Risk and Uncertainty

Question 1

What are the aims of a GP consultation

Answer 1

1. Initiate the session
2. Gather information
3. Provide structure
4. Build relationship
5. Explanation and planning
6. Closing the session

Question 2

What are Roger Neighbour’s approach to a consultation

Answer 2

To connect with patient
To summarise and verbally check reasons for attendance are clear
To hand over and bring consultation to a close
To ensure safety nets exist in that no serious possibilities have been missed
To deal with the housekeeping of recovery and reflection

Question 3

What is risk

Answer 3

The chance of consequences

Question 4

What is uncertainty

Answer 4

The state of not being completely confident or sure of something

Question 5

What is it meant by individualising care

Answer 5

Basing care on their health beliefs and education, social, cultural and economic backgrounds

Question 6

What is resilience

Answer 6

Positive capacity to deal with change, uncertainty and error

Question 7

What is safety netting

Answer 7

If uncertainty remains, it should be communicated to the patient:

• arrange follow-up
• ensure patient knows exactly how to seek help if needed
• patient should know the likely time course of the illness
• make it clear that if they have any concerns they should seek further medical advice

Question 8

What different forms of guidance are available to help deal with risk and uncertainty

Answer 8

National - SIGN & NICE guidelines
Local Guidance or Pathways - made by NHS region
Immediate Guidance or Protocol (i.e. of acute condition)
Peer group - discussion with colleagues (formal consult or informal)
Reflection

Question 9

What is housekeeping

Answer 9

Realising a difficult consultation
Documenting it well
Dictated the referral that was promised
Need to make time before next consultation

Question 10

What are some strategies for managing risk

Answer 10

Developing a good doctor-patient relationship (giving time with good communication and creating trust)

Considering each patient as an individual and taking their background into consideration (support, social-network, education) - i.e. patient who lives alone may be treated differently to someone who lives with reliable others

Use external evidence (evidence-based medicine i.e. risk calculation, guidelines) and respect the internal evidence (doctors and patients)

Consider using mental checklists for diagnosis (exclude red-flag symptoms)

Good organisation and note keeping

Be aware of your feelings

Apply reflective practice

Peer group discussions with seniors

Question 11

What is hypothetic-deductive reasoning

Answer 11

Thinking about many reasons of why something is happening
Recognising the more probable reasons by deduction
Do not assume there are no other causes
Hold the important but rare possibilities in back of mind
May have to positively exclude these