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This collection of essays on general practice, written by a variety of eminent contributors working in primary care, considers the influence and leadership of GPs and general practice in the wider community in order to improve the understanding of general practice.
This innovative and timely book draws on pioneering precedents, basic principles, current examples and international experience to capture the narratives, examples and ideas that underlie and demonstrate the exceptional potential of general practice: "If health care is not at is best where it is needed most, health inequalities will widen." "The unworried unwell are not hard to reach but they are easy to ignore and are often ignored." "With patient contact, population coverage, continuity, coordination, flexibility, long term relationships and trust, general practices are the natural hubs of local health systems." "... practitioners ... are not only scientists but also responsible citizens and if they did not raise their voice who else should?" Written for family doctors looking to strengthen local collaboration, it brings together the traditional strengths of consultations, caring, continuity, coordination and coverage with the current and future challenges of building capacity, community, creativity, consistency, collegiality and campaigning. It highlights the critical importance of working with patients, maximising the use of serial encounters, integrating care, joint working between practices, social prescribing, community development and advocacy based on patient and practitioner experience. Drawing on the highly-regarded work of Deep End GPs serving the poorest communities in Scotland ̶ www.gla.ac.uk/deepend ̶ the book is an invaluable handbook for all primary care doctors, irrespective of health care system or country, seeking to provide unconditional continuity of personalised care for all patients, whatever problem or combination of problems a patient may have.
Good Practice: What it means to put the patient first, not politics, posturing, pretentiousness, protocols or process. This is a text book for all doctors but especially GPs, Appraisers and Registrars. It is written by a 40 year plus front line NHS doctor who for most of his career worked twice to three times the current doctors’ Working Time Directive limited week. Chris Heath has been a Paediatric Lecturer in a teaching hospital, an Anaesthetist, various junior specialists and a GP for over 30 years in 3 different practices. He has been a GP Trainer and Appraiser and has seen politics and political correctness harm patients’ interests constantly over the last half of his career. From the way the NHS selects young doctors to the way they are educated and assessed, the best interests of the patient are largely ignored. This is a text book but it also contains home truths, advice, insights and original, honest guidance on being a safe, effective doctor. As well as giving an assessment of what has gone wrong with the NHS over the last 20 years, the author explains why today’s politicians, medical schools, Royal Colleges and many doctors will resist the changes essential to put the patients’ needs first again. 1 Politics, Who we are, The CQC etc 2 Administration, Training, The Consultation and Teaching 3 Basic Biology 4 Acute Medicine in General Practice 5 Alcohol 6 Allergy 7 Analgesics 8 Anticoagulants, Clotting 9 The Breast 10 Cancer and Terminal Care 11 Cardiology 12 Useful Clinical Signs, Eponymous diseases 13 Dermatology 14 Diabetes, Metabolism 15 Diet, Vitamins and Nutrition 16 Driving 17 Odd drugs 18 Ear, Nose and Throat 19 Gastroenterology 20 Geriatrics 21 Haematology 22 Hormones 23 Immunisation and Vaccines 24 Infections, Antibiotics, Microbiota 25 Legal Issues 26 Liver 27 Miscellaneous 28 Musculoskeletal, Orthopaedics, Sports, NSAIDs 29 Neurology 30 Ophthalmology 31 Paediatrics 32 Pathology 33 Pregnancy, Obstetrics and Gynaecology, Contraception 34 Psychiatry and Controlled Drugs 35 Respiratory 36 Sex and STDs 37 Sleep 38 Travel 39 Urology 40 Work References
This is a text book for all doctors but especially GPs, appraisers and registrars. It is written by a 40 year plus front line NHS doctor who for most of his career worked twice to three times the current doctors’ Working Time Directive limited week. Chris Heath has been a Paediatric Lecturer in a teaching hospital, an Anaesthetist, various junior specialists and a GP over 30 years in 3 different practices. He has been a GP Trainer and Appraiser and has seen politics and political correctness harm patients’ interests constantly over the last half of his career. From the way it selects young doctors to the way they are educated and assessed, the best interests of the patient are largely ignored. This is a text book but it also contains home truths, insights and a warts and all appraisal of how to be a good doctor as well as an unbiased assessment of what is wrong with today’s NHS. It also explains why today’s politicians, medical schools and doctors will resist the changes that are needed to put the patients’ needs first again.
The book describes what goes on behind the scenes in undergraduate and postgraduate medical education, scientific research and general medical practice in the United Kingdom. It covers the years 1945 to 2012 and is an account of a unique medical journey. The author was brought up by parents who were general practitioners in Yorkshire. His upbringing was thoroughly middle class and his observations of his parents work and lifestyle resulted in his wanting to be a doctor. Medical student life at University College London was hard work. Several of his teachers were eminent and world famous. Two of them were Professors J Z Young (anatomy) and Andrew Huxley (Physiology and Nobel Prize winner). Life-long friendships were made with fellow students who worked together dissecting a human body. Experiments were performed on one another. The social life in the 1960s of a group of medical student friends is described. Studying octopuses and squid in Naples, Italy. Was part of an extra degree course which was undertaken before starting hospital clinical studies? These were at The London Hospital, Whitechapel, in the east end of London. There was so much to learn before being allowed to practice as a doctor. Clinical studies were undertaken at The London Hospital, Whitechapel. This is one of the oldest hospitals in the UK. There is a huge learning curve which resulted in a doctor just about able to deal with patients. A year of pre-registration work started on the medical wards at Mile End Hospital followed by a period in the Receiving Room (Accident and Emergency Department) at The London Hospital. The pre-registration house jobs sometimes involved working 100 hours a week. Nights in the accident emergency department were manned by one pre-registration house officer and a nurse. There is a description of what is involved undertaking research to PhD level in physiology. A new clinical thermometer was designed, tested and eventually manufactured and sold by the instrument developer Muirhead Ltd. So soon after being a student, the wheels had turned and the author was teaching students himself. There is an account of starting work as a General Practitioner in Cheltenham having not seen a single patient for the previous three years. After that he worked for a short time in a London practice and then in Castleford, West Yorkshire from 1978 to 2005. He and his wife build the practice up from a zero base to a thriving training practice housed in a large modern clinic. Doing this was financially risky as well as stressful. The development of postgraduate general practice education in Yorkshire in the last two decades of the twentieth century is described. There are descriptions of becoming a trainer of prospective GPs and then organising and managing trainers. The role of a GP tutor in the education of GPs was undertaken as a specific job. Work on the assessment of the competence of trainee GPs was overseen in the Yorkshire Deanery, based in Leeds, West Yorkshire. Work on the monitoring of the GP contract with the NHS and the GP appraisal scheme was undertaken by NHS Wakefield district, a Primary Care Trust. The author worked for both these bodies and what was involved in GP appraisal and inspection of practices target achievements is examined in detail. Work with ill and underperforming general practitioners is described as well as mentoring GPs with problems and worries. Very few patient problems and cases are included in this book which rather tells of the work that went on in the background. It is that work that produces high quality doctors and also year on year improvement in patient care. The last chapter involved informal interviews in 2012 with people studying and working in the same fields experienced over the years by the author and outlined above. Readers are asked to judge whether the present day situation is an improvement on
Provides information on medical care and health care policy from around the world.
Looks at a wide range of important general practice issues relating to professional and practice development and quality improvement, under the broad themes of teaching, learning and leadership.
In this final volume of his best-selling 'Inner' trilogy, Roger Neighbour explores the relationship between a doctor's professional and private selves. He suggests that the mind of every doctor retains an untrained 'ordinary human being' part - their Inner Physician - which makes an important, though often neglected, contribution to medical practice. This 'Inner Physician', which he also describes as the 'amateur within' or the 'expert minus the expertise', plays a major role in diagnosis and treatment, and is the chief source of insight, empathy and clinical acumen. Roger shows that skilled use of the Inner Physician is one thing that distinguishes the generalist from the specialist.
Epidemiologic Studies in Cancer Prevention and Screening is the first comprehensive overview of the evidence base for both cancer prevention and screening. This book is directed to the many professionals in government, academia, public health and health care who need up to date information on the potential for reducing the impact of cancer, including physicians, nurses, epidemiologists, and research scientists. The main aim of the book is to provide a realistic appraisal of the evidence for both cancer prevention and cancer screening. In addition, the book provides an accounting of the extent programs based on available knowledge have impacted populations. It does this through: 1. Presentation of a rigorous and realistic evaluation of the evidence for population-based interventions in prevention of and screening for cancer, with particular relevance to those believed to be applicable now, or on the cusp of application 2. Evaluation of the relative contributions of prevention and screening 3. Discussion of how, within the health systems with which the authors are familiar, prevention and screening for cancer can be enhanced. Overview of the evidence base for cancer prevention and screening, as demonstrated in Epidemiologic Studies in Cancer Prevention and Screening, is critically important given current debates within the scientific community. Of the five components of cancer control, prevention, early detection (including screening) treatment, rehabilitation and palliative care, prevention is regarded as the most important. Yet the knowledge available to prevent many cancers is incomplete, and even if we know the main causal factors for a cancer, we often lack the understanding to put this knowledge into effect. Further, with the long natural history of most cancers, it could take many years to make an appreciable impact upon the incidence of the cancer. Because of these facts, many have come to believe that screening has the most potential for reduction of the burden of cancer. Yet, through trying to apply the knowledge gained on screening for cancer, the scientific community has recognized that screening can have major disadvantages and achieve little at substantial cost. This reduces the resources that are potentially available both for prevention and for treatment.