Caring for Carers
Social influencers that matter
The GP never seems to get to a point where George is adequately accounted for, and until this lady's priority is addressed then the safe management of her condition cannot be achieved, as the safe management of George is similarly unmet.
Each GP will have an agenda to explain and inform the patient about the risks as they identify it, but how this is handled is key to an effective outcome.
Do you share the GPs optimism that the X-Ray will take just an hour on the day of the appointment? It's possible, but difficult to guarantee. What about longer term issues and making sure she is able to care for herself in the way she is caring for George?
SCA Feedback Statements
Data gathering was insufficient to enable safe assessment of the condition/situation
Examiners felt that the history taken was insufficient in terms of breadth or depth to enable you to safely assess the condition and its severity.
Suggestions
Ensure you consider the presence or absence of relevant ‘red flags’.
An exhaustive enquiry into a list of all possible symptoms is unnecessary and impractical; but ask enough to demonstrate you have considered the relevant serious possibilities.
Be curious and interested in the severity of the patient’s presentation and how the symptoms are affecting them.
Watch videos of your consultations, or role play scenarios with your supervisor or peer study group.
Have you enough information to form a differential diagnosis and distinguish significant illness from something more minor or self-limiting? For example, if you decide a patient has mechanical back pain, have you excluded cauda equina? If they are bleeding PV, have you considered pregnancy, or if their smear is up-to-date? With each consultation consider, what else could this be? What do I need to exclude?
Create short lists to prompt red flags for common presentations in GP.
Watching other more experienced colleagues consult will help.
Existing information about the case was insufficiently utilised
Examiners felt that the consultation would have benefitted from reference to information provided in the case notes. Data gathering includes understanding and incorporating data from the patient record to inform the consultation.
For example, if a patient has seen a doctor previously, refer to this. ‘I note you saw my colleague last week about nose bleeds and she made some suggestions. How have you been since then?’ Or ‘Our notes say you are taking metformin, atorvastatin and ramipril, is that correct?’ Rather than, ‘are you taking any medication?’
You might notice a patient has an allergy or has previously tried a medication. Perhaps their smear is due. They may have suffered a recent bereavement. Consider if this might be relevant or referred to in your consultation.
A low MCV might indicate iron deficiency anaemia, so a change in bowel habit may need more urgent investigation than a normal Hb might suggest. A change in eGFR may mean that medications such as metformin need their dose adjusting.
Suggestions
Take time before starting a consultation in your surgery. What information is helpful for you to know? What is the patient’s past medical history? What medications are they taking? How recently have they been seen and for what reason? Are there any ongoing health issues that should be raised?
Notice how familiarity with the patient record informs the consultation, compared to seeing someone ‘blind’ with no record, for example, in an Urgent Unscheduled Care or A&E setting.
Plan a tutorial on record keeping and the function(s) of GP notes.