Saturday, May 25, 2013

Teaching during a day of clinical general practice

There are many reasons I love my work. One of the reasons is that it is impossible to be bored! We see a whole range of people who believe they have or might have a problem and want to discuss it. Sometimes, that might be a significant medical emergency. Sometimes it might be a significant chronic disease. Sometimes it might be a significant mental illness, or a self limiting condition, or a request for information or support to get housing. Sometimes it might be loneliness. Often these occur together in the same person. This list could be endless - the only limit is the world population and imagination. And there is almost nothing where we can say "That's not our business."

So how do you teach that? In essence, we need a safe approach for anything that can come through the door. And that means there is no learning off limits, nothing we can learn that can have no application. But we can't know everything.

I thought it might be interesting just to post the variety of topics that Michael and I covered in one day, Admittedly it was a day where we had more chance to chat than usual. But the range covered would not be unusual. I'll describe what we did, and reflect a bit on why this might be relevant to General Practice. (Some of the info might be a bit vague - I don't want to run the risk of any patients being identified! Confidentiality is a cornerstone of our work!)

As you'd expect, we do talk about medical conditions and treatments.

COPD and inhalers

A quick discussion in the corridor on the use of Salmeterol/Fluticasone combination (you all know it by another name: "The Purple Inhaler!") in COPD. The evidence shows that people are more likely to have a serious pneumonia on a steroid inhaler. The long acting beta agonist is probably helpful, but we should be cautious about the combination. This wasn't the information we were often taught about this combination, and we have both felt a bit duped by drug companies!

A Rash!

There probably isn't a day in General Practice where you can't use a rash as a teaching opportunity. We're usually taught rashes as if pattern recognition is the only game in town, but it's always always always worth sitting on your hands before looking at the rash and taking a history. It's true for any set of symptoms, and it's true for rashes. And diagnosis isn't the only game in town. You need to be able to form a management plan acceptable to the patient (or their parents) and explain it and understand and alleviate any particular concerns.

 Rare Diseases

Every GP has a few people they know well with a rare disease. The care of a patient with a rare disease can't really be discussed online, because the person is all too readily identifiable. As GPs we are so unlikely to see any one particular rare disease, so we don't usually know about them until we see them. But as GPs, we also know that these are people, and the diagnosis of a rare condition isn't what defines them as  person - though it often has  huge impact. We thought about whether the symptoms my patient had might be related to their rare condition, or whether they might be something else more common, perhaps unrelated. After all, people with rare diseases need the rest of their medical care, too, including preventive care. And I had one of those frisoons of pleasure as Michael quoted back at me the paper I'd co-written. (I think he knew this!) (I'm biased, but I think it's worth a read - it sets out the common problems faced by people with a rare disease, and also an approach GPs might take)

Childhood Obesity

Michael and I have discussed the problem of obesity and food security quite often (and I have drawn on these thoughts blogging here and here) and we have shared Michael Pollan's books which take a cultural view of healthy food, rather than a nutritional approach. On Tuesday, we listened to this podcast from Freakonomics, which highlighted discussions from a range of experts across different fields. It was interesting to see the personal responsibility versus social policy play out again, as well as a search for technical solutions. If you're thinking aboout setting up a tapeworm company, there might well be an opening for you...

Over to you
The day finished with me (Tim) learning 2 things. I learnt what Takotsubo syndrome was. And I learnt that I was the only person in the world who'd never heard of it before!

We'd love to hear your thoughts on these topics - either using the #supertwision hashtag or in the comments below. What's the range of things you cover? What's the strangest resource you've used?