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Yeah. Yeah. Um All right. So we'll just get started. Um, if anyone can't hear me or there's any issues with the powerpoint, just, um, give me a shout or write it on the chat. Um, so my name is Connor Barr, I'm a G PST one, in the Belfast Trust. And, um, ka just asked me to do a short presentation on General Practice and I, um, obviously any exam questions are all ski stations involved with general practice, um, are going to overlap a lot of the other specialties, um, because anything could come on. But, um, and there's a few things that are quite common that would be more leaning towards a general practice, um, station and I've highlighted here that I see an E in general practice. So if there is, um, if you're in an OS station and you think it could be a General practice station if you ask about ideas, concerns and expectations. And that's where a lot of the mark is gonna be and that's where, um, you'll get big text from the governor. And so just an introduction. And also if you have any questions at any time on any of these slides and just, um, interrupt, um, or we can do some questions at the end but happy to be interrupted. Um, if you have any specific questions. Um, so we'll talk about, about history taking, um, very important in general practice, um, approach to telephone consultations. It's becoming more and more frequent. Um And I don't think it's out of the realm of possibility that that could come up in an AUS station unless you've been told otherwise we'll talk through some common cases and presentations. Um And then like safety netting and housekeeping again, if you can sort of twig on if an OS station is a general practice station, then talking about housekeeping and safety net is where a lot of the marks will be and then we'll take some questions at the end. And so as I said, history is going to be very important and you will have some examinations to do in a possible General Practice station on your in your a but it's mostly going to be history taking counseling, um breaking bad news, you know, explaining diagnoses, diagnoses, things like that. Um So the history and especially the social history is going to give you a lot of answers. Um So with any station just introduce yourself, hand washing all the usual um if you're standing outside the station, um and they tell you that a patient presents to your practice with certain condition, chest pain or a rash, you don't just wanna go on and say, oh tell me about your chest pain or tell me about the rash. You want to ask a patient what's brought them up? So what's brought you here today? Um They'll normally give you a one or two word answer about why you're here maybe a bit more and then, um always think about using open questions. So tell me more about this. Um Can you elaborate on this? Is there anything else I need to know? Um, and I know in an ak situation, time is of the essence, but, um, you've probably heard of the golden minutes. So if the, if you go on and the patient says, oh, I've got a rash, don't just jump on immediately and say, oh, when did that start? Tell me, tell me more about the rash. Where is it? Um How long have you had it for maybe just stop for 10 or 15 seconds and see if the patient is gonna, um, uh volunteer any more information. Um It, the examiner will know that that's what you're doing. Um They won't think that you're struggling in the station. They'll know that you're giving the patient time to talk. Um And although it might feel a bit awkward at the time and you'll be nervous in your exams and, uh, it's always good to keep that in the back of your mind if you can just for 10 or 15 seconds at the start of the station. Um, the social history is going to be very important. So everyone knows how to do a social history. You're talking about smoking, you're talking about alcohol, you're talking about what they work as. Um, again, if it's more of a history taken slash counseling slash, there's no examination, it's more talking station. You should really hone in on the social history. So, alcohol smoking occupation, but other things to talk about are, you know, who do you live at home with? Um Have you got relatives nearby? Uh Do you drive? How do you get around? Do you do your own shopping? What your diet is like, what your sleep is like? Um realistically, if you take a very detailed social history, uh there'll be a lot of marks for that and the answer or if you're struggling in the station and you can't really get to the bottom of the diagnosis. If you take a good social history, the patient, hopefully there'll be something in there that the patient will give you some cues regarding that. Um So, you know, it's hard to, it'll depend on the clinical scenario, what your history is going to be, whether it's cardiovascular history or abdominal history or a neurological history. But uh social history is going to be the same across the board. So if you can spend a bit of time on that, if you do have time, then you'll always get good marks for that. So Um again, as mentioned at the start and what I'll talk about a lot through the presentation is you talk about your ideas, concerns expectations and there's an extra e in there for effects on daily activities. Um So again, if you, if you've sort of twig on that, this is what would happen in a general practice or this is examined and what your consultations with patients, you ask them, what was your idea when you were coming here today? Did you have any idea what was wrong? Um Did you have any concerns coming here today or concerns about what it might be? Um And what's your expectations? What do you get, what do you want to get out of this um like interaction or appointment? Um You know, that's gonna get a lot of good marks from the examiners and it can be done in a lot of stations, not just general practice stations, it shows good rapport with the patients and sometimes a lot of the time the patients will give you um the answers or tell you exactly what they want. So somebody comes out and presenting with low mood and you start doing, uh you know, depression or psychiatric history and you could spend 40 minutes, 45 minutes doing that in the real world. And at the end of it, they basically just want a sick line to get off work for two weeks because they feel a bit stressed. Whereas if you start um and ask them, what was your expectations coming here today? They might say I just need some time off work. I'm struggling, I'm stressed and, and you know, you still obviously take a history about their mo and as that, but you probably don't need to go into as much detail if that's what they're there for. Um And you can support them with that, but if the main reason they're there is, you know, to get some time off work, then that might be all they need. Um, the extra e effects on daily activities does tie in with the social history. So it will be, can you still get about, are you still able to work? How has this affected your interactions? Do you still go see friends or do your own hobbies? Um Again, it helps you build a rapport with the patient and find out what exactly how exactly their condition is affecting them. Um, safety netting is very important. Um You know, you need to offer people review appointments. If you're worried, you need to see them again, you need to tell them to either seek medical help or go to A&E or phone 99 if they're worried or if things get worse. So if pain gets any worse, if they start vomiting or having temperatures or if they're worried at all, um, again, it's going to give you good marks on a general practice station and common examinations that you'll get are ent exams, dermatology exams, mental state exams, M SK exams, knee, um, knee examinations, like shoulders, maybe, um, and pediatrics. So, um, as I say, most of these exams will be covered in all our specialties, but these are things that could overlap with the GP STATION. So if these are coming up then have in the back of your mind that, you know, although I'm asked to do an ent exam here, this could well be something that I come across in general practice. So I'm going to ask about ideas, concerns expectations and social history. Um So moving on to telephone consultations, um this probably does happen to a lot of people but don't do this and you ay um finally building up the courage they don't answer, call them back and the motivation is gone. Um So definitely don't do this. Uh Even though that might be how you feel, I suppose the slide is probably would be a bit harsh. Um Much more a situational judgment um thing. But uh if somebody doesn't answer the phone, it might be a question at the end. If they don't answer the phone initially, what would you do? So you would obviously try and phone them again, you would try and phone their next of kin. Um You would try a different phone number and there's a couple of things that you would need to do. Um And it might throw some people off. Um It's telephone consultations are increasing increasingly common. Um, it can be challenging. Um, I suppose in an osk scenario, it's similar to your hand washing and introduction and comfort.