Key Themes

Learning on your clinical visits has to be opportunistic. General Practitioners are unable to predict exactly who will be visiting their surgery on any given day, but we can guarantee that the visits will generate a wealth of learning opportunities.

Themes we would like you to consider on the visits are:

1.    The Doctor-Patient Relationship

Doctors all have different consulting styles and differ in the way they relate to patients. Think about the strengths of the style adopted by the doctors that you meet. Are there disadvantages in the approach they adopt? What style are you comfortable with? How do you think the relationship between GPs and patients differs from that of hospital doctors and patients?

2.    Reason for the Consultation

A common cause of problems in consultations is that the doctor fails to identify the problem that concerns the patient. Patients are sometimes hesitant about revealing the true reason for their attendance; they may be concerned that the doctor will judge them or ridicule them. Patients see their GP for all sorts of reasons not just to establish a diagnosis. For example, it may be for reassurance about a symptom or to legitimise absence from work. Each time you observe a consultation, try and identify the reason for the patient’s attendance. Does the GP you are working with agree with your problem definition?

3.    Psychosocial Consequences of Illness

Even minor illness can have a significant effect on a patient, disrupting their life and causing anxiety. There is often a complex mix of psychosocial and physical dimensions to consultations. Observe how the psychosocial components impact on the patient’s presentation.

4.    Ethical Issues in Doctor-Patient Encounters

Medical ethics is concerned with the moral principles and rules of conduct followed by the medical profession. During visits you are asked to identify ethical issues that may occur in normal consultations. Although you may not encounter a major ethical dilemma, you should consider how elements of what you have already learnt apply to all the consultations you observe. The four main ethical principles are: respect for autonomy, beneficence, non-maleficence and justice.

We hope that on each visit you will be able to meet a patient with a problem which relates to the current module you are studying. GP tutors will do their best to arrange this but it will not always be possible. Throughout the visits you should apply the learning you have achieved in communication workshops to the consultations you observe.