Evolution of general practice

September 2016

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Clinical challenge

Volume 45, No.9, September 2016 Pages 691-692

Questions for this month’s clinical challenge are based on articles in this issue. The clinical challenge is endorsed by the RACGP Quality Improvement and Continuing Professional Development (QI&CPD) program and has been allocated four Category 2 points (Activity ID:59922). Answers to this clinical challenge are available immediately following successful completion online at http://gplearning.racgp.org.au. Clinical challenge quizzes may be completed at any time throughout the 2014–16 triennium; therefore, the previous months’ answers are not published.

Each of the questions or incomplete statements below is followed by four suggested answers or completions. Select the most appropriate statement as your answer.

Case – Eric

Eric, a medical student aged 18 years, joins your clinic for the month on his first clinical placement. He asks you how being a doctor has changed over time. You reflect on the available literature and on the importance of national surveys of practising general practitioners (GPs) and their clinical activity.

Question 1

The concept ‘medical gaze’ describes the doctor’s:

  1. measurement of visual acuity
  2. search for signs of disease
  3. acknowledgement of limits
  4. increasing use of medical imaging.

Question 2

What is the immediate clinical application of the genome-wide association study (GWAS) and related association studies?

  1. Conclusively demonstrates that all disease emerges at the individual, molecular level
  2. Permits the identification and prevention of type 2 diabetes
  3. Provides correlations between genes and diseases that are open to interpretation
  4. Provides searchable DNA databanks that inform individual decisions

Question 3

Disease aetiology from the medical perspective in the 18th century:

  1. was unique to the patient and their narrative
  2. was personalised to the patient and their genome
  3. de-emphasised professionalism in medicine
  4. was expressed as a list of patient risk factors.

Question 4

What does the concept ‘statistical body’ describe?

  1. The body of evidence-based decision making
  2. A panel or individual with expertise in medical statistics
  3. The patient as a collection of disease-causing genomes
  4. The patient as a collection of risk factors for disease

Question 5

What are the potential benefits of genome-based ‘personalised medicine’?

  1. Predicting pharmacological response or adverse events
  2. Understanding DNA and RNA, to fully control disease
  3. Reducing reliance on doctors’ judgement and interpretation
  4. Data collection by personal genomic companies

Question 6

Which one of the following is true of Australian general practice over the last 25 years?

  1. GP claims from the Medicare Benefits Schedule (MBS) have grown by 37.4%.
  2. Eighty-five per cent of Australians visit a GP at least once a year.
  3. Medicare-claimed GP visits have decreased per head of population.
  4. Patients can access all medical services directly now.

Question 7

Which one of the following is true of the characteristics of Australian GPs in the past 25 years?

  1. As more women have joined the workforce, GPs have been working for lower pay.
  2. The percentage of GPs who graduated in Australia has been increasing.
  3. The percentage of older GPs has been increasing.
  4. The number of general practice registrars has been decreasing.

Question 8

Which one of the following best describes the changes in GP clinical encounters over the last 25 years?

  1. An increased proportion of all age groups
  2. More acute problems per encounter
  3. The same proportion of older age groups
  4. More complex problems per encounter

Question 9

Which one of the following best describes the changes over the past 25 years in the rate of GP intervention?

  1. Medication prescribing rates have increased.
  2. Medication prescribing rates are unchanged.
  3. Clinical treatment rates have increased.
  4. Numbers of procedures performed have decreased.

Question 10

Which one of the following is true of GP management of chronic conditions?

  1. Referrals to pathology and imaging have decreased per encounter.
  2. MBS coverage of allied health professionals may have increased their use.
  3. Referrals to medical specialists have decreased per encounter.
  4. The ageing population has reduced its reliance on GP management.

Correspondence afp@racgp.org.au

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