General Practice Today: A Practical Guide to Modern Consultations First Edition Jane Wilcock 1351966979 9781351966979

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Product details:

• ISBN 10: 1351966979
• ISBN 13: 9781351966979
• Author: Jane Wilcock

General Practice Today explores the GP consultation in the context of external ‘stressors’ and ‘helpers’ that doctors use to make best clinical decisions. Over the last 30 years there has been a move towards mandatory training on legal aspects, risk scores and guidance. Additionally, with widespread access to IT there has been a huge growth in the information doctors need to know and manage. Yet today’s GP has never been more time-poor or under so much pressure. All these outside considerations can seem challenging and remote for the doctor sat with their patient; yet in today’s reality they have never been more important. This book offers insight into the practical impact and importance of these external factors. It offers advice on everything from law, technology and time management to mental health issues, ethics, religion and culture, exploring how to determine which issues are relevant to each individual consultation.

Table of contents:

1 Laws and regulations

Capacity and the Mental Capacity Act (MCA) 2005

MCA discussion

Fraser guidelines for contraception provision in the under 16s

Consent

Implied consent

Consent in an adult with capacity

Emergencies and consent

Difficult decisions: Legal frameworks and guidelines in end of life care

Lasting power of attorney (LPAs)

Advance statements and advance care planning (ACP)

Advance decisions to refuse treatment (ADRT)

Do not attempt cardiopulmonary resuscitation (DNACPR)

Implantable cardioverter defibrillator (ICD) deactivation

Palliative therapy

Death certification

Confidentiality

Other commonly encountered rules and regulations

Patient group directives (PGDs) and patient specific directions (PSDs)

Chaperones

Use of social media and phones

Complaints

Abortion and the law

Female genital mutilation (FGM)

Discussion on safe-guarding, coervice behaviour, and ‘mandatory’ training

The Mental Health Act (MHA) 1983 (Review 2007)

MHA discussion and sectioning

2 The consultation

What is a consultation?

Accessing the general practice

Telephone consultations

Arrival at the practice

Problems with consultations: Time and money

Why have a consultation?

Bringing patients back: Avoiding the revolving test door

Consultation models

Examination

Diagnosing normal signs

Diagnosing ‘not-normal’ signs

Expecting abnormal examination findings – targeted examination

Continuing symptoms and negative examination findings

Investigations

Rounding off the consultation

The inner consultation

Behaviours which aren’t logical

Personal experience which make patients and doctors risk averse

Criminalisation

Patients who won’t leave the consultation

Continuing consultations are quite different

Patient with continuing illness

Patients requiring repeat medication review

Sexual, obstetric and gynaecological histories

Mental health histories

Breaking bad news

Giving away consultations and curriculum

3 Knowledge and evidence

Size of information

Knowing that we can’t know

Selecting information

Using figures of benefit and risk of harm in general practice

Risk scores

QRISK2: A risk score for the prediction of CVD in primary prevention

Family history, ethnicity, genes and epigenetics

Prescribing issues and guidance integration

Medical statistics: A brief introduction

Standard deviation, absolute risk and relative risk

Changes in prevalence of conditions influences statistical benefits/harms

Sensitivity and specificity

Positive and negative predictive values

4 Ethics and behaviours

Ethical models

Aristotle ethics

Beauchamps–Childress framework for medical ethics

The large picture

On failures, errors and whistle blowing

On change and positivity

Apprenticeship–master model of medical education

How we learn on the job: Teams and leaders

Teams

Leaders: Cops, robbers and magistrates

Religion and culture

Exploring Jehovah’s witnesses, Catholicism, Judaism and Islam

Interpreters

Conscientious objection to abortion and to contraception

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