Tutorial 1 - General Practice Flashcards
What will most graduates choose a career in?
General Practice
What are the three roles of a general practitioner?
1) Caring for the whole person as well as their illness
2) The promotion of healthy lifestyles
3) The first point of contact
What are the 4 major skills general practitioners have?
1) Enjoy problem-solving with their patients
2) Combining evidence based medicine
3) Wide ranging clinical skills
4) Compassion to care for the individual
Give 5 personal qualities required to be a good GP
1) Ability to care about patients and their relatives
2) Appreciation of the value of team work
3) Good interpersonal and communication skills
4) Organisational ability
5) An ability to seek help when appropriate
What is a GP practice?
1) Responsive to local health need (thus vary considerably)
2) Larger practices (either owned by GPs themselves or the local NHS organisation)
3) Most GPs are independent contractors - either owning and running the business on their own or in partnership with others (this means that they can makes decisions about the priorities of the practice)
What are the main IT systems in use?
Vision and EMIS
What are the uses of practice IT systems?
1) Store + book appointments
2) Assist in consultations (patient records)
3) Support prescribing
4) Allow GPs to manage hospital letters and blood results electronically
5) Identify patients for screening programs
What is the work life balance of being a GP?
1) Deicide their own pattern of work
2) Take on other roles - working in another hospital department or at the University
3) Flexibility - choose number of sessions worked per week (one session = half day)
4) Opt in for out of hours care (night/weekend cover)
What is the ongoing learning of being a GP?
1) Undertake a 5 year cycle to be revalidated (and continue working as a doctor)
2) Prepares for appraisal by reading literature, attending curses and performing audits
3) Allocated study leave
What is very important to being a GP?
Ongoing reflection
Who makes up the practice team?
Manager IT / admin staff Secretarial staff Reception staff Nurses - junior / senior Advanced nurse practitioners / physican associates Phlebotomists / health care assistants
Why is a manager employed?
Most GP practices employ a manager to assist them in the running of their business
What is a role of the administration team?
Use IT system to manage + recall patients for clinics and immunisations
Some roles of receptionists
Assist with appointments, phone out blood results and scanning to keep computer records up to date
Roles of junior nurses
Blood taking and dressing
What do senior nurses often run?
Long term condition clinics such as Diabetes or Asthma
What profession in the NHS gives the clearest sense of the needs and changes in the local community?
General practice - responsive to the needs of the local population
What is the importance of longitudinal care?
1) Get to know the families
2) They will come to trust you - due to this relationship the consultations will be quicker and easier
3) Confidence in your knowledge + guidance
What is central to clinical practice?
Doctor - patient communication (doctors can perform 200,000 consultations in a professional lifetime)
What does effective communication improve?
Patient satisfaction, recall, understanding, concordance and outcomes of care
What are the 4 essential components of clinical competence?
Knowledge
Communication skills
Physical examination
Problem solving
What are the three broad skills needed for successful medical interviewing?
Content skills - what doctors communicate (the information they gather and give)
Perceptual skills - what they are thinking and feeling (their internal decision making)
Process skills - how they do it (the ways doctors communicate with patients)
What are factors influencing the consultation?
Physical factors - environment, adequacy of medical records (avoids wasting time), time constraints, patient status
Personal factors (doctor and patient) - age, sex, backgrounds + origins (language difficulties), knowledge + skills, beliefs (everyone has their own beliefs about all sorts of aspects of illness and disease - influenced by media, other people, past experiences and often not medically accurate), the illness (terminal vs minor illness)
What are three styles of doctor/patient relationships in medical in interviewing?
The major variables = degree of participation and the feeling of autonomy (patient) and the degree of domination by the doctor
Authoritarian or paternalistic relationship = patient feels no autonomy CLOSED
Guidance/co-operation = greater feeling of autonomy
Mutual participation relationship = MOST DESIRABLE, greatest feeling of autonomy (created by appropriate moderation of the doctor’s use of his authority) OPEN
What is the most desirable way to work with a patient?
Partnership - research shows that patients are more satisfied with the consultation if they feel you have asked, and listened, to their views
What activities does the medical consultation typically involve?
Talking together (always) Doctor examining the patient (often) Performing procedures (sometimes)
What are the interviewing techniques?
The open-ended question - initiating the interview
Listening and silence - active listening (asking relevant questions, nodding, making eye contact + picking up on the patients body language) and silence encourages communication
Facilitation - manner, gesture or words that do not specify the kind of information sought
What are the different questions that should be used?
Open-ended = is not seeking a particular answer but simple signals the patient to tell their story Direct = asks about a specific item Closed = can only be answered "yes" or "no" Leading = presumes the answer (and is best avoided) Reflected = allows the doctor to avoid answering a direct question from the patient
What non-verbal communications (body language) can be identified?
Instinctive (e.g. crying)
Learned - from life experiences or from training
Clinical observation
When interpreting body language, what is important to consider?
Culture - body language differs between cultures and care most be taken not to misinterpret it
Context - e.g. the posture the patient develops may be backer of back pain, not because of the non-verbal message
Gesture clusters - a single gesture may be easily misinterpreted, it is therefore important the the interpretation is based on gesture clusters (the cluster of gestures reinforces the message)
Congruence - non-verbal messages are more reliable than words, and any incongruence between the two requires attention (research has shown that when there is a lack of congruence, non-verbal gestures carry five times more impact than the verbal channel)
What are four things that we can get body language from?
Gaze behaviour - inadequate eye contact can indicate when a person is being dishonest or holding back information
Posture - a depressed person often looks literally depressed (head bowed, slumped posture), an anxious person is often restless and fidgety, hands placed behind the head can suggest a confident or superior attitude
Specific gestures - body language can tell you if the patient is comfortable about the topic or not, common barrier positions include folded arms, legs or feet crossed and ankle lock gestures, holding a handbag or fiddling with a cufflink may indicate unease
Also note hand to face actions, hand clenched
