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Is Knowledge Important in General Practice? - Dr Mark Burgin

22/07/19. Dr. Mark Burgin BM BCh (oxon) MRCGP considers situations where knowledge gaps might worsen the care that GPs can offer their patients.

Although to become a member of the Royal College of GPs a candidate must pass an applied knowledge test AKT there has been resistance to USA style exam-based recertification.

FOI requests have indicated that 20-30% of senior doctors in the UK have insufficient knowledge to reach the standard compared with the published figures of 10-20% in the USA.

These standards are set by the GMC and Health Education England, but little information is available as to how these bodies determine the type of knowledge that is required for a GP.

It has been estimated that up to 90% of a GP’s role involves soft knowledge about the human condition not tested in the formal MCQ type of assessments.

Solving Clinical Mysteries

GPs are often faced with mysterious symptoms that neither yield a medical diagnosis nor appear to be clearly psychosocial in origin, so they use time as a diagnostic tool.

Repeated assessments show the evolution of the problem, often too mild and nebulous to justify a referral to a specialist, and often more troubling to the GP than the patient.

Knowledge is the key to working out whether this is a common presentation of a rare disease or a rare presentation of a common disease and preventing a missed diagnosis.

All GPs will miss diagnoses but the higher the GP’s knowledge the less chance that the patient will be suffering from untreated illness until they are diagnosed or die.

Urgent and Evolving Illness

It is said that GPs are not good in an emergency as their soft interpersonal skills are a liability to a patient who needs prompt and practiced action.

Illnesses which are not immediately life threatening such as infections can benefit from the biopsychosocial model assessment to choose the right approach for the individual.

The GP must also have in mind the right systematic approach to identify red flags and plan the clinical management in a way that makes the patient safe.

Clinical skills and instinct are a poor substitute for a checklist of steps without which the GP can become overwhelmed by the signals that something is wrong.

Explaining and Empowering

Most of General Practice is giving advice which is using the GP’s excellent communication skills to empower the patient and relying upon the patient to take care of themselves.

The skills required to relieve a patient’s anxiety include rapport and listening but to really empower the patient the GP needs knowledge of the illness.

Ideally the GP’s explanation would create a model of the illness which both explains the current symptoms and predicts what will happen next.

The patient would then be able to use that model to check whether their symptoms are expected or not and recognise when to return for further review.

Conclusions

Knowledge has a secondary role in General Practice but is essential to reduce emergency and late presentation of undiagnosed illness.

Knowledge tests for GPs should be tailored to ensure that they are relevant to the senior doctor’s practice and do not merely test their memory for values that can be looked up.

Patient stories are valuable in assessing what role knowledge played in their care and whether knowing a fact would improve a GP’s performance.

Once knowledge testing for senior doctors has been properly developed it should be offered on a voluntary basis so that GPs can have assurance that they are up to date.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

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