PowerPoint Presentation(e.g. communication skills, patient centeredness, health promotion, whole person care)
2- Applied professional knowledge and skills
(e.g. physical examination and procedural skills, medical conditions diagnosis, decision making-management)
3- Population health and the context of general practice
(eg. epidemiology, public health, prevention strategies)
4- Professional and ethical role
(eg. duty of care, standards, non-judgemental approach)
5- Organisational and legal dimensions
(eg. Documentation/records, reporting, confidentiality, practice management.)
Source: ACRRM PESCI online module
• At least 70% of Domain aspects needs
to be addressed
• Have to pass 3 out of 5 cases or 3 out
of 4 cases
• Result displayed as
Before you start the consultation:
New patient (please build rapport, ask if aboriginal if not already asked by
the receptionist and be compassionate if new, refugee or psych or abuse) or
old patient (Review his file from software)
Child> talk to him …. Adolescent > Alone please
Disabled or Trauma > Wheelchair please
If BIB friend, relative or police > ask patient if they want them to stay or if
they have the enduring power of attorney (if patient incompetent)
From the hospital > Read the discharge summary & referral letter first
Aboriginal, refugee or Immigrant > Involve AHC/ALO +- Interpreter +- Cultural
awareness method (language + cultural beliefs + Costs + Psych issues +
Nutritional Deficiencies, under immunisations, infections + neglected Oral
Dental & chronic diseases + children poor growth, Development & IDA)
EMERGENCY MANAGEMENT AT A GP LEVEL
1- Pain & Hemodynamic Stability
2- In Emergency (Say the word) let receptionist call 000 for ambulance or
PIPER 1300 137 650 (RCH in Melbourne) for Paediatric cases and mention
the hospital by name to show familiarity & say what's going to happen in the
hospital and precautions like Nil per Mouth if the case is surgical)
If in a rural area say air ambulance but in the meantime call emergency
registrar for advice)
Now, transfer to treatment room & involve your supervisor & nurse
immediately taking a quick history while examining the patient and while
the nurse helping you in pulse oximeter, IV cannula, bloods, ECG, O2,…
DON'T ever leave the patient unattended in case of emergency. When
paramedics arrive do the handover, Formal transfer of care + Referral letter
to ED + call relatives with patient’s consent) .
If the patient is incompetent, look for the medical power of attorney.
Give a pain killer ( Parenteral please) & NPO (if a surgical case)/.
HISTORY (Medical interviewing)
SOCRATE1 of the complaint (like the pain mnemonic)
( Site & Severity, Onset & Offset, Character & Course, Radiation, Aggravating &
relieving factors, Timing (duration), is it the First time ?)
Acknowledging patient’s complaint & asking about impact on life
Elicit patient's further concerns
Do you have enough support?
For a chronic complaint, ASK PREVIOUS MEDICAL ASSISTANCE, any tried treatment
and any visit to other health professionals.
Associated Symptoms & Systems Review
DDS & Causes/Risk Factors (start with most serious > Ask RED FLAGS)
Complications of case, cause & treatment
Assess Safety in psych, abuse cases & in paediatric cases
HISTORY (Medical interviewing)
Female > 5Ps & Confidentiality (ask if can be accessed by other practitioners via medical records)
Child> BINDSMA
HEADSSS & Confidentiality (including sexual health) (MSIGECAPS & MSE if low mood or anxious) (H includes social history : Home, marital status, Indigenous status, children & occupation) D is depression & Anxiety screen) ASK adverse life events (unemployment, death of a loved one, separation, divorce, childhood abuse) Ask for collaborative (Collateral) history
Preventive Medicine Qs (including Immunizations) & Travel & Contacts ( in Infections especially)
SADMA + PMHx + FHx (In Medications check dose, adherence compliance, SE& current indication ALSO, check non prescribed complimentary & alternative medicines CAM)
Preventive Activities All ages > Opportunistic SNAP, Skin cancer & Anxiety & Depression
Child > Growth velocities, Immunizations, Breastfeeding, Metabolic screen, Hearing newborn, Vision (3-5 years), Oral health & Sun protection
Adolescents > Gardasil Vaccine (12-13) & STI, Unwanted pregnancy (up to 29), Anxiety & Depression (from 12), Illicit drug use
Pregnancy > Partner violence (esp. in adolescence) & Anxiety AND Depression Ask Immunisations (GIVE Influenza, Pertussis Booster), family history of genetic disorders (and her partner if he smokes), past history of chronic diseases, ethnicity, nutritional habits,
BRUSH D (Blood count, Blood group, Rubella, Urine MCS chlamydia, Syphilis, Hep B, HIV, vitamin D) Support & Private medical insurance ( upgrade for 12 months obstetric cover), Advice SNAP & coffee
ABORIGINAL (all ages) : Rheumatic fever, Hearing loss, Trachoma, Influenza (>15) & Pneumococcal vaccine as with COPD ( >15 smoker & >50 healthy), AUSDRISK & CKD (in >18), IDA by Hb test in (6,9&18M), Skin impetigo & scabies (in children)
>18 BP >25 Cervical screening Program (until 74)
>40 DM2 AUSDRISK
>45 CVS risk, Cholesterol & kidney Disease
>50 ADD Cancer Colon FOBT & Mammogram (until 74 both) & Osteoporosis risk assessment in Men (& in women after menopause of any age)
>65 ADD Immunizations (influenza & pneumococcus) Vitamin D, Continence (females esp.), falls, Vision, Hearing, Cognitive GPCOG form & Oral Health (All can be done under Medicare >75 Health Assessment), Medications Review (HMR) (Polypharmacy), WEIGHT LOSS
MEDICAL & FINANCIAL POWER OF ATTORNEY, Advanced care plan & Directive (MMSE or GPCOG for capacity first)
Aged Care Assessment Team (ACAT) including Occupational therapist ( to see if patient can live alone or falls)
Support for carers (in-home care, respite care, inpatient community palliative centres, after hours services)
Preventive Activities (Cont.)
PE & Investigations
PE (in General Appearance PICCLED + BMI + Waist circumference)(PE is according to DDs)
(INFORM PATIENT, CONSENT, LOGICAL SEQUENCE & be SENSITIVE TO PATIENT COMFORT)
NB IF pelvic exam for a woman, offer to be examined by a female colleague doctor
OFFICE TESTS & Tools (like DASS21 or K10 or Edinburgh postnatal depression scale or MMSE ) demonstrate bed side procedural skills like urine tests, BSL, spirometry or surgical in management)
List the DDs (clinical judgment) as working diagnosis & alternatives
Investigations (clinical judgment) to confirm & explain the rational behind it
Management (Treatment/Advice) Inform the Supervisor (say Dr '..' and tell him your history and PE findings ) or (Ask
MDO Medical indemnity insurer if medico legal)
(Professionalism seeking help, knowing your own limits skills knowledge & clinic facilities..)WHEN UNSURE, say I will check MIMs, Therapeutic Guidelines, White book in abuse...)
5C ( including condition, cause, commonality & course prognosis)
Reassure & Rx (PLEASE take the patient's consent in treatment plan according to his preferences, values & cost of treatment ) (Short & Long term plan)
1- Pharmacological > State SE & r/o C.I. & Discuss costs, PBS & finances )
2- Education & Counseling : - if psych say in an empathetic non-judgemental way & involve family, offer to counsel them, offer to talk or send a letter to year coordinator in UNI or school teacher in younger children & social peer support groups & help lines, workers, online CBT and mindfulness apps)
- If infections educate on spread, treat (or prophylaxis) contacts (household) & Exclude from school or child care until 24 hours at least after treatment or dried lesions) -If congenital offer family screening
3- Surgical or procedural in the clinic (Take a written consent and explain complications)
Referral
Explain who (by name if you know) , why & what's expected to be done
then ensure patient has all investigations done & medical record copy
otherwise will be repeated by the specialist) (Mention MDT & patient’s
centred approach (his culture & values to make decisions) & will review
you up after hospital discharge or specialist appointment), Cardiac
Rehabilitation in IHD, High risk pregnancy clinic
Paperwork
Care plan (GPMP, MHTP, Group Allied HS for TIIDM), Action Plan or
Health assessment (Aboriginal, refugees, intellectually disabled or
geriatric) (Involve Nurse)
certificate for mother of sick child, Centrelink medical
certificate, Work Cover(certificate of work capacity), letter to
UNI or school
Australian Immunizations Register AIR )
Management (Treatment/Advice)
Return to DRIVING & related medical conditions (Reasonable to say I'll check the guidelines) & who drove you today to the practice and will drive after?
Report to childcare or school, medical bracelet, Department of health (DHS) notifiable diseases ,Medical Board against other colleague, Driving Licensing Authorities (DLA) or Child Protection Services (CPS).
Reading material & Red flags
Review (Follow up is very important in PESCI, Make a reminder ) & 24-48 hours in any acute case . For Effectiveness of treatment, compliance, adverse effects of treatment, Investigation results, Complications & Overall physical and mental health.
END by (I WILL DOCUMENT EVERYTHING)(incl. Injuries & abuse signs) & Self-reflection on what you’ve done so far
Management (Treatment/Advice)