My first experience in Primary Care as a medical student
1. My First Experience in Primary
Care as a Medical Student
Kieran Lall
Cardiff University
2. Objectives
• Exposure to General Practice as a speciality
• Insight into social and economic aspects of
medicine
• Opportunity to enhance communication skills
• Develop reflective skills
4. Overview
• One of 7 early clinical attachments in first year
• Limited previous experience of Primary Care
• First half of the day spent observing General
Practitioners at work
• Second half spent with a patient in their own
home
6. Depression
• Linked with unhappiness
• Different symptoms
• Tiredness, poor sleep, chronic pain
• Can be treated with counselling, medication
or both depending on the degree of severity
7. Challenges
• Balancing professional opinion with the
patient’s wishes
• Elderly patient with angina but also back pain
• Should they be sent to the cardiologist, pain
clinic, or both?
8. Meeting our patient
• Aimed to spend 60-90 minutes in patients
home with a colleague
• Discussed their medical history
• Tried to find out the effects of their medical
problems on their day to day life
10. Our Patient
• 71 year old gentleman
• Lives with wife
• Married for 50 years
• Ex factory worker
• Ex smoker
11. Medical History
• Myocardial infarction
• Pacemaker fitted
• Endocarditis
• Type II Diabetes
• Diverticulitis
• Greatly reduced activity
• More reliant on others
12. Reflections
• General Practitioners deal with a wide variety of
issues
• Not just involved with treating illness – social
aspects
• Establishing a good rapport with patients is
crucial for history taking
• Putting myself in the patients shoes – empathy
Introduce yourself
What will you be talking about?
And here’s what we hoped to gain...exposure, insight, comm skills...essential in good medical practice, discussion with colleagues and portfolio
Indication of where I was
2nd of 7, Limited experience, 2 parts to the day, 1st in surgery, 2nd in patients home
Expected to see lots of coughs and colds….wide variety from contraception queries to pyschiatric problems. Lead on to depression case.
Linked with unhappiness but different symptoms including those listed. Mention treatment and how severity affects treatment.
Speaking to doctor in breaks, alerted me to challenges…describe case of angina w/lower back pain.
Establishing rapport, Biopsychosocial model in disease manifestation and treatment.
As we talked about his medical history, it became clear that the patient had suffered from a wide variety of medical conditions....One of the more sobering moments of the afternoon came when we learnt that he nearly didnt make it when he had endocarditis, an infection of the heart. His medical problems had slowed him down greatly, forcing a move from factory work to the office, and making every day activities such as walking the dog and getting around the house more difficult, putting more reliance on his wife in particular for support
After we left there was time for reflection, which was important as it allowed me to summarise what I had learnt during the day.
