Examples of situations when I want my registrar to contact me.
Now while the patient is still here.
1. Anyone ‘sectioned’ on a mental health form.
2. Any situation with mental health issues/distress when an individual may be at risk.
3. Serious suicide risk.
4. Psychotic illness.
5. Threatening behaviour/abuse/by patient or staff.
6. Pigmented lesions especially where GPR has decided not to refer.
7. Any situation where GPR is hesitating in referral for admission, and decided on balance not to do so.
8. Acute severe illness.
9. Patient under 16 unaccompanied by guardian.
10. When GPR feels treatment is indicated, but patient declines treatment.
Stuff I need to know today:
1. Uncertainty re diagnosis/management.
2. Near misses/actual or suspected adverse medical outcomes.
3. Any situation where patient dies.
4. If they hear about a patients death.
5. Serious diagnosis – cancer, MI, CVA, MS, especially in children e.g. DM.
6. Adverse events/mistakes e.g. vaccination expiry dates, prescriptions etc.
7. Emergency services contacted.
8. Suspected elder abuse.
9. Child safety issues / NAI.
10. Where there is a suspicion that criminal charges may occur e.g. drink driving/assault.
11. Suspected domestic violence.
12. Where a medico legal case may arise and a medico legal report required.
13. Major conflict with staff, hospital colleagues.
14. If registrar becomes aware of dissatisfaction/complaint about GP trainer/staff/themselves.
15. Malpractice threat.
16. Where trainee has intuitive feeling that something is not right.
17. If definite follow up required and trainee will not be there.
18. Telephone call from hospital/other health professional with information re patient.
Next tutorial.
1. If GPR feels behaviour of a patient is inappropriate e.g. bribery, inappropriate request for cert etc.
2. Any patient with whom GPR feels uncomfortable.
3. Registrar feels behaviour of other health care professional/staff inappropriate.
4. Errors made by GPR or noticed by GPR on going through files e.g. follow up of high PSA, prescribing error.
5. Abuse of prescribed meds.
6. Inappropriate request or blood tests or drugs.
7. Patient requesting travel vaccination.
8. Sit in for ENT, Eye Resp Abd and joint consult at least one per year.
9. All out of hours consults.
10. Urgent calls when GP on leave.
11. Any new long term diagnosis.
12. A rare diagnosis.
14. Suspected diagnosis known to be associated with poor clinical/ medico legal outcome e.g. scaphoid # or nasal septal haematoma.
15. Any patient with whom they feel uncomfortable.
16. Refusal to see GPR.
17. Changes in on call/holidays.
18. Patient requesting to join practice.
19. Procedures being done by GPR prior to them being done.
20 Unusual dynamics e.g. parents in with adult child, joint consultations if unclear why other person present.
21. New abnormal investigation.
22. Communication illegibility, phone call from pharmacist or nursing home that can’t read script/letter etc.