A few things to do before you arrive...

  • Read the recommended readings from the online reading list;
  • Decide on the sort of information they would like to find out from the patients (e.g. why the patients have come to surgery today; how satisfied they are generally with their general practice; do they always follow the advice they are given); and
  • Think about health promotion and what the term means;
  • Understand the reasons for having consultation models.

"The illness is the patient's perception of something being wrong, the sense of unease in the functioning of the body or mind; the disease is a defined entity which offers the benefits and risks of scientific medicine. Illness is what the patient has on their way to see the doctor, disease is what they have on the way home. The former is subjective, the latter objective. Most disease involves illness, but by no means all illness involves disease. Both the disease and the illness can be more or less serious. The task of the general practitioner is to make these distinctions and to diagnose disease, to refer serious treatable disease to specialist colleagues, to treat less serious disease and to acknowledge and witness the suffering brought about by illness"
Iona Heath, The Mystery of General Practice 1994

"On a psychological level recognition means support. As soon as we are ill we fear that our illness is unique. We argue with ourselves and rationalise, but a ghost of the fear remains. And it remains for a very good reason. The illness, is an as yet undefined force, is a potential threat to our very being and we are bound to be highly conscious of the uniqueness of that being. The illness, in other words shares in our own uniqueness. By fearing its threat, we embrace it and make it specially our own. That is why patients are inordinately relieved when doctors give their complaint a name. The name may mean very little to them; they may understand nothing of what it signifies; but because it has a name; it has an independent existence from them. They can now struggle against it. To have a complaint recognised, that is to say defined, limited and de-personalised, is to be made stronger."
John Berger, A Fortunate Man
"Just because your doctor has a name for your disease, doesn't mean (s)he knows what's wrong with you!"Anon





Review of last week and prepare for this week

Primary care in practice

What goes on in a consultation?
Read: 'The 3 second consultation'
Group discussion

Consultation observation

Sitting in with different members of the practice team

Reflective writing

Review of last week's reflective writing pieces with the community tutor



Patient interviews

Patients will come in to the practice or you will undertake home visits in pairs

Review of the day

What are consultation skills? What is the role of a GP?


Looking at your learning objectives for the day and prepare for Day 3

Learning Objectives

By the end of the day, students should be able to:
• Report and reflect on their experience of meeting a patient for the first time as a medical student.
• Describe some reasons why patients present in general practice
• Describe some differences in relationships between patients and different members of the Primary Care Team, and how these are expressed
• Identify some of the skills doctors use in their relationships with patient
• Demonstrate how to obtain consent from a patient for history-taking
• Explain the ethical and practical guidelines for interviewing patients
• Describe a health promotion intervention they have observed, such as a new patient check

Reflective writing

What reasons do patients present in general practice?; Do patients communicate differently with non-clinical and with clinical staff. How did you feel you did when you were interviewing a patient? Did you feel the patient felt comfortable talking to you?
Why should you ensure patient’s consent to any examination and treatment has been obtained?
Why is health promotion is important in primary care? What do you think the GPs role is in health promotion? Which other health care professionals have health promotion roles?

On making yourself understood:

"The inarticulatedness of the English is the subject of many jokes and is often explained in terms of puritanism, shyness as a national characteristic, etc. This tends to obscure a more serious development. There are large sections of the English working and middle class who are inarticulate as the result of wholesale cultural deprivation. They are deprived of the means of translating what they know into thoughts which they can think. They have no examples to follow in which words clarify experience. Their spoken proverbial traditions have long been destroyed: and, although they are literate in the strictly technical sense, they have not had the opportunity of discovering the existence of a written cultural heritage.
Yet this is more than a question of literature. Any general culture acts as a mirror which enables the individual to recognise himself - or at least to recognise those parts of himself which are socially permissible. The culturally deprived have far fewer ways of recognizing themselves. A great deal of their experience - especially emotional and introspective experience - has to remain unnamed for them. Their chief means of self-expression is consequently through action: this is one of the reasons why the English have so many hobbies. The garden of the work bench becomes the nearest they have to a means of satisfactory introspection"
John Berger, A Fortunate Man
His novel, Corker's Freedom attempts to illuminate this further.

Reflection for discussion:

What obstacles are there when doctors and patients try to make themselves understood and how might they be overcome?

Essential reading

GMC | Good Medical Practice: Duties of a doctor
Sociology as applied to medicine - Scambler, Graham, 2008
Book | Read Morgan chapter - 'The doctor-patient relationship' p47-62
Clinical communication skills - Washer, Peter, 2009
Book | Read Chapter 2 'The Structure and Process of the Medical Interview' p11-17
Principles of biomedical ethics - Beauchamp, Tom L., Childress, James F., c2009
Book | Read chapter on Professional Patient relationship Note: this chapter is very long the important bit is the sub-section on confidentiality i.e. pages 418 – 429

Further information

See the reading list for other books about general practice and East End GP David Widgery
Read the rough guide to ethics and recommended chapter on ethics on your reading list