By Kilburn, J.
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More impressive counsellors are more verbally active rather than just listeners. • Writing therapy (disclosure of traumas onto paper and bringing them to consultation) under care of GP alone is cost-effective. • Recent survey shows higher referral rates to clinical psychologist after counselling and no difference in outpatient psychiatry. • Insufficient evidence for the use of generic counsellors alone in major depression. RELEVANT LITERATURE Relationship between practice counselling and referral to outpatient psychiatry and clinical psychology.
Time-consuming consultation. • Medical assessment. Issues for the practice • • • • Use of clinical nurse for education and monitoring/lifestyle risk factors. Use of written material, videos etc. Practice formulary for prescribing. Prescribing costs. Information-sharing • • • • • Explanation of physiology. Risk-benefit assessment. Awareness of side-effects. Mutual agreement on different therapeutic approaches. Importance of the patient’s own unhurried choice. PRACTICE QUESTIONS 25 Evidence-based decision re principal effects Cardiac There may be a protective role in patients with significant risk factors or previous MI but clear evidence inconclusive.
He is on the highest dose of morphine that you have encountered and is still bed-bound and in pain. You call to visit. What is your approach? PRACTICE QUESTIONS 51 INTRODUCTION Care of the terminally ill affects all GPs. It involves careful consultation skills, effective teamwork and knowledge of palliative care with continual reassessment as agreed with the patient and his attendees. FIVE POINT PLAN The doctor-patient relationship • • • • • The need to respond to patient’s personal desires and needs.
Answer Plans for the MRCGP by Kilburn, J.