Updated: May 21, 2020
I have long been struck by the difference between the instinctive, pragmatic, jobbing GP approach that most experienced GPs adopt when faced with a particular scenario, and the huge challenge the same situation can be for trainees setting out in a career in general practice who don't yet have that experience behind them. The instinct to turn to guidelines for direction is helpful for the foundational knowledge trainees might need to base their consultation upon, but the dry, detail-heavy approach of a clinical guideline doesn't tell them how to fit it all into 10 minutes or give any insights into what the patient might be thinking, and what might really matter in the encounter they are facing. Two Houses Guides are an attempt to bridge this gap, to give a framework for trainees as they develop and refine their approach to a consultation. They are based on the Two Houses model and my hope is that they will be a useful resource for trainees, trainers, established GPs and other healthcare professionals engaged in the challenging and rewarding task of communicating in primary care.
As I started to write the guides, I haveI focused on those consultations I have seen trainees struggle with over the years, and which often come up in the CSA exam. I have chosen clinical topics that always pose a challenge because they rarely crop up in secondary care, like the menopause; or something a trainee might be familiar with but never had to deal with on their own before, like new onset atrial fibrillation. Other topics, like a new diagnosis of diabetes just have so much to cover that they feel overwhelming and we don't know where to start, or we worry we will miss something of vital importance. And then there are some classic CSA scenarios that don't fit neatly into a clinical case, meaning there is no NICE guidance we can turn to that might tell us what to do; like dealing with an angry patient, for example, or a consultation that starts with a request for genetic testing.
I chose the menopause and the angry patient to include within The GP Consultation Reimagined, since I wanted to include one that was clearly a clinical topic and another that could cover any area of medicine, but deserves an idea of structure nevertheless. The ideas behind Two Houses Guides are covered in detail in the book, but key to understanding them is that they aim to give a broad stroke, working structure to a consultation, which is rather different to the detailed clinical guidelines we are used to. In addition to the two guides in the book, I have developed the website with the following guidelines in place:
The Guide to the Guides - under the bonnet of the guides, a good place to start.
Managing the menopause
The angry patient
New onset diabetes
New onset atrial fibrillation
A request for genetic testing
I hope these are good ones to start with and will be writing more in coming months. Supporting a concerned relative, erectile dysfunction and a request for alternative therapy are all high on my to do list, but I would be interested in any suggestions, so please submit a comment if you would like to suggest any future topics.