Interpreting the data
Managing the priority
The GP explores the patient's alcohol alongside other factors that can influence LFTs such as fatty liver changes and diet. These issues are given equivalent status to the alcohol consumption and the context of this consumption, when the amount of units makes this by far the most likely contributor to changes.
Is this because the medication and diet feel like more comfortable topics?
Does the GP know how to calculate units of alcohol from the patient's description?
It doesn't seem like an appropriate use of resources to utilise the Advice and Guidance of the hospital team if Jennifer is drinking 63 units or more of alcohol per week. Diet and medication are peripheral issues by comparison so the GP should be focussing the management on safe reduction of the patient's consumption and when ready two to three alcohol-free days a week.
The GP has a role as gatekeeper to take responsibility for managing the care of patients and not inappropriately add to secondary care workload- it's an important aspect of the reciprocal duty between Primary and Secondary care.
SCA Feedback Statements
The implications of relevant findings identified during the data gathering were insufficiently recognised or understood
Examiners felt that you did not demonstrate an ability to identify or recognise significant findings in the consultation. Some findings may have been identified but not acted upon appropriately, so that examiners conclude you did not recognise their significance. This skill requires you to correctly recognise and respond to the significance of information in the consultation. The abnormal findings will often relate to common or important conditions.
A patient who you find to be cognitively impaired may not be able to follow complex management instructions without additional support. Or perhaps a patient experiencing unilateral headache was diagnosed as migraine rather than temporal arteritis, despite tenderness on brushing their hair.
A newly confused patient who takes DOACs may need an urgent CT head to exclude a subdural.
Suggestions
Consider how you pick up on abnormal findings and respond safely and appropriately. Discuss your consultations with colleagues, asking them to comment, particularly on your response to abnormal findings that emerge in the consultation.
The management plan relating to investigations was inappropriate or not reflective of current practice
You are expected to show that your clinical management skills are in line with current UK best practice. You may not have suggested investigations at all, where they were needed. You may have suggested inappropriate or unjustifiable investigations. Or you may have arranged investigations when none were needed in this case.
For example, it may not be necessary to request an MRI scan for simple back pain, or a sputum sample for an URTI. If someone has symptoms of irritable bowel syndrome it may be unclear why a vitamin D level is suggested. Alternatively, after a cough worsening over several weeks, it may have been advisable to request a chest Xray.
Suggestions
Your management plan should be coherent and feasible. You should be familiar with current national guidelines such as those published by NICE (National Institute of Clinical Excellence) and SIGN (Scottish Intercollegiate Guidelines Network).
Investigations requested should be targeted and relevant, answering a specific clinical question. It should be clear why they are being chosen, based on the probability of disease and with an awareness of budgetary governance.
You may feel that it would be better to be ‘on the safe side’ by ordering a battery of tests and whilst understandable, this can make you appear indiscriminate.
Collect a list of all the investigations you have requested over a few sessions at work. Compare with others, peers or your supervisor. What was the reason for choosing those investigations? Were they helpful and/or justified? Plan a tutorial where you share and action your supervisor’s results list and vice versa.