Problem Framing RCGP Curriculum

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Problem FramingRCGP Curriculum
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GP Problem Solving

• Marshall Marinker

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3.1 Relate to prevalence and incidence of illness

• Knowledge of prevalence and incidence
• Knowledge of age-sex distribution
• Use of clinical reasoning and decision tools
• Time
• Incremental investigation
• Presentation common conditions

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• The unusual presentation of a common disease is
  more likely than a common presentation of an
  unusual disease.
• Occams Razor lex parsimoniae
• All things being equal, the simplest solution
  tends to be the right one. (ie uses the least
  number of assumptions).
• Suttons Law its where the money is!!!

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3.2 Selectively gather/interpret information and
apply to management plan in collaboration with
the patient

• Willing to involve patient in management plan.
• History taking, examination skills and
  interpreting information.
• Knowledge of patients relevant context, family,
  social factors.
• Knowledge of available investigations and
  treatment resources.

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Five Pitfalls

• Representativeness Heuristic be aware of the
  base levels of factors and not ascribe too much
  weight to one factor. If have a cough, does this
  mean lung cancer. What if a smoker.
• Availability Heuristic Bias because condition
  readily recalled or seen recently. Odds of
  winning lottery same next week.
• Overconfidence Not good at recognising gaps.
  Joharis Window. Feedback and reflection.
• Confirmatory Bias notice and recall information
  that fits diagnosis and ignore that which
  contradicts. Specifically ask for contradictory
  information.
• Illusory Correlation perceive two events as
  causally related when they may not be eg
  improvement with antibiotics.
• Jill Klein

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3.3 To adopt appropriate working principles

• Adopting stepwise procedures in medical decision
  making and using time as a therapeutic tool.
• Adapting skills and attitudes to demonstrate
  curiosity, diligence caring.
• Understanding acceptance of uncertainty in
  primary care problem solving and development of
  strategies that demonstrate this.

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3.4 To intervene urgently when necessary

• Specific decision making skills in emergency
  situations.

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3.5 To manage conditions that may present early
and in an undifferentiated way

• Know when to wait and reassure and when to
  investigate further.
• Knowledge that symptoms and signs vary in their
  predictive value.

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3.6 To make effective use of diagnostic and
therapeutic interventions

• An understanding of cost efficiency and
  cost-benefits of treatments.

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Role Play

• A 49 year old accountant who is a month overdue
  for his hypertension review (Amlodipine 5mg BP
  155/90 done 7 months ago HT diagnosed 3 years)

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• The fool doth think he is wise but the wise man
  knows himself to be a fool.
• Shakespeare