Collusion isn't sharing a decision
Avoiding the issue won't pay off
The GP is accepting and honest about his lack of insight into the effectiveness of the medications mentioned, and adopts a fairly pragmatic approach that is rooted in the patient's welfare- this is a successful approach. what follows is a lack of pushback when the patient dismisses the idea of a statin, having not yet reached a point where she's been fully informed.
His attitude could be described as 'whatever you like' and this is a little too passive.
It may be after full consideration of the potential benefits and risks that she decides the statin is not for her based on present risk, but the GP goes along with her wishes and then offers to recheck in 12 months, rendering the consultation 'pretty pointless' in the patient's mind.
SCA Feedback Statements
The management plan relating to prevention, health promotional or rehabilitation was inadequate or inappropriate
You are expected to encourage prevention of illness, offer health promotion and rehabilitation strategies, where needed. These may include issuing a sick note, encouraging patient autonomy and self-care, prioritising ‘lifestyle’ advice. Sometimes this might include recognising the ‘gatekeeper’ role of the GP in prioritising NHS resources and/or reducing dependency on healthcare.
For example, a patient with COPD would benefit from pulmonary rehabilitation, smoking cessation and flu vaccination. Did you focus mainly on which inhaler to provide?
Another patient may need a sick note due to their psoriasis flare. Did you refuse this unnecessarily? Or grant one that may be unhelpfully long in duration, when self-certification may be a good first step?
Someone with threadworms might be gently signposted to the pharmacist for simple over the counter medications in future, assuming they can afford this.
Suggestion
Consider whether there are important areas of prevention, health promotion or rehabilitation you might encourage. For example, do you know some simple exercises for mild knee pain? Or understand how to support someone locally with smoking cessation or weight loss? Are you aware of NHS screening programs? How do you respond to requests for housing letters or fit notes?
Think about the different types of NHS resource that GPs are ‘gatekeepers’ for, and how reference to these emerge in our consultations. This does not mean that you are expected to refuse access to services, new medications or ‘fit notes’, but that you show your awareness of the issues and responsible use of resources.
The circumstances relevant cultural differences and or preferences of those involved were insufficiently responded to
Examiners felt that you might not have made full use of the information given by the patient to you during the consultation. You may not have sufficiently demonstrated the ability to work in partnership with your patient to develop a shared management plan. It is important to take account of the patient’s agenda, health beliefs or preferences in the development of a management plan.
For example, a coughing patient whose neighbour has lung cancer may need particular reassurance or investigation to assuage their fear. Another patient who is vaccine hesitant due to health beliefs which are understandable and strongly held in their community might be receptive to signposting of resources produced by community leaders and a non-pressurising approach.
Patient-centred doctors are responsive to patient preferences about their health. This does not mean you can/should always be patient led. But the information about their unique situation and preferences should inform how you proceed and what you do next.
Suggestions
Practice responding appropriately to your patients’ agenda and preferences, incorporating these where possible into your plans and explanations. Try to involve patients in making decisions wherever possible.
There are many educational resources about consulting skills (both in print and online) that will help.