Looks like the management is ok- or is it?
Cognitive Dissonance
This decision feels a little more directive and Doctor-centred. By limiting the conversation to prostate treatment options he is not open to the possibility of a mixed picture.
Note the body language and hand movements when Leroy asks his question about surgery. There's no imposition by the GP but it's clear that this is not the clinician's preferred option.
The words spoken seem reasonable but the suppressive hand gestures are very persuasive that the choices available are Finasteride or fluid restriction, and the GP would be keeping his hands on the keys to a referral!!This is then subtly dressed as referring back to Leroy's libido concerns.
Existing information about the case was insufficiently utilised
SCA Feedback Statements
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.
The persons agenda health beliefs and all preferences were insufficiently explored
The examiners felt the consultation was insufficiently person-centred.
It is important to understand the context of the illness; and attach importance to the subjective aspects of medicine. This means always seeing the patient as a unique person and being curious; then valuing patient preferences and expectations.
For example, a patient whose neighbour has lung cancer may have fears about their own cough. Another patient may be vaccine hesitant due to health beliefs which are understandable and strongly held in their community.
Suggestion
Ensure you explore the person's ideas, concerns and expectations; also consider the impact the situation has had on their life.