GENERAL PRACTICE

What makes GP different from other doctor jobs?

• the relationship with the patient "person centredness"
• whole of patient "comprehensiveness"
• whole of lifetime"continuity of care"
• inclusive vs exclusive
• normalising vs pathologising
• making decisions without tests and opinions of others in short period of time
• doctor needs to be safe and comfortable with uncertainty

General Practice in Australia

• 85% of Australians see the GP at least once per year.
• 2.57 Million GP visits each week in Australia
• Writing 7 scripts/100 problems managed
• performing 14 procedures per 100 problems managed
• Writing 1 referral for every 10 problems managed
• And also advising patients NOT to have all of the above

A quick history of medicine

• first doctors x
• originally barber surgeons
• start of modernsm scientific medicine in x
• up until x you could just leave uni ad become GP
• in x fellowship became compulsory, must be registrar and take exam

What is GP training?

• Medical school = 5-7 years
• interneship
• residency( PGY1-2)
• Registrar 3 years at least
• RACGP Exams, written and clinical
• Project
• Then become a GP
• The most junior GP registrar has at least 8 years of medical training behind them, most have more.

What is the GP doing?

• listening( taking a history)
• asking questions( clarifying, elliciting red flags, creating a problem list)
• Making a list of differential diagnoses
• Examining the patient
• Ordering Investigations
• Making a management plan
• Safety Netting and follow up

And the rest

• the patient has and agenda - so does the doctor
• Proactive screening and health promotion eg. 50 and over health check, smoking cessation
• engaging the patient as a partner
• motivational interviewing
• following up previous issues to check they are resolved
• "ticket of entry problem" and "disguised presentation"
• building and keeping rapport
• making notes

HOW TO GP'S KNOW WHAT IS WRONG THE PATIENT AND WHAT TO DO?

• Pattern recognition
• Structure history taken
• spot diagnosis
• know the patient
• algorithms eg. health pathways, autofills
• red flags
• time as a diagnostic tool
• know normal well
• follow up and safety netting

WHAT IS THE FUTURE OF GENERAL PRACTICE?

• more specialists
• more tests available
• higher expectations of patients
• longer lived patients
• each family has less children
• more need for GP's to care for people from cradle to grave,and implement the latest science at the coal face

What makes things go wrong in GP land?

• HALT - Hungry, Angry,Late,Tired.
• Biases
• Poor relationship with patient
• Poor work environment
• Swiss cheese

yourgp.racgp.org.au/Your-GP/awareness-campaign#video

SPELLING WORDS

• Practice
• Registrar
• Myocardial
• Infarction
• Atrial Fibrillation
• Anticoagulation
• Arrythmia