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ABC of general practice

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Its nature and content
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General practice is a traditional method of bringing primary health care to the community. It is a medical discipline in its own right, linking the vast amount of accumulated medical knowledge with the art of communication.

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Definitions
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General practice can be defined as that medical discipline which provides ‘community-based, continuing, comprehensive, preventive primary care’, sometimes referred to as the CCCP model. The RACGP has defined 5 domains of general practice:

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  • communication skills and the doctor-patient relationship

  • applied professional knowledge and skills

  • population health and the context of general practice

  • professional and ethical role

  • organisational and legal dimensions

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Unique features of general practice
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Features that make general practice different from hospital or specialist-based medical practices include:

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  • first contact

  • diagnostic methodology

  • early diagnosis of life-threatening and serious disease

  • continuity and availability of care

  • personalised care

  • care of acute and chronic illness

  • domiciliary care

  • emergency care (prompt treatment at home or in the community)

  • family care

  • palliative care (at home)

  • preventive care

  • scope for health promotion

  • holistic approach

  • health care coordination

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Apart from these processes, the GP has to manage very common problems including a whole variety not normally taught in medical school or in postgraduate programs. Many of these problems are unusual yet common, and can be regarded as the ‘nitty gritty’ or ‘bread and butter’ problems of primary health care.

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A diagnostic perspective

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The basic model
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The use of the diagnostic model requires a disciplined approach to the problem with the medical practitioner quickly answering five self-posed questions (Table A1).

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Table Graphic Jump Location
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Table A1

The diagnostic model for a presenting problem

  1. What is the probability diagnosis?

  2. What serious disorders must not be missed?

  3. What conditions are often missed (the pitfalls)?

  4. Could this patient have one of the ‘masquerades’ in medical practice?

  5. Is this patient trying to tell me something else?

++ 1. The probability diagnosis
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This is based on the doctor's perspective and experience of prevalence, incidence and the natural history of disease. The question is ‘for this particular patient with this specific problem/s presenting today, what is the likely diagnosis?’

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To achieve early recognition of serious illness the GP needs to develop a ‘high index of suspicion’. This is generally regarded as largely intuitive but is probably not so—it would be more accurate to say that it comes with experience. The serious disorders that should always be considered ‘until proven otherwise’ are listed in Table A2 and can be classified as V—vascular, I—infection (severe) and N—neoplasia ...

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