GP 4001 Lecture Series

2007-2008
1. Introduction
 What I plan to cover
today

Learning outcomes for the course

Evaluation and assessment of this
course
How general practice differs from
hospital medicine
Nature and scope of general practice
 Learning Outcomes for
this course - I
Develop a rapport with patients such that
patients are at ease in discussing their
health problem(s) (comm)
Gather appropriate information on the
patients health problem(s) including
information on the patients own
perspective on the problem(s). (udp,
comm)
Generate a reasonable range of diagnostic
possibilities for undifferentiated medical
problems presented by patients (udp)
Investigate these diagnostic possibilities
using appropriately focused history taking
and selective physical examination (udp,
comm)
 Learning Outcomes for
this course - II
Construct a general model for the safe
and effective management of patients
with multiple and long term health
problems (cdm)
Adapt this model to the long term health
problems commonly encountered by
doctors (cdm)
Construct an appropriate and feasible
management plan to deal with the
physical, psychological and social aspects
of patients problem(s) (udp, cdm)
Negotiate this plan with the patient.
(comm)
 Learning Outcomes
three principal domains
Dealing with undifferentiated
problems presented by patients (udp)

Management of chronic ill health

(cdm)

Communication (comm)
 Assessment and
Evaluation
Assessment
End of year exam MEQ format
GP attachment assessment by GP tutor
Diagnostic thinking
Patient management
Attitudes to patients and staff
Responsiveness to teaching and enthusiasm for
learning
Evaluation
Will be asked to complete an on-line evaluation by
MarkClass
In class evaluation exercises throughout the year
 How general practice differs from
hospital medicine I - the nature of
illness seen
General Practice Hospital
non-illness & nearly all clear cut
disorganised illness disease
acute self-limiting acute life
chronic stable threatening
all age groups acute-on-chronic
mixed physical, categorised by age
psychological and physical and
social psychologial divided
- virtually no social
GP v Hospital morbidity

by selected ICD
categories I
GP v Hospital morbidity

by selected ICD
categories II
Spectrum of morbidity
in General Practice
 Bio-psycho-social
diagnosis
(a.k.a. tri-axial
Diagnosis indiagnosis)
physical
psychological
and social terms
Note - not either/ or but degrees of each
A manifestation of holistic medicine - non-
reductionist
Philosophically breaking down Cartesian
dualism - the mind-body split
Common problems seen
in general practice -
Physical
Respiratory tract - colds, flu, asthma,
bronchitis
Gastro-intestinal tract - D&V,
gastroenteritis, peptic ulcer, irritable bowel
Cardiovascular - IHD, hypertension
Musculoskeletal - backache, OA, soft tissue
Endocrine - diabetes, thyroid disease
Genito-urinary - cystitis, STDs
Common problems seen
in general practice -
Psychological
Adjustment reactions e.g. grief reaction
Anxiety
Depression
Mixed anxiety-depression
Drug and alcohol problems
Chronic stable schizophrenia
Post-traumatic stress disorder
Common problems seen
in general practice
-Social
Relationship difficulties
Job dissatisfaction
Effects of poor housing
Effects of unemployment/ social
deprivation
Lack of education
 How general practice differs
from
hospital medicine II -
Organisation
General Practice Hospital
small units, non- large
institutional institutional units
non-hierarchical highly
teams hierarchical
low tech teams
easily accessible high tech
filtered access
 Levels of care
location of care People looked after
Regional Hospital 1,000,000

General hospital 20,000

2,000
General practitioner

5
Self care
The illness ice-berg

MAJOR ILLNESS

MINOR ILLNESS

SELF-CARE

PRE-SYMPTOMATIC DISEASE

HEALTH
 The gate-keeper
function
Controls access to more expensive
secondary care resources
Necessary (essential) for cost-
containment
Appropriate specialist selected for
patients who need one
Avoidance of hazards of specialist care for
patients who dont need it
Maintenance of skills of specialists
 The amoeba that is
general practice (after Metcalfe,
David)

HOSPITAL
SOCIETY PRIMARY
CARE
ageing Low capital Capital intensive
increasing chronic
morbidity Labour intentsive
declining family ties Lean manpower
changing attitudes to Non- Hierarchical
professionals hierarchical
polico-economic
change
ecological change Stiff interface
Fluid interface
 Recommended
Textbooks
Pocket Essentials of General Practice
by Colin Bradley Saunders/ Elsevier
ISBN 13-978-0-7020-2648-5
A Textbook of Family Medicine by Ian
R. McWhinney Pub Oxford Medical
ISBN 0-19-515518-X
General Practice by John Murtagh
McGraw-Hill Education
ISBN: 0074711776