The Problem of General Practice Today
Hello and welcome to this Facebook Live. My name is Dr. Tom Rolley for GraduateMedicine.com.
I wanted to drop in to what I see as the essential problem of being a GP, at least in Australia in the 21st Century.
And while there's a lot of distractions around about are we getting paid enough, how do we do this, how do we do that, what's the training doing?
But to me what we are actually facing is a problem of too much information.
Too much information that essentially, as general practitioners, having to go across all of the different subspecialties and then have a patient walk in with an undifferentiated problem and be able to work out what's going on. But once we get into what's going on, each of those problems has actually got vast amounts of information.
And to me it's just not possible anymore to be an authority on all of the potential topics that we have to be across as good GPs.
So the outcome of this problem is often ... well let's take it to the exams. We train on getting through the exams and to me the outcome of this too much information is that there is a lack of confidence about whether I know enough. And you must face the reality that there is always going to be more. Any single topic now can drop down into 52 pages of up to date.
It takes an hour and a half to delve into and then each of those has references and I didn't quite get that and suddenly it's three, four, six hours to work out one single topic. And yet, for the exam, maybe 125 core topics and then another 250 moderate topics. And then there's still more peripheral topics that we could come up across. So it's very hard to get the time to actually go very deep on each of these.
Remember that many of these topics are managed by specialists who are only focusing on that subspecialty and the topics that fall in within them. So that lack of confidence because you couldn't draw, where's the line? Where do I need to finish the work so that I actually go, "Okay I get it." And what this means is that your head may be swimming in information and it starts to merge into one another and it's no longer clear how to separate out COPD from asthma from chronic bronchitis from bronchiectasis.
And under exam conditions, they all start merging together and it's like ugh. What is going on? So you can't function well in exams because there's been so much information that's not clearly delineated and that leads to worries about exam performance. And I can't be sure about yes this is clearly COPD and not bronchiectasis. All right, so let's move from that issue. What the heck do we do about it? Okay, here it is.
We need the ability to draw the boundaries and say, "That is enough." And what I'm going to draw upon is perhaps that most challenging of exams, the key feature problem exams. It gives a clue on how to deal with this issue and that is to focus on the key features of each of these exams. By doing that we can limit the amount of information that we have to cover and go, "Okay, what is the classical version of this disease?" And have a picture in my mind or in your mind about yes, I'm clear on what those key features are across history, examination, investigations that go make up that disease. And then again, moving into the management. We can look at the key features of treatment, of what advice we would provide to the patient, of what they need to change in their life. And then think about are there any other key aspects of management that I need to include?
So you would actually know the information well. You'd know it clearly by drawing the boundaries, focusing on key features and then under exam conditions, suddenly it's clear what the answers are going to be, that you know your material. And this is not just for the exam. This is going to carry forward as well into your career as a GP. And any GPs out there thinking and watching this like, "Okay, yeah, right. This is helpful." Hopefully you're seeing that this is helpful to deal with the patients that we see each day.
All right, so what's the path forward? That as you are working towards your exam, actually going through and having a summary sheet of each condition that is the key features and then you can go and expand out into further information, maybe document it on my map or however you want to learn. But when it comes to these last weeks before the exam that you are down to the key features across the 125 core topics, the 250 moderate topics and whichever peripheral topics you wanted to go into beyond that. So hopefully this has been helpful for you, that this is the solution, drawing boundaries and focusing on key features is actually the solution to the problem that we face as GPs in 21st century of too much information.
I hope you've enjoyed this presentation, this little video. Hope you got a lot out of it. Have a think about how it can apply to your life today. Does anything need to change in your practice or in your exam prep? I look forward to seeing you again on future videos from myself and from Graduate Medicine.
