General Practice Medicine Book Pdf

[Stephani Kapnick]

GPshave distinct expertise and experience in providing whole person medical care, whilst managing the complexity, uncertainty and risk associated with the continuous care they provide. GPs work at the heart of their communities, striving to provide comprehensive and equitable care for everyone, taking into account their health care needs, stage of life and background. GPs work in, connect with and lead multidisciplinary teams that care for people and their families, respecting the context in which they live, aiming to ensure all of their physical health and mental health needs are met. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is used in the United States.[1]

A core element in general practice is continuity of care, that bridges episodes of various illnesses over time. Greater continuity with a general practitioner has been shown to reduce the need for out-of-hours services and acute hospital admittance. Continuous care by the same general practitioner has been found to reduce mortality.[2]

In rural areas, a GP may additionally be routinely involved in pre-hospital emergency care, the delivery of babies, community hospital care and performing low-complexity surgical procedures.[3][4] GPs may work in larger primary care centers where they provide care within a multidisciplinary healthcare team, while in other cases GPs may work as sole practitioners or in smaller practices.

The term general practitioner or GP is common in the United Kingdom, Republic of Ireland, Australia, Canada, Singapore, South Africa, New Zealand and other Commonwealth countries. In these countries, the word "physician" is largely reserved for medical specialists often working in hospitals, notably in internal medicine. In North America the term is sometimes synonymous with the terms family doctor or primary care physician.

General practice is an academic and scientific discipline with its own educational content, research, evidence base and clinical activity. Historically, the role of a GP was performed by any doctor with qualifications from a medical school working in the community. However, since the 1950s, general practice has become a medical specialty with additional training requirements.[5][6][7][8] The 1978 Alma Ata Declaration set the intellectual foundation of primary care and general practice.

The basic medical degree in India is MBBS (Bachelor of Medicine, Bachelor of Surgery). These generally consist of a four-and-a-half-year course followed by a year of compulsory rotatory internship in India. The internship requires the candidate to work in all departments for a stipulated period of time, to undergo hands-on training in treating patients.

The registration of doctors is usually managed by state medical councils. A permanent registration as a Registered Medical Practitioner is granted only after satisfactory completion of the compulsory internship.

In Bangladesh, the completion of a 5-year MBBS program is succeeded by a one-year rotational internship encompassing various specialties. Bangladesh Medical & Dental Council (BM&DC) then provides permanent registration to the doctors, after which the candidate may choose to practice as a GP or opt for specialty training..[10] As of 2019, there are some 86,800 doctors, and dentists registered with the BM&DC.[11]

In Pakistan, 5 years of MBBS is followed by one year of internship in different specialties. Pakistan Medical and Dental Council (PMDC) then confers permanent registration, after which the candidate may choose to practice as a GP or opt for specialty training.

The first Family Medicine Training programme was approved by the College of Physicians and Surgeons of Pakistan (CPSP) in 1992 and initiated in 1993 by the Family Medicine Division of the Department of Community HealthSciences, Aga Khan University, Pakistan.[14]

In France the mdecin gnraliste (commonly called docteur) is responsible for the long-term care in a population.[17] This implies prevention, education, care of the diseases and traumas that do not require a specialist, and orientation towards a specialist when necessary. They also follow the severe diseases day-to-day (between the acute crises that require the intervention of a specialist).

They have a role in the survey of epidemics, a legal role (constatation of traumas that can bring compensation, certificates for the practice of a sport, death certificate, certificate for hospitalisation without consent in case of mental incapacity), and a role in the emergency care (they can be called by the samu, the French EMS). They often go to a patient's home when the patient cannot come to the consulting room (especially in case of children or old people), and have to contribute to a night and week-end duty (although this was contested in a strike in 2002). [citation needed]

This ends with a doctorate, a research work which usually consist of a statistical study of cases to propose a care strategy for a specific condition (in an epidemiological, diagnostic, or therapeutic point of view).

General Practice was established as a medical specialty in Greece in 1986. To qualify as a General Practitioner (γενικός ιατρός, genikos iatros) doctors in Greece are required to complete four years of vocational training after medical school, including three years and two months in a hospital setting.[20] General Practitioners in Greece may either work as private specialists or for the National Healthcare Service, ESY (Εθνικό Σύστημα Υγείας, ΕΣΥ).

General practice in the Netherlands and Belgium is considered advanced. The huisarts (literally: "home doctor") administers first line, primary care. In the Netherlands, patients usually cannot consult a hospital specialist without a required referral. Most GPs work in private practice although more medical centers with employed GPs are seen. Many GPs have a specialist interest, e.g. in palliative care.

In Belgium, one year of lectures and two years of residency are required. In the Netherlands, training consists of three years (full-time) of specialization after completion of internships of 3 years.[21] First and third year of training takes place at a GP practice. The second year of training consists of six months training at an emergency room, or internal medicine, paediatrics or gynaecology, or a combination of a general or academic hospital, three months of training at a psychiatric hospital or outpatient clinic and three months at a nursing home (verpleeghuis) or clinical geriatrics ward/policlinic. During all three years, residents get one day of training at university while working in practice the other days. The first year, a lot of emphasis is placed on communications skills with video training. Furthermore, all aspects of working as a GP gets addressed including working with the medical standards from the Dutch GP association NHG (Nederlands Huisartsen Genootschap).[22]All residents must also take the national GP knowledge test (Landelijke Huisartsgeneeskundige Kennistoets (LHK-toets)) twice a year.[23] In this test of 120 multiple choice questions, medical, ethical, scientific and legal matters of GP work are addressed.[23][24]

In Spain GPs are officially especialistas en medicina familiar y comunitaria but are commonly called "mdico de cabecera" or "mdico de familia".[25] It was established as a medical specialty in Spain in 1978.[26]

For the provision of primary care, Spain is currently divided geographically in basic health care areas (reas bsicas de salud), each one containing a primary health care team (Equipo de atencin primaria). Each team is multidisciplinary and typically includes GPs, community pediatricians, nurses, physiotherapists and social workers, together with ancillary staff. In urban areas all the services are concentrated in a single large building (Centro de salud) while in rural areas the main center is supported by smaller branches (consultorios), typically single-handled.[27]

Becoming a GP in Spain involves studying medicine for 6 years, passing a competitive national exam called MIR (Medico Interno Residente) and undergoing a 4-year training program. The training program includes core specialties as general medicine and general practice (around 12 months each), pediatrics, gynecology, orthopedics and psychiatry. Shorter and optional placements in ENT, ophthalmology, ED, infectious diseases, rheumathology or others add up to the 4 years curriculum. The assessment is work based and involves completing a logbook that ensures all the expected skills, abilities and aptitudes have been acquired by the end of the training period.[28][29]

In the Russian Federation, the General Practitioner's Regulation was put into effect in 1992, after which medical schools started training in the relevant specialty.The right to practice as a general practitioner gives a certificate of appropriate qualifications. General medical practice can be carried out both individually and in a group, including with the participation of narrow specialists. The work of general practitioners is allowed, both in the medical institution and in private.The general practitioner has broad legal rights. He can lead junior medical personnel, provide services under medical insurance contracts, conclude additional contracts to the main contract, and conduct an examination of the quality of medical services. For independent decisions, the general practitioner is responsible in accordance with the law.

In the United Kingdom physicians wishing to become GPs take at least five years' training after medical school, which is usually an undergraduate course of five to six years (or a graduate course of four to six years) leading to the degrees of Bachelor of Medicine and Bachelor of Surgery.

The postgraduate qualification Membership of the Royal College of General Practitioners (MRCGP) was previously optional. In 2008, a requirement was introduced for physicians to succeed in the MRCGP assessments in order to be issued with a certificate of completion of their specialty training (CCT) in general practice. After passing the assessments, they are eligible to use the post-nominal letters MRCGP (so long as the physicians continued to pay membership fees to the RCGP, though many do not). During the GP specialty training programme, the medical practitioner must complete a variety of assessments in order to be allowed to practice independently as a GP. There is a knowledge-based exam with multiple choice questions called the Applied Knowledge Test (AKT). The practical examination takes the form of a "simulated surgery" in which the physicians is presented with thirteen clinical cases and assessment is made of data gathering, interpersonal skills and clinical management. This Clinical Skills Assessment (CSA) is held on three or four occasions throughout the year and takes place at the renovated headquarters of the Royal College of General Practitioners (RCGP), at 30 Euston Square, London. Finally, throughout the year the physician must complete an electronic portfolio which is made up of case-based discussions, critique of videoed consultations and reflective entries into a "learning log".

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