Tutorial 1: General Practice

Question 1

Understand the career pathways of graduates

Answer 1

• General Practice
• Hospital consultant
• In training

Question 2

What does it mean by holistic care?

Answer 2

General Practice is about caring for the whole person as well as their illnesses, the promotion of healthy life styles, and providing the first point of contact and out of hospital care for patients.

They use evidence-based medicine, problem-solving and managing risk and uncertainty, and a wide rage of clinical skills.

Question 3

Discuss lay and professional perspectives on the role of a GP

Answer 3

Gp’s first point of contact for healthcare in the community and is trusted

Have a role to prevent diseases as well as treat them (holistic care)

GP’s have knowledge of a broad range of illnesses and health conditions

GP’s tend to know their patient’s medical history and social circumstances

Question 4

Give an example of a working day in General Practice.

Answer 4

Morning surgery

Afternoon surgery

paperwork-results, letters, reports

phone calls

house call

practice business and staff issues

Question 5

Give some personal qualities which may required for General Practice

Answer 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 the quality of one’s own performance
• Appreciation of the value of team work
• Clinical competence
• Organisational ability

Question 6

Discuss aspects of running the business of General Practice

Answer 6

Most GPs are independent contractors, either running their own practice or with partnerships

They are responsible for running their business affairs of the practice and proving adequate care and safe patients

They are also responsible for employing training staff

Question 7

What are the benefits of online record keeping?

Answer 7

Easy to access

GPs can access information in a more effective way

The software can store appointments, assist in consultations, support prescribing, and allow GP’s to manage hospital letters and blood results online

Question 8

Give example of the flexibility in work available for GP’s

Answer 8

Can decide the pattern of their work

Can take on other roles such as working in university or hospital

GP can choose the number of sessions worked in a week with one session being half a day

GP’s are no longer required to be on call but they can choose to do so if they like

Question 9

What is GP practice like now compared to the past?

Answer 9

Practices are responsive to local health needs and vary considerably.

There are still some small single handed practices rurally, but these are less common.

There are trends to larger practices with up to 1700 registered pateints.

The Practice or building might be owned by the G.P.’s themselves, or by the local NHS organisation.

Question 10

What is an appraisal and how can GP’s prepare for it?

Answer 10

All GP’s are required to undertake a 5 year cycle in order to be revalidated and allowed to continue working as a doctor.

Reading literature, attending courses and performing audits.

The BMA recommended salaried GP contract has time negotiated as protected for appraisal, and most partnerships accommodate GP partners learning needs with allocated study leave.

Question 11

Gives example of who might be in the practice team? (8)

Answer 11

Manager
IT/Admin Staff
Secretarial Staff
Reception Staff
Nurses – Junior/Senior
Advanced Nurse Practitioners/Physicians Assistants
Phlebotomists/Health Care Assistants

Question 12

What are the benefits of high quality communication?

Answer 12

Research shows that it improves patient satisfaction, recall, understanding, concordance and outcomes of care.

Question 13

What are the 4 essential parts of clinical competence?

Answer 13

Knowledge
Communication
Physical Examination
Problem Solving

Question 14

What are the three broad types of skills needed for successful medical interviewing?

Answer 14

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

Perceptual skills - What they are thinking and feeling - their internal decision making, clinical reasoning; their awareness of their own biases, attitudes and distractions.

Process skills - How they do it - the ways doctors communicate with patients; how they go about discovering the history or providing information; the verbal and non-verbal skills they use; the way they structure and organise communication.

Question 15

What factors influence the consultation?

Answer 15

Physical

Personal factors (of GP or Patient)

Question 16

What are the three styles of doctor/patient relationships in medical interviewing that have been described (Szasz and Hollender, 1956).

Answer 16

Authoritarian/paternalistic relationship - the physician uses all authority and the patient has no autonomy, the patient tries hard to please the doctor and doesn’t actively participate in their own treatment

Guidance/co-operation - physician has authority and the patient is obedient, a greater feeling of autonomy for the patient and participates somewhat to treatment

Mutual participation relationship

Question 17

What are the benefits of adopting a mutual participation relationship?

Answer 17

Patients take on more responsibility for their own health

Patients feels a greater sense of autonomy

Patient compliance is improved

Patient satisfaction is improved

Question 18

Give example of the question types (5)

Answer 18

open-ended - allows the patient to tell their story

closed questions - normally yes or no questions

direct question - asks about something specifically

leading question - presumes the answer

reflecting question - doctor lets the pateint think about the answer to their own question

Question 19

What are the challenges of a 10 minute consultation?

Answer 19

the problems are not adequately dealt with, they are dealt with but take longer than 10 minutes, or the patient is asked to make a further appointment. All of these outcomes are bad for patients and stressful for doctors.

Question 20

Describe personal factors that can influence a consultation?

Answer 20

Age - younger doctors are sought after by younger patients and older by older patients

Sex - (similar to age) barrier may exist to effective communication if a patient is forced to consult a doctor of the opposite sex when the reverse is preferred.

Backgrounds and origins - social, ethnic class, or language barriers

Knowledge and Skills - This is an important factor to the doctor but to a lesser extent with the patient. Consider the position of the doctor when he or she is a patient!

Beliefs - Everyone has their own health beliefs about all sorts of aspects of illness and disease Beliefs may be influenced by your medical training. Health beliefs are often influenced by the media, other people, past experiences, and are often not medically accurate.

The Illness - a consultation in which a patient is to be told that he has a terminal illness will be much more difficult to conduct than one where only a minor illness is present.

Question 21

Describe physical factors that can influence a consultation?

Answer 21

Site and environment

Adequacy of medical records

Time constraints

Patient status
New patient or known patient, new problem or old problem

Question 22

List 3 interviewing techniques

Answer 22

The open-ended question

Listening and Silence

Facilitation (attentive manner of doctor)

Question 23

List 3 non-verbal communication

Answer 23

Instinctive (crying, laughter)

Learned (from life experiences or from training)

Clinical observation (pain or abnormal movement, distress, degree of sickness also recognising clinical syndromes eg.acromegaly)

Question 24

What 4 points should you be aware of in interpreting body language?

Answer 24

Culture
Context
Gesture Clusters
Congruence