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Answer Plans for the MRCGP by Kilburn, J.

By Kilburn, J.

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EBM Nov/Dec: 203, 1996. 30. Discuss with reference to the evidence the treatment of depression in general practice. INTRODUCTION Depression is a widespread and commonly overlooked diagnosis. Primary care physicians are ideally placed to find and treat it. FIVE POINT PLAN Issues for the patient • • • • Presentation with physical complaint. Problems of social isolation. Different cultural beliefs. Relevant life events. 46 PRACTICE QUESTIONS Issues for or the doctor • • • • • Better consultation skills improve likelihood of recognizing depression.

Own GP? Problems for the partnership • Additional burden on other staff. • Concerns for the future of the practice. • The need to maintain supportive relationship between all partners. PRACTICE QUESTIONS 53 Practice organization • • • • • May impact provision of out of hours care. May require temporary leave of the partner. Communication strategy for staff and patients. The need for a locum. Are there underlying problems within the practice which should be reexamined? Medico-legal and ethical issues • Duty of confidentiality.

INTRODUCTION COPD is a chronic, slowly progressive disease responsible for a great deal of morbidity and mortality. In over 90% of cases the sole cause is smoking. FIVE POINT PLAN Issues for or the patient • Limitation of lifestyle. • Loss of autonomy. • Beliefs regarding the dangers of smoking. Issues for the doctor • Awareness of British Thoracic Society guidelines. • Knowledge of local services. • Need for shared care. Issues for or the practice • Purchase of a spirometer or availability of open-access spirometry.

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