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Anderson, Bridges-Webb and Chancellor4 emphasise that ‘the unique and important work of the general practitioner is to provide availability and continuity of care, competence in the realm of diagnosis, care of acute and chronic illness, prompt treatment of emergencies and a preventive approach to health care’.
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The features that make general practice different from hospital- or specialist-based medical practices include:
first contact
compassion
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 and patient education
holistic approach to management
health care coordination
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The GP has to be prepared for any problem that comes in the door (FIG. 1.1).
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Apart from these processes the GP has to manage very common problems including a whole variety of problems 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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In considering the level of care of symptoms, 25% of patients abandon self-care for a visit to the GP. Ninety per cent of these visits are managed entirely within primary care. Levels of care are represented in FIGURE 1.1.5
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Holistic approach to management
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The management of the whole person, or the holistic approach, is an important approach to patient care in general practice. Whole-person diagnosis is based on two components:
the disease-centred diagnosis
the patient-centred diagnosis
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The disease-centred consultation is the traditional medical model based on the history, examination and special investigations, with the emphasis on making a diagnosis and treating the disease. The disease-centred diagnosis, which is typical of hospital-based medicine, is defined in terms of pathology and does not focus significantly on the feelings of the person suffering from the disease.
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Whole-person care—mind and body—is the hallmark of the good GP.
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The patient-centred consultation not only takes into account the diagnosed disease and its management but also adds another dimension—that of the psychosocial hallmarks of the patient, including details about:
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Taylor and colleagues, in their patient-centred model of health care, emphasise six interactive components of the patient-centred process:6
exploring both the disease and the illness experience
understanding the whole person
finding common grounds regarding management
incorporating prevention and health promotion
enhancing the doctor–patient relationship
being realistic regarding time and resources
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Contemporary general practice focuses on patient-centred medicine, which, in alliance with evidence-based medicine, benefits both patient and doctor.