Tutorial 1: General Practice Flashcards
Understand the career pathways of graduates
- General Practice
- Hospital consultant
- In training
What does it mean by holistic care?
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.
Discuss lay and professional perspectives on the role of a GP
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
Give an example of a working day in General Practice.
Morning surgery
Afternoon surgery
paperwork-results, letters, reports
phone calls
house call
practice business and staff issues
Give some personal qualities which may required for General Practice
- 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
Discuss aspects of running the business of General Practice
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
What are the benefits of online record keeping?
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
Give example of the flexibility in work available for GP’s
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
What is GP practice like now compared to the past?
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.
What is an appraisal and how can GP’s prepare for it?
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.
Gives example of who might be in the practice team? (8)
Manager IT/Admin Staff Secretarial Staff Reception Staff Nurses – Junior/Senior Advanced Nurse Practitioners/Physicians Assistants Phlebotomists/Health Care Assistants
What are the benefits of high quality communication?
Research shows that it improves patient satisfaction, recall, understanding, concordance and outcomes of care.
What are the 4 essential parts of clinical competence?
Knowledge
Communication
Physical Examination
Problem Solving
What are the three broad types of skills needed for successful medical interviewing?
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.
What factors influence the consultation?
Physical
Personal factors (of GP or Patient)
What are the three styles of doctor/patient relationships in medical interviewing that have been described (Szasz and Hollender, 1956).
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
What are the benefits of adopting a mutual participation relationship?
Patients take on more responsibility for their own health
Patients feels a greater sense of autonomy
Patient compliance is improved
Patient satisfaction is improved
Give example of the question types (5)
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
What are the challenges of a 10 minute consultation?
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.
Describe personal factors that can influence a consultation?
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.
Describe physical factors that can influence a consultation?
Site and environment
Adequacy of medical records
Time constraints
Patient status
New patient or known patient, new problem or old problem
List 3 interviewing techniques
The open-ended question
Listening and Silence
Facilitation (attentive manner of doctor)
List 3 non-verbal communication
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)
What 4 points should you be aware of in interpreting body language?
Culture
Context
Gesture Clusters
Congruence
