Tutorial 1 - General Practice

Question 1

What will most graduates choose a career in?

Answer 1

General Practice

Question 2

What are the three roles of a general practitioner?

Answer 2

1) Caring for the whole person as well as their illness
2) The promotion of healthy lifestyles
3) The first point of contact

Question 3

What are the 4 major skills general practitioners have?

Answer 3

1) Enjoy problem-solving with their patients
2) Combining evidence based medicine
3) Wide ranging clinical skills
4) Compassion to care for the individual

Question 4

Give 5 personal qualities required to be a good GP

Answer 4

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

Question 5

What is a GP practice?

Answer 5

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)

Question 6

What are the main IT systems in use?

Answer 6

Vision and EMIS

Question 7

What are the uses of practice IT systems?

Answer 7

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

Question 8

What is the work life balance of being a GP?

Answer 8

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)

Question 9

What is the ongoing learning of being a GP?

Answer 9

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

Question 10

What is very important to being a GP?

Answer 10

Ongoing reflection

Question 11

Who makes up the practice team?

Answer 11

Manager
IT / admin staff
Secretarial staff
Reception staff
Nurses - junior / senior
Advanced nurse practitioners / physican associates 
Phlebotomists / health care assistants

Question 12

Why is a manager employed?

Answer 12

Most GP practices employ a manager to assist them in the running of their business

Question 13

What is a role of the administration team?

Answer 13

Use IT system to manage + recall patients for clinics and immunisations

Question 14

Some roles of receptionists

Answer 14

Assist with appointments, phone out blood results and scanning to keep computer records up to date

Question 15

Roles of junior nurses

Answer 15

Blood taking and dressing

Question 16

What do senior nurses often run?

Answer 16

Long term condition clinics such as Diabetes or Asthma

Question 17

What profession in the NHS gives the clearest sense of the needs and changes in the local community?

Answer 17

General practice - responsive to the needs of the local population

Question 18

What is the importance of longitudinal care?

Answer 18

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

Question 19

What is central to clinical practice?

Answer 19

Doctor - patient communication (doctors can perform 200,000 consultations in a professional lifetime)

Question 20

What does effective communication improve?

Answer 20

Patient satisfaction, recall, understanding, concordance and outcomes of care

Question 21

What are the 4 essential components of clinical competence?

Answer 21

Knowledge
Communication skills
Physical examination
Problem solving

Question 22

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

Answer 22

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)

Question 23

What are factors influencing the consultation?

Answer 23

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)

Question 24

What are three styles of doctor/patient relationships in medical in interviewing?

Answer 24

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

Question 25

What is the most desirable way to work with a patient?

Answer 25

Partnership - research shows that patients are more satisfied with the consultation if they feel you have asked, and listened, to their views

Question 26

What activities does the medical consultation typically involve?

Answer 26

Talking together (always)
Doctor examining the patient (often)
Performing procedures (sometimes)

Question 27

What are the interviewing techniques?

Answer 27

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

Question 28

What are the different questions that should be used?

Answer 28

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

Question 29

What non-verbal communications (body language) can be identified?

Answer 29

Instinctive (e.g. crying)
Learned - from life experiences or from training
Clinical observation

Question 30

When interpreting body language, what is important to consider?

Answer 30

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)

Question 31

What are four things that we can get body language from?

Answer 31

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