A

ABC OF GENERAL PRACTICE

Its nature and content

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.

Definitions

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:

• 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

Unique features of general practice

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

• first contact and ‘gatekeeper’

• diagnostic methodology

• early diagnosis of life-threatening and serious disease

• continuity and availability of care

• personalised care/compassion

• 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

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.

A DIAGNOSTIC PERSPECTIVE

The basic model

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).

1. The probability diagnosis

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?’

2. What serious disorders must not be missed?

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 ...