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Introdction

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The doctor should have a kind disposition, great patience, self-possession, meticulous freedom from prejudice, an understanding of human nature resulting from an abundant knowledge of the world, adroitness in conversation and a special love of his calling.

G Griesinger 1840

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The Macquarie Dictionary says that counselling is ‘giving advice’: that it is ‘opinion or instruction given in directing the judgment or conduct of another’. In the clinical context counselling can be defined as ‘the therapeutic process of helping a patient to explore the nature of his or her problem in such a way that he or she determines his or her decisions about what to do, without direct advice or reassurance from the counsellor’.

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The counselling process in general practice is based on the therapeutic effect of the doctor. There is an enormous and ever-increasing need for people in the community to have many of their emotional and social problems addressed by the health profession. Modern medicine has acquired a much more scientific face over recent years at the expense of its once respected humanistic one. Medicine is primarily a humanitarian pursuit, not an economic or scientific one, and uses science as a tool. Many feel that medicine is losing sight of this, at the considerable expense of its standing in the community.1

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The public perceives that GPs can and do counsel people because more people go to their GP for counselling than to any other group of health workers, including psychologists, psychiatrists, social workers, marriage guidance counsellors and clergy.1 People do not generally tell the doctor or even realise that counselling is exactly what led them to come to the doctor in the first place. The GP is, therefore, ideally placed in the community to make the most significant contribution to fill the community's needs in this area.

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The GP as an effective counsellor

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GPs can be effective counsellors for the following reasons:2

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  • They have the opportunity to observe and understand patients and their environment.

  • They are ideally placed to treat the whole patient.

  • Their generalist skills and holistic approach permit GPs to have a broad grasp of a patient's problems and a multifaceted approach to treatment.

  • They can provide treatment in comfortable and familiar surroundings, including the doctor's rooms and the patient's home.

  • They are skilled at working as a member of a professional team and directing patients to more expert members of the team as necessary.

  • They can readily organise ‘contracts' with the patient.

  • They often have an intimate knowledge of the family and the family dynamics.

  • They fit comfortably into continuing patient care with appropriate follow-up treatment programs.

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To be an effective counsellor the GP must prepare for this role, first by making a commitment to its importance, then by acquiring the knowledge and skills for basic counselling by reading, attending workshops ...

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