorted view of the presentation of illness.
You did not find anything on brief examination and picked up on some verbal and body language cues from Lisa. In only 10 minutes you focused the consultation from a presentation of abdominal pain to one Lisa’s new pregnancy and associated concerns.
What form of problem solving does a GP use to rapidly narrow down the list of likely diagnoses?
Hypothetico-deductive reasoning
Neighbour suggests Safety Netting in a consultation to minimise risk. Could you give three example of that?
If uncertainty remains, that should be communicated to the patient. They must know what to look out for and be told how exactly to seek help for given outcomes or clinical features.
It may be important to arrange follow-up face to face or by phone. They should know exactly how to seek help if needed.
They should know what to expect about time course. Where information about the likely time course of illness is known, safety-net advice should include this information. However, it should be made clear that if a patient (parent/carer) has concerns they should not delay seeking further medical advice.
Lisa’s GP performs a 2nd pregnancy test which is also positive. She wonders whether she will keep the baby or not. List two ETHICAL, two PSYCHOLOGICAL and two SOCIAL issues that Lisa may be considering?
Ethical
Beliefs regarding termination
Any religious beliefs
Thoughts regarding bringing a child into the world that you do not feel able to care for
Psychological
Anxiety about being a parent
Anxiety about going through with a termination
Stress/anxiety about level of support she may have from family and friends
Social
Support network - does Lisa feel her friends would be supportive
Her social life will dramatically change after having a baby
Ability to find a job/work will be affected in the short or longer term
Lisa knows that she doesn’t have the healthiest lifestyle and until now has not felt much need for change. What factors might increase the chance of someone changing their behaviour? (Give five factors)
You think the advantages of change outweigh the disadvantages
You anticipate a positive response from others to your behaviour change
There is social pressure for you to change
You perceive the new behaviour to be consistent with your self-image
You believe you are able to carry out the new behaviour in a range of circumstances
Using Smoking or Alcohol as an example, how might these apply to Lisa’s current situation? (Give five factors)
The advantages of not drinking/smoking (healthy baby) outweigh the disadvantages
You anticipate a positive response from others to your behaviour change (e.g. your partner also wants the unborn child to be healthy)
There is social pressure for you to change (very socially unacceptable to drink/smoke when obviously pregnant!)
You perceive the new behaviour to be consistent with your self-image (a good mother)
You believe you are able to carry out the new behaviour in a range of circumstances (at home, celebrations, etc.)
Lisa attends her GP to discuss actions she might take to keep her unborn baby healthy. Other than Smoking or Alcohol, what other factors affecting foetal wellbeing might her GP discuss with her? (Give five factors)
Illicit Drugs
Prescription drugs
OTC medication, Internet Remedies, Herbal Medication
X-Rays
Dietary Factors - Lack of Folic Acid, soft cheese, pate
Infectious Diseases e.g. TORCH (Toxoplasma, Rubella, Cytomegalovirus, Herpes)
What kinds of actions might a government take to promote health in the population as a whole? (List five actions)
egislation/policies on smoking/alcohol (e.g. minimum age to buy products, licensing laws, taxation) Improvements in housing Provision of health education Health and safety laws Traffic/transport legislation/policies
A few weeks later, Lisa tells the GP that her partner Martin has left her, but he still turns up at her house late at night at the weekend after drinking with his friends. He is usually drunk, often upset and occasionally angry.
Are there any issues that the GP would note here? Which other health professional might the GP liaise with to get a better picture of the home situation? (Name one issue and one Health Professional)
Potential for gender based violence (domestic abuse)
Might be Child Protection issues at a later date?
The Health Visitor (regular contact with families of pre-school children)
