Registrar pre teaching session worksheet
>click here for printable version<Discuss with your Supervisor and decide if you will cover all or some of the areas below, depending on the time available and your needs. Reflect on your AOGP Block Release sessions in mental health and think about whether there are any areas where you have difficulty transferring your knowledge and skills into a general practice setting.
Part A. How do we deal with the time demands?
For 3 consecutive mental health consultations record the length of the visit and reflect on factors that affected this. Divide these into those that you think could potentially be altered by your actions, and those that are unavoidable.
Part B. Dealing with emotional response
Consultations with depressed patients can typically leave doctors feeling washed-out or helpless. Reflect on recent consultations you have had. Have you been left with any other emotions or feelings after such a consultation? What were the factors that contributed most to your response? Can these factors cause a similar response in other clinical presentations?
Part C. Real world versus EBM
Read the following two letters to the editor and associated documents in the links.
http://www.mja.com.au/public/issues/183_05_050905/letters_050905_fm-1.html
Pull a health record from a patient you have seen recently who was distressed.
Read through your case note entry, recall the interaction and answer the following questions:
- How did you become aware that the patient was distressed?
- What were the dilemmas that he/she was facing?
- What symptoms of depression were present?
- Did you think he/she was “depressed” or was the presentation due to external stressors?
- What did you think his/her level of risk was?
- What strategies did you put in place to help the patient?
- What follow up and “safety netting” did you put in place?
Part D. Identifying and dealing with “Blocks”
Record the total number of consultations over a one week period that are primarily for the treatment of depression. Is this a large or small proportion of your total patient load?
BEACH data from 2005 suggests that depression is the primary reason for encounter in 3.7% of GP consultations. Further analysis of this data suggests that depression is far more common in GP consultations, even though it may not be the prime reason for encounter. Reflect on the comparison between your numbers and national data.
http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/
2006issues/afp200603/200603beach.pdf
A summary of BEACH data for depression in general practice.
http://www.aihw.gov.au/publications/gep/pbsfbeach-art99-06/pbsfbeach-art99-06-c05c.pdf
See p 78 which is a more detailed analysis of the data for depression.