Preface

This is the book that I looked for when I first moved to Australia. A group of GP registrars wanted help preparing for their Fellowship exam and examples of clinical cases did not exist, so I began writing questions. This book is the teaching material that I have developed and refined since then.

It has been rewarding to hear many stories of doctors who found the book useful. Doctors have persuaded non-medical friends, partners and spouses to role-play patients and the instructions have proved adequate to provide realistic exam practice.

One GP registrar expressed concern that the book was too ‘cook book’ or formulaic. Forgive me if I have unintentionally promoted uniformity. Each time I see a GP at work or in a role-play, I see new ways of being a GP. Each of us brings our personality and experience to our role, but some core principles apply to each consultation. I hope that my practice will forever include the formula of an introduction, building rapport to understand something of the person’s life and situation, hearing their concerns, assessing the problem in bio–psycho–social terms and working with them to create a plan that they understand and want to implement.

We have to judge each situation, without being judgemental, listen intently and be supportive without being patronising. How I achieve this varies for different patients and makes the job both challenging and satisfying. This ‘how’ of calibrating words and actions to individuals is crucial in exams and in practice; the ‘what’ of creating therapeutic relationships, and explaining medical terms is different for fractious children, over-stretched middle-aged professionals or an elderly person facing losing health and their independence.

Most of the cases are adapted from my clinical practice and identifying details have been changed to protect the patient’s identity. If you think you can spot yourself or a friend it is only because these cases cover common clinical conditions. I appear in them and, with their permission, so do many of my family.

I hope that this book assists medical students, GP registrars and GPs to learn more about the art and science of being an effective GP.