General Practice Todayã 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.
Packing each chapter with realistic examples, author Jane Wilcock draws on her own extensive experience to help GPs make considered, contextual decisions that enhance the health and well-being of their patients. This book is essential reading for any General Practitioner, allied health care practitioner or trainee preparing to practice in our complex modern world.
Foreword. Introduction. Before the patient enters the consultation. Inner consultation skills. Non-verbal and verbal consultation skills. EBM. Risk scores and guidelines: which ones and why. Accessibility within a consultation. Who writes them - conflicts of interest (gifts and sponsorship). Grey/ unpublished trials - Big Pharma and conflicts of interest. How to use them. Statistics in medicine with analysis examples. Statistics and interpretation - what is truth? Personal bias. Ethics in the consultation. Legislation. Consent. Capacity. Special cases: vulnerable adults and children. Carers and family members. Translators. Gifts. Sex, contraception and abortion. End of Life and DNR. Mental Capacity Act and best interests. Lasting Powers of Attorney (LPA). Advanced Directives (AD). Deprivation of Liberties (DOLs). Safeguarding Vulnerable Adults. Safe-guarding children. Benefits. Harms. Autonomy. Justice. Aristotle's Virtues. Doctor patient relationships. Chaperone. Treating family and friends. Cultural and religious influences. Duties of a Doctor. Record keeping (phone consultations benefits and pitfalls). Contextualising to the patient. Investigations. Management plans - non medical patient centred. Teams and communication within a practice and outside agencies. Communication, timing, replies. Prescribing. Polypharmacy. Multiple diagnoses with examples of potential problems and solutions. Patient views. Hurdles to patient accessing doctors. Patient influences i.e., journalism. Patient understanding and opinion forming. Long term adherence: factors for and against. Reaching an agreement and planning. Conclusion. Cases illustrating use of the outer consultation framework to enhance clinical decision making. Long term care and enjoyable careers.