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Table of Contents 1. Frontmatter 1. Halftitle 2. Dedication 3. Title page 4. Copyright 5. The authors 1. Professor John Murtagh AM 2. Dr Jill Rosenblatt 3. Dr Justin Coleman 4. Dr Clare Murtagh 6. Foreword 7. Contents 8. Acknowledgments 1. Photo credits 9. Preface 10. Making the most of your book 1. Diagnostic strategy models 2. Key facts and checkpoints 3. The staff of Asclepius 4. Red and yellow flags 5. Clinical framework 6. Seven masquerades checklist 7. Diagnostic triads 8. Evidence-based research 9. Extensive coverage of paediatric and geriatric care, pregnancy and complementary therapies 10. Practice tips 11. Clinical photos 12. Full colour illustrations 13. Significantly enhanced index 14. Patient education resources 11. Reviewers 1. Content consultants 2. Survey respondents 12. Laboratory reference values 13. Normal values: worth knowing by heart 14. Abbreviations 2. Part 1: The basis of general practice 1. Introduction 3. Chapter 1: The nature, scope and content of general practice 1. Introduction 2. Definitions 3. Unique features of general practice 1. Holistic approach to management 4. Continuing care 1. Home visits 5. Common presenting problems 1. Most frequent presenting symptoms in the author’s practice 6. Symptoms and conditions related to litigation 7. Chronic disease management 8. References 9. Resources 4. Chapter 2: The family 1. Introduction 2. Characteristics of healthy families 3. Families in crisis 1. The effect of illness 2. Guidelines for the doctor 4. Significant presentations of family dysfunction 5. The patient and family dynamics 1. How to evaluate the family dynamics 1. The genogram 6. The family life cycle 1. Family assessment 2. The questionnaire1 3. Assessment based on the questionnaire 7. Family-based medical counselling 1. The BATHE technique9 1. Background 2. Affect 3. Trouble 4. Handling 5. Empathy 8. Steps to bring about behaviour change 9. Marital disharmony 10. Basic counselling of couples 1. Some important facts 2. Positive guidelines for success (summary)10 3. Making lists—a practical task 4. Pitfalls1 5. Other pitfalls 6. Possible solutions to avoid pitfalls1 11. References 12. Resources 5. Chapter 3: Consulting skills 1. Introduction 2. The skills of general practice 3. Models of the consultation 4. Phases of the consultation 5. The history 1. Good questions 2. Basic interviewing techniques 1. Questions 2. The open-ended question 3. Information from other sources 4. Problem definition 5. Touching the patient 6. The physical and mental examination 7. Medicolegal guidelines for examinations 8. Investigations 9. Management phase of the consultation 1. The sequence of the management interview4 2. Closing the session 3. A patient management strategy 1. Prescriptions 2. Referral 4. The ‘gatekeeper’ role of the GP 5. The healing art of the doctor 10. References 6. Chapter 4: Communication skills 1. Introduction 2. Communication 1. Communication in the consultation3,4 2. Prepare 3. Open 4. Gather 5. Non-verbal communication 6. Interpreting body language 7. The patient’s perspective 8. Communicating during the physical examination or procedure 9. Negotiate and agree on a plan 10. Close 11. Use of relationship-building skills 12. Other rapport-building techniques 1. Mirroring 2. Pacing 3. Vocal copying 4. Manage flow 3. References 7. Chapter 5: Counselling skills 1. Introduction 2. The GP as an effective counsellor 3. Features of counselling 4. A problem-solving approach 5. Counselling models 1. The PLISSIT model 2. The Colagiuri and Craig model 6. The value of patient-centred counselling 7. Basics of counselling and psychotherapy 1. Counselling strategies4,7 2. What counselling is not 3. Cautions1 8. Patients unlikely to benefit 9. Types of psychotherapy 1. Cognitive behaviour therapy 2. Mindfulness 10. Specific areas of counselling 11. Crisis management 1. Aims of crisis intervention 2. Principles of management 3. Ten rules to help those in distress 12. Bereavement 1. Stages of normal bereavement 2. Pathological bereavement 1. The GP as counsellor1 2. Long-term counselling 13. Breaking bad news 1. Sharing bad news with a patient 2. Basic guidelines 3. Management 4. Coping with patient responses 5. Children 6. Unexpected death 1. Guidelines for the doctor 14. The depressed patient 15. Chronic pain 16. Problem gambling 1. Dangers 2. Key warning 3. Other telltale signs 4. First-line management 5. Counselling approach 17. Patient education resources 18. References 8. Chapter 6: Difficult, demanding and angry patients 1. Introduction 2. Management strategies 1. Complaints 2. A ‘heartsink’ survival kit 3. The angry patient 1. What is anger? 2. Consulting strategies10 3. Analysing the responses 4. Recognising distress signals 5. Questions to uncover the true source of anger 1. Rapport building 2. Confrontation 3. Facilitation, clarification 4. Searching 6. The drug-dependent doctor shopper12 7. Management 4. References 9. Chapter 7: Health promotion and patient education 1. Introduction 2. Health education 3. Illness education 4. Health promotion in general practice 5. Opportunistic health promotion 1. Methods 6. Health goals and targets 7. Promoting healthy lifestyle in general practice 1. The SNAP guide6 2. The NEAT guide 8. Psychosocial health promotion 9. Patient education/hand-outs 10. References 10. Chapter 8: The elderly patient 1. Introduction 2. Ageing and disease 1. Deterioration in health and the ‘masquerades’ 2. The ‘classic’ triad4 3. Changes in sensory thresholds and homeostasis 4. Establishing rapport with the elderly patient 5. Loneliness in the elderly 6. Doctor behaviour that can irritate and confuse elderly patients 7. Assessment of the elderly patient 1. History 2. Physical examination 1. Practice nurse 2. Doctor 3. ‘Rules of 7’ for assessment of the non-coping elderly patient 4. The mini-mental state examination 1. The clock-face drawing test 5. Laboratory investigations 8. Behavioural changes in the elderly 9. Elder abuse 10. Depression and dementia 1. Dementia (chronic organic brain syndrome)13 1. Management of suspected dementia 2. Management of dementia 3. Driving 4. Comorbidity/associated problems15 5. Dementia and Parkinson disease 6. Medication15 7. Available drugs for Alzheimer disease 8. Cholinesterase inhibitors 9. Aspartate (NMDA) antagonist 10. Complementary therapy15 11. Dementia prevention strategies 12. Causes of mild neurocognitive impairment 13. Benign senescent forgetfulness 14. Late life depression and suicide 15. Paraphrenia 16. Sarcopenia 17. Falls in the elderly 1. Assessment 2. Management and prevention 18. Prescribing and adverse drug reactions 1. Factors predisposing to adverse drug reactions in the elderly1 2. Risk factors predisposing to medicine-related problems 3. Starting medications15 4. Minimising medication problems 5. Other tips for medication in the elderly 19. References 20. Resources 11. Chapter 9: Prevention in general practice 1. Introduction 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Relationship between types of prevention 2. The practice of preventive medicine 3. Optimal opportunities for prevention 4. Mortality and morbidity considerations 5. A global strategy for good health 1. Behaviour modification 6. Vascular disease 7. Malignant disease 1. Updated important facts about cancer in Australia* (current and immediate future) 2. The role of immunity in cancer 8. Asthma and other respiratory diseases 9. Periodic health examination 1. Aims of screening 10. The history 11. Screening for children 1. General development 12. Screening in the elderly 13. Screening for adults 14. Immunisation 15. Adverse effects of vaccination 1. The case for vaccines 16. Neonatal screening 1. Genetic screening 17. Key checkpoints 1. Resource: 18. References 12. Chapter 10: Nutrition in health and illness 1. Introduction 2. Protein 1. Protein 1. Energy malnutrition 2. Marasmus 3. Kwashiorkor 3. Carbohydrates 1. The glycaemic index (GI) 4. Fat 5. Nutritional assessment 6. The general principles of optimal nutrition 1. What is a serving?2 7. The Lyon Heart Study 8. Antioxidants 1. Prime sources of antioxidants in food9 2. Folate-containing foods 9. Vitamin deficiency disorders 10. Gout 11. Dietary control of diabetes 1. Obesity 12. Anaemia and iron 13. Guidelines for safe consumption of alcohol (current NH & MRC recommendations 1. Healthy males and females 2. Young people 3. Pregnancy and breastfeeding 14. Coeliac disease 15. Foods associated with migraine 16. Nutrition and chronic simple constipation 17. Recurrent urinary calculi 18. Iodine deficiency 19. Dietary guidelines for children and adolescents in Australia (NHMRC) 20. Dietary guidelines for Australian adults (NHMRC) 21. Patient education resources 1. Resource 22. References 13. Chapter 11: Palliative care 1. Introduction 2. The diseases 3. The special role of the family doctor 4. Support for patients and carers 5. The Gold Standards Framework (UK) 6. Symptom control 1. Common symptoms 2. The grief reaction 1. Pain control in cancer 3. Use of analgesics7 1. Step 1: Mild pain 2. Step 2: Moderate pain 3. Step 3: Severe pain 4. Guidelines