Re-evaluating expectations.
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Burnout, Professional↗
Biomedical subjects
C Holmwood
Publications and source records attributed to C Holmwood.
Insulin and type 2 diabetes. Last resort or rational management?
BACKGROUND: Recent evidence indicates that lower glucose levels in people with type 2 diabetes result in fewer complications. People with diabetes generally have sub-optimal glycaemic control. The natural progression of diabetes is characterised by increasing glucose levels requiring increasing therapy. OBJECTIVE: This article explores the possible role of therapeutic insulin in the management of type 2 diabetes. Arguments for earlier use of insulin, illustrative cases and common dilemmas faced when introducing insulin are examined. DISCUSSION: Findings from the United Kingdom Prospective Diabetes Study (UKPDS) are reviewed. It suggests that active and aggressive management of type 2 diabetes in general practice can have a role to play in reducing complications from diabetes. It now appears that insulin has a role earlier in the management of type 2 diabetes.
Adult↗
Challenges facing primary care mental health in Australia.
BACKGROUND: Changes to the organisation of mental health services in Australia and a recognition that general practitioners deliver the great bulk of mental health services to the community have necessitated a re-examination of the role of general practitioners in the clinical area. OBJECTIVE: This article examines controversies in mental health care such as the difficulties with detection, the nature of general practice psychiatry, the inappropriateness of undergraduate training, workforce related issues, mental health services in rural areas and continuing medical education. DISCUSSION: General practice based services for people with mental disorders are distinct in many respects from specialist psychiatric services. Systemic changes need to be made to training for general practitioners, to incentives for delivery of complex care and to the way in which the different health care sectors work together.
Australia↗
Value-adding in the rural training stream: a release program for hospital-based rural training stream registrars.
This paper describes a release program developed in 1995 for year I hospital based GP registrars in the Rural Training Stream of the Royal Australian College of General Practitioners Training Program in South Australia. Background, objectives, content and organisation, and evaluation are described. The 1996 program that developed from this pilot is also described.
Australia↗
How do general practice registrars learn from their clinical experience? A critical incident study.
OBJECTIVE: This preliminary study of RACGP registrars in the period of subsequent general practice experience examines the types of clinical experiences from which registrars learn, what they learn from the experiences and the process of learning from such experiences. METHOD: A critical incident method was used on a semi structured interview process. Registrars were asked to recall clinical incidents where they had learnt something of importance. Data were sorted and categorised manually. RESULTS: Nine registrars were interviewed before new categories of data ceased to develop. Registrars learnt from the opportunity to follow up patients. An emotional response to the interaction was an important part of the learning process. Learning from such experiences is haphazard and unstructured. Registrars accessed human resources in response to their clinical difficulties rather than text or electronic based information sources. CONCLUSION: Registrars should be aware of their emotional responses to interactions with patients; these emotional responses often indicate important learning opportunities. Clinical interactions and resultant learning could be made less haphazard by structuring consultations with patients with specific problems. These learning opportunities should be augmented by the promotion of follow up of patients.
Australia↗
Common dilemmas in diabetic care.
This article looks at some commonly encountered problems faced by doctors managing diabetes. The increasing prevalence of diabetes, dilemmas relating to insulin use, the use of insulin pens and home blood glucose technologies, concerns with commonly prescribed drugs in the diabetic patient, and advice regarding travel, are discussed.
Administration, Oral↗
Critical thinking within the RACGP Training Program and the college examination.
Current developments with the formalisation of the Program's curriculum provide the opportunity for the College to clarify its position on this important educational area. While not all GPs want to be involved in research, increasing demands for accountability for expenditure of insurer's (ie the government's) funds are inevitable. Skills related to audit of actual practice process and outcomes are likely to be required in the near future. The option of developing an audit project segment for the College examination should be considered. Critical appraisal skills could be assessed in the context of the development of standards for the audit. Similarly the efficacy of the Training Program in the development of accurate self-assessment skills in trainees should be researched. If found lacking, steps should be put in place to ensure that these educational processes become effective.
Australia↗
The importance of assessing risk in prevention.
So all is not as simple as it seems! When instituting some preventive strategy, be it screening or treatment, one needs to pay particular attention to the initial level of risk. Treating low risk patients can be a high risk strategy.
Humans↗
Diet and Type 2 diabetes. Guidelines for general practice.
Type 2 diabetes (NIDDM) is common and increasing and results in enormous costs to all concerned. The average Australian diet is inappropriate for this condition, which regular exercise and healthy eating could delay or prevent even in high risk groups (family history, age over 50 years, over-weight). This article outlines a practical programme that general practitioners can use for people with, and people at risk of, Type 2 Diabetes and provides a comprehensive Further reading list.
Diabetes Mellitus, Type 2↗
Chronic fatigue syndrome. A review from the general practice perspective.
There is no doubt that the chronic fatigue syndrome exists. It is a condition that is debilitating and of unknown cause. Research into chronic fatigue syndrome demonstrates possible psychiatric or organic causes. The truth may be somewhere in between. Evidence for the existence of an ongoing chronic infection is now not convincing. Treatment should be based on supportive counselling, explanation, psychiatric help (both pharmacological and non pharmacological) and a graded programme of increased activity with the eventual aim of resumption of full functioning.
Antibodies, Viral↗
Patient education. Footcare in diabetes.
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Diabetes Complications↗
Nursing care study. Subacute bacterial endocarditis: Louise's losing battle.
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Adult↗
Direct observation. A primer for supervisors of doctors in training.
Direct observation and review of videorecordings of registrars in practice are valuable for learning clinical skills. They also engender an atmosphere of disclosure and professional honesty within the discipline of general practice. The theoretical background to direct observation, barriers to carrying it out, and strategies for enhancing the process are discussed.
Australia↗