Milestone

Fellowship

Last updated 13 September 2022
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Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

1. Deliver culturally safe care

Do

  • Undertake respectful cultural assessments.
  • Routinely offer access to an interpreter or Aboriginal and Torres Strait Islander health worker, community health worker or liaison officer in consultations.
  • Be aware of and respectfully enquire about sociocultural beliefs and obligations, such as ‘Sorry Business’, segregation of men’s and women’s business and issues regarding spirituality (eg in some communities it is common to hear the voices of departed loved ones, which could be misdiagnosed as auditory hallucinations and raise concerns about mental illness).
  • Be willing to work effectively with cultural educators and mentors to increase awareness and understanding of the depth and diversity of Aboriginal and Torres Strait Islander culture.
  • Be humble, engaged, aware and respectful of differences in social structure, culture and impacts of intergenerational trauma and the way that these impact perceptions of health, wellness and approach to healthcare.

Do

  • Undertake respectful cultural assessments in cross-cultural consultations.
  • Routinely offer access to an interpreter for consultations.
  • Use interpreters effectively (competency 3.4.2).
  • Respectfully enquire about an individual’s history, cultural beliefs and practices and how these affect perceptions of health and access to health services. For example, experience with health services in country of origin, cultural dietary restrictions or practices (eg fasting, avoidance of animal products) and cultural beliefs (eg regarding mental illness).
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

2. Provide person-centred and comprehensive care, using a biopsychosocial approach

Do

  • Incorporate consideration of preferences and health beliefs into management plans to support appropriate referrals, clinical handover and provision of care.
  • Consider:
    • the patient’s language and level of health literacy
    • the patient’s values, preferences and health beliefs
    • the patient’s previous experiences, including interactions with health services and experiences of trauma that may impact ability to access care
    • tailoring information to engage the patient in their care
    • barriers to care, including financial, geographical, resource limitations, etc.
  • Incorporate consideration of preferences and health beliefs into management plans to support appropriate referrals, clinical handover and provision of care.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

3. Manage consultations and communicate effectively with patients, families and carers

Do

  • Identify the range of challenging patient encounters that can occur with patients who may:
    • have experienced trauma, including adverse childhood experiences
    • be distressed or agitated and/or present as physically or verbally aggressive
    • be about to be given bad news
    • have made a complaint about a doctor or other colleague
    • have unreasonable expectations about the consultation or the care to be provided, including blurring of therapeutic boundaries
    • present with symptoms of an STI.
  • Understand types and causes of trauma, including that trauma may be caused by exposure to family violence, sexual, physical and/or emotional abuse, and/or neglect in childhood.
  • Understand the potential impacts of trauma on the therapeutic relationship, including:
    • barriers to establishing rapport, trust and open communication
    • reticence to be examined or undergo procedures.
  • Establish a therapeutic relationship by:
    • practising trauma-informed care, including using sensitive and empathic communication when caring for patients who may have experienced trauma
    • using communication techniques, such as active listening and validation of a patient’s experience
    • conducting safety assessments for patients who are in situations in which they are continuing to experience trauma
    • conducting mental health and risk assessments
    • providing emotional support, psychoeducation, and encouragement of active use of social support and self-care strategies
    • considering referral for trauma-focused cognitive behavioural therapy, dialectical behaviour therapy for complex PTSD, or eye movement desensitisation and reprocessing, etc.
  • Identify early signs of behaviour that may lead to aggression (eg individuals who are noticeably affected by substances such as alcohol or methamphetamines, signs of physical agitation such as pacing or responding to auditory hallucinations).
  • Use simple de-escalation techniques and implement safety net strategies if these are not effective, such as ensuring there is an escape route if confronted, considering safety of other staff, use of duress alarm or calling emergency services.

Do

  • Acknowledge barriers to communication, including:
    • social (including gender, sexuality, socioeconomic status)
    • psychological
    • language
    • health condition (eg sensory, intellectual and physical disabilities)
    • cultural.
  • Proactively address these barriers through use of skills and knowledge, specifically:
    • ensuring adequate time for consultations
    • acknowledging perceptions of power imbalances in the therapeutic relationship and discussing these with the patient to address impacts
    • acknowledging fear and mistrust of mainstream health services due to past mistreatment or other negative experiences, and working with the patient to manage these
    • acknowledging Aboriginal and Torres Strait Islander peoples and respectfully enquiring about their land and community or ‘mob’
    • considering displaying Aboriginal and Torres Strait Islander flags in the clinic room, and including an acknowledgement of country in correspondence signature
    • engaging with Aboriginal cultural mentors and educators to support culturally safe care for Aboriginal and Torres Strait Islander patients
    • identifying the need for interpreters and using them effectively; for example, maintaining eye contact with the patient, speaking slowly and concisely, breaking speech up into short phrases and pausing so that the interpreter can translate. Request that the interpreter identify any cultural misunderstandings, trust their judgement, and rephrase questions or statements where misunderstandings have occurred
    • using LGBTIQ+ inclusive language, avoiding assumptions (eg asking about partner or parents rather than boyfriend/girlfriend, husband/wife, mother/father) and acknowledging diversity. For example, respectfully ask how a patient describes themselves or what pronoun they use, rather than asking what they prefer. Consider having a visual identifier in the clinic room, such as a rainbow sticker, to communicate being an LGBTIQ+ inclusive practitioner
    • identifying the most effective way to communicate and collaborate with people with disability by working with them and their family/carers, if appropriate, as a team to optimise outcomes, including avoiding using a deficit model when providing care, maintaining a focus on strengths and understanding the sociocultural context to maximise effectiveness of communication
    • recognising that some individuals with disability may have impaired capacity to consent to some decisions; however, they should remain at the centre of the decision-making process, with assistance from a guardian if required.

Do

  • Demonstrate effective time management and use respectful, effective communication and clinical problem-solving skills to:
    • consider patient’s agenda for consultations and balance this against other outstanding clinical issues
    • prioritise issues to be covered in the consultation (eg assess high-risk issues and defer less urgent issues)
    • set reasonable expectations for what can be achieved, provide a clear explanation and suggest a rational follow-up plan if all of the outstanding issues cannot be addressed in the current consultation
    • communicate rationale for the plan to demonstrate commitment to follow-up and continuity of care
    • address any concerns that arise about deferred issues and organise follow-up appointments in an appropriate timeframe.

Do

  • Demonstrate effective shared decision making, including:
    • provision of accurate and comprehensive information to the individual, tailored to their sociocultural context (particularly the level of health literacy and appropriate language) about the options available, and the risks and benefits of these options
    • acknowledging and managing any conflicts between the patient and their family or carers when setting goals or preferences for management (eg request for contraceptive script for an adolescent less than16 years of age, mental illness that threatens safety of individual, eating disorder management)
    • effectively assessing capacity of patient to provide consent
    • ethically and appropriately involving family and/or carers (including ensuring privacy and confidentiality of patient and seeking consent prior to sharing information) and identifying and managing impacts of burden of care responsibilities.
  • Develop personalised management plans, considering:
    • model of care (eg care, cure, rehabilitation, palliation and advance care planning)
    • investigation and/or treatment options, including consideration of barriers to accessing these (eg financial, geographical, cultural)
    • impacts of burden of care on family and carers and identifying signs of stress in carers; providing support and advice about management, and discussing and organising respite, as required.

Do

  • Clearly communicate relevance of research or application of a guideline to patients, considering relevant biopsychosocial approach -cultural factors.
  • Avoid jargon and communicate evidence effectively, taking into consideration the patient’s level of health literacy, values, preferences and health belief system, and tailor how information is conveyed to assist in collaboration, shared decision-making and to achieve person-centred care.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

4. Collaborate and coordinate care (within healthcare teams and with other professional stakeholders)

Know

  • Recognise the importance of the GP’s role in providing holistic person-centred care to efficiently identify and manage acute and chronic conditions and minimise fragmentation of care.
  • Understand the roles of each member of a patient’s healthcare team, to minimise fragmentation and reduce risks, as well as to avoid unnecessary duplication of care.
  • Understand the value of the complementary skills of other clinic staff (eg practice nurse), non-GP specialists and allied health professionals in optimising quality of care and improving patient outcomes (particularly for patients with complex, chronic health conditions and/or those who have psychosocial risk factors, such as unstable accommodation, substance dependency issues, problems with medication concordance, etc).

Do

  • Coordinate and, where appropriate, lead care to avoid duplication and fragmentation:
    • as part of the general practice team with GP colleagues , practice manager, practice nurse, administrative staff and allied health colleagues
    • as part of the multidisciplinary team with external practitioners, such as non-GP specialists, allied health professionals (eg Aboriginal health workers, liaison officers, cultural mentors and educators, physiotherapists, dentists, podiatrists, optometrists, exercise physiologists, psychologists, audiologists, naturopaths, osteopaths, Chinese medicine and Ayurvedic practitioners, social workers and residential healthcare staff).
  • During the peri-operative period, work with patients, particularly those with chronic diseases, to optimise their health prior to, during and after surgery.
  • Provide continuity and effectively collaborate, lead and coordinate patient care by:
    • undertaking appropriate assessment, investigation, clinical problem-solving and management prior to referring individuals to other services
    • facilitating appropriate referrals and verbal and written clinical handover by:
      • efficiently organising appropriate referrals and management plans for allied health and non-GP specialist care, using effective communication to minimise the risk of unnecessary repetition of investigations or therapies, which can be burdensome to patients and the broader community, and containing all relevant information on current and past medical history, family history, current medications, allergies, risk factors and sociocultural factors
      • using case conferencing with documentation of opinions and agreement on management plan and actions/roles of individual practitioners
    • ongoing use of effective communication to ensure the care team is kept informed of relevant information about a patient’s health status and therapies, and understands the patient’s needs and wishes.
  • Optimise continuity through effective use of practice quality and safety systems, including recall systems to optimise access to screening, monitoring of medication, and follow-up of abnormal urgent and non-urgent pathology and radiology results. Recall systems should be considered for patients who have been referred to other services for serious health conditions that require intervention, to inform and prompt for follow-up if reviews do not occur in an acceptable time frame.
  • Provide education and support to improve concordance and health outcomes.
  • Maintain privacy and confidentiality and safely use eHealth strategies to collaborate and coordinate care, such as:
    • video conferencing
    • internet telephone services (eg Zoom)
    • email
    • SMS
    • web services and e-care planning tools
    • electronic referrals systems (with use of appropriate encryption)
    • electronic prescribing
    • electronic patient health records (including PCEHR)
    • electronic communication with Medicare, pathology and medical imaging providers
    • electronic or tele-based recall systems.
  • Address barriers to effective communication with other health professionals, such as:
    • difficulties communicating during consulting hours
    • delays in creating and handing over documentation (eg referral letters and discharge summaries)
    • incomplete or difficult-to-read documentation resulting from time pressures or inadequate medical record systems, etc
    • conflict about patient management or personality conflicts or bullying; minimise conflict within a care team by:
      • recognising and addressing signs of dysfunctional interactions
      • avoiding judgement or blame
      • behaving respectfully and empathically with all members of the team
      • identifying situations where health professionals may be breaching their professional code of ethics in how they interact with others.

Be

  • Be collaborative and respectful.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

5. Identify and manage uncertainty and acute and undifferentiated presentations (across the lifespan and appropriate to context)

Know

  • Know the limits of own knowledge and skills and when to ask for assistance from supervisor and/or colleagues to manage common acute and emergency conditions as outlined in competencies 5.3.1 and 5.3.2.

Do

  • Undertake a structured and rational assessment of the presenting symptoms by taking a concise, focused, patient-centred history, doing a relevant and respectful physical examination using appropriate equipment, and using clinic tests and/or screening tools.
  • Establish a working diagnosis or a rational list of differential diagnoses that identifies any red flag conditions and high probability acute conditions, and do so largely independently without assistance from supervisor or colleagues.
  • Identify patients who are significantly ill or at risk of acute clinical deterioration, stabilise (competency 5.3.5) and access clinical support appropriately.
  • Initiate management of patients who are significantly unwell, including stabilisation and appropriate urgent referral to tertiary facility for the following conditions, appropriate to context, in both children and adults:
    • hypovolaemia and septic shock
    • acute anaphylaxis
    • acute coronary syndromes, including cardiac arrest, ventricular fibrillation, asystole
    • collapse, altered conscious state and loss of consciousness
    • acute abdomen
    • respiratory failure
    • physical trauma, including cervical spine protection.
  • Establish a rational and safe management plan, including investigation or procedures, and/or initial therapy, and/or review and safety-netting, and/or referral.
  • Logically and concisely present assessment findings, verbally or written, to enable another clinician to understand clinical problem-solving and management plan to continue management.
  • Interpret results of investigations in the context of the patient (identify the significance of abnormal or, in some cases, normal investigation results for the individual in the context of their relevant past and family history, current symptoms and medications). This includes understanding the physiological impacts of ageing and disease processes, such as:
    • the significance of low normal platelets and low-level elevation of transaminases in individuals with hepatitis B
    • the ideal ferritin targets for individuals with haemochromatosis
    • the HbA1C targets for individuals with type 1 and type 2 diabetes
    • acceptable creatinine levels in an individual with chronic renal impairment
    • mildly elevated bilirubin in patients with Gilbert’s syndrome.
  • Use reflective practice.

Do

  • Demonstrate continuity of care and awareness of the need for follow-up and reassessment of patients, as appropriate, to minimise risk of clinical reasoning errors and consequent risk to patients by:
    • reviewing following investigations, and/or practising watchful waiting, and/or conducting initial therapeutic trial to determine status and whether another assessment is required
    • willingness to consider other differential diagnoses and investigating or referring appropriately
    • following evidence-based guidelines and recommendations for diagnosis and investigation of common acute conditions, complex acute conditions (competency 5.4.3) and ongoing undifferentiated conditions (competency 5.4.4).

Do

  • Identify and manage patients who are at risk of deterioration and/or who are at risk of delayed recovery, including those who present with:
    • evidence of being acutely unwell (competencies 5.3.1 and 5.3.6)
    • complex presentations that are undifferentiated (competency 5.4.4)
    • complex comorbidities
    • psychosocial prognostic indicator flags for delayed recovery.
  • Be familiar with categorisation of psychosocial prognostic indicator flags (particularly relevant for chronic pain) for delayed recovery in complex acute conditions:
    • yellow flags (psychological factors such as prominent distress and high perceived disability, low resilience and low belief in self-management, passive approach to recovery)
    • orange flags (mental health equivalent of red flags, including existing mental health diagnosis, such as personality disorder); consider need for mental health review
    • blue flags (perceptions about the relationship between work and health that may inhibit recovery)
    • black flags (systemic or contextual obstacles related to particular people, systems or policies; eg compensation claims with need to prove validity of symptoms).
  • Identify and manage complex comorbidities in acute presentations, including:
    • renal or hepatic impairment
    • diabetes with complications
    • severe disability that may impact communication
    • cancer (undertaking chemotherapy and/or radiotherapy)
    • patient taking multiple medications to manage chronic disease, which may interact with new medications.

Know

  • Understand types of uncertainty that may occur in general practice, including diagnostic, management and prognostic, and have structures to manage these safely, while avoiding over-investigation and inappropriate referrals.
  • Know the natural history of common undifferentiated conditions.
  • Be familiar with serious conditions that must not be missed, conditions commonly missed, and conditions that may present with unusual or elusive symptoms.

Do

  • Undertake an adequate assessment and:
    • explore the ideas, concerns and expectations of the patient
    • identify physical and psychological components of the presenting condition that may be contributing factors to presenting symptoms (eg borderline personality disorder with recurrent self-harming, Munchausen syndrome or Munchausen by proxy, trichotillomania, compulsive skin-picking causing unusual rashes, and weight changes related to eating disorders)
    • identify impacts of ongoing undifferentiated symptoms on psychological and social wellbeing
    • understand the use of time as a diagnostic tool.
  • Identify types of clinical uncertainty, including:
    • diagnostic – patients presenting with undifferentiated conditions that are acute, subacute or chronic (medically unexplained symptoms)
    • management – chronic pain with requests for analgesics, or off-label prescribing or other situations where evidence is limited or lacking; for example, patient use of complementary therapies in combination with conventional therapies
    • prognostic – for example, an individual with a new cancer diagnosis who wants to understand likelihood of survival and benefits of treatment.
  • Use effective and empathic communication to:
    • acknowledge and validate the person’s experience, concerns and frustration with uncertainty
    • assess and support patients to identify a possible psychogenic origin of symptoms through assessment of anxiety or other mental health symptoms
    • characterise undifferentiated conditions and explain management outcomes to patients.
  • Adopt a structured and safe approach to managing patients with undifferentiated conditions, including regular review, and recognise that some symptoms and presentations may never be attributed to specific conditions.
  • Access evidence-based resources and use sound clinical reasoning to assist shared decision-making to manage undifferentiated conditions and minimise health and economic risks, including presentations such as:
    • fatigue
    • insomnia
    • cough
    • dizziness
    • anorexia
    • nausea
    • sexual difficulty
    • weight and appetite loss
    • chronic pain (including headache, chest, back, pelvic, and abdominal pain, which has been explored clinically and investigated with no precise diagnosis).
  • Use follow-up, safety-netting and continuity of care to avoid duplication of investigations and risk of causing iatrogenic harm.
  • Focus on symptom relief.
  • Involve the multidisciplinary team, if indicated, to support recovery and assist with symptom management.
  • Consider psychological factors contributing to, or the consequence of, physical symptoms:
    • somatic dysfunction, such as chronic pain or irritable bowel syndrome
    • compulsive skin picking
    • trichotillomania
    • weight changes secondary to eating disorders
    • Munchausen syndrome or Munchausen by proxy
    • borderline personality disorder.
  • Consider mental health diagnoses that may present as, or compound, presentations of undifferentiated conditions, including:
    • anxiety (generalised anxiety and obsessive-compulsive disorders) and depressive symptoms, somatoform disorders, psychotic disorders, complex PTSD, substance use disorders, etc
    • other psychological contributing factors, such as fear related to past experiences, obsessional thinking, anxiety related to concomitant mental health diagnosis, style of thinking that is pertinent to the individual’s personality type or disorder, etc.
  • Manage diagnostic uncertainty in cases of somatisation, when psychological conditions present as physical symptoms, considering:
    • treatment versus non-treatment
    • referral versus non-referral
    • serious versus non-serious.
  • Use a range of strategies to manage clinical scenarios where evidence is lacking or may not be known by, or be readily available to, the doctor, such as:
    • the use of off-label prescribing
    • enquiring about the patient’s use of over-the-counter and complementary therapies and considering the potential benefits and risks of potential interactions or side effects
    • enquiring about use of alternative or non-conventional treatments.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

6. Manage individuals with chronic and complex conditions, providing continuity of care (across the lifespan and appropriate to context)

Do

  • Identify common chronic conditions that are likely to present with multisystem impacts and comorbidities, including:
    • chronic back pain and mental health issues
    • type 1 and type 2 diabetes with complications, particularly neuropathy, retinopathy, nephropathy, microvascular and macrovascular disease
    • obesity, metabolic syndrome, ischaemic heart disease, hypertension, hepatic steatosis, obstructive sleep apnoea, gout and psoriasis
    • obesity and osteoarthritis (knees and hips).
  • Identify appropriate surveillance strategies and time intervals for common chronic conditions. These may include:
    • regular pathology screening to identify deterioration or complications (eg HbA1c, ACR, fasting lipids in type 2 diabetes, LFTs, FBE viral load in hepatitis B, thyroid-stimulating hormone in hypothyroidism to assess adequacy of thyroid hormone replacement)
    • regular radiology screening to identify deterioration or complications (eg liver ultrasound in hepatic steatosis, fibro scan +/– liver ultrasound in hepatitis)
    • monitoring medication side effects
    • regular assessment for development of deterioration, recurrence or complications.
  • Use processes to help with documentation, sharing of information and follow-up of essential aspects of a patient’s care over time (eg chronic disease management plans).

Know

  • Know useful techniques for motivational interviewing and brief interventions and strategies to help improve health literacy and set goals.
  • Know how to access useful resources, including online resources that support behaviour change and/or concordance with treatment.
  • Understand local community resources that can support individuals with treatment concordance; for example, pharmacy medication reviews and use of blister packs for medication.

Do

  • Identify barriers to behaviour change and/or concordance with management, and work with the patient to address these.
  • Provide clear information to patients and families to educate about a chronic condition, improve health literacy and optimise collaborative goal setting.
  • Promote self-efficacy.
  • Identify the patient’s stage of change (competency 7.4.1) to support this process.
  • Identify patients who may benefit from motivational interviewing and other strategies to improve health literacy and collaboratively set goals to optimise health; for example, patients who:
    • demonstrate signs of substance dependence, with psychological, social and/or cultural contributing factors (competency 7.4.1)
    • maintain unhealthy lifestyle choices, particularly risk factors for preventable chronic conditions, such as poor diet, sedentary behaviour, smoking or binge drinking.
  • Use brief interventions, effective communication and motivational counselling to establish a collaborative therapeutic relationship and, if relevant, to minimise risk of harm to the individual.
  • Provide follow-up and continuity of care.

Be

  • Empathic, patient and non-judgemental.

Do

  • Provide continuity of care to ensure that acute, undifferentiated and chronic conditions and abnormal results are followed up promptly to minimise risks and improve health outcomes, and to ensure that preventive care is delivered opportunistically.
  • Use effective communication strategies to establish trust, rapport and a sound therapeutic relationship that supports shared decision-making and collaboration (competencies 3.4.2 and 3.4.4).
  • Consider and discuss a range of models of care to allow patients and families to make informed choices; for example:
    • when palliation may be an alternative to active treatment, such as in the case of advanced cancer, severe ischaemic heart disease or an incurable chronic condition (eg COPD, Alzheimer’s disease)
    • when there are options for curative treatment or rehabilitation
    • regarding voluntary assisted dying in jurisdictions where there are legislative frameworks available.
  • Use therapies and lifestyle interventions to improve quality of life, reduce risk of complications and prolong life.
  • Discuss and document advance care directives with patients and their families and carers, as appropriate.
  • Formulate safe strategies to provide care for patients who decline evidence-based management options (eg individuals who opt to access non–evidence-based treatment as an alternative to, or in combination with, no treatment), taking a non-judgemental approach and offering ongoing support for monitoring, review, education and health promotion (competency 10.4.2).
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

7. Promote health and deliver preventive care (across the lifespan and appropriate to context)

Know

  • Understand the concept of harm minimisation and the stages of change model and how this informs effective motivational interviewing and support for behaviour change for individuals with lifestyle risk factors.

Do

  • Identify patients for whom application of the stages of change model, brief interventions and/or motivational counselling may be useful, including individuals who:
    • demonstrate signs of substance dependence, when it can be useful to also identify possible psychological, social and cultural contributing factors
    • are struggling with concordance with management or with making important lifestyle changes, which impacts their risk of chronic disease or development of complications (competency 6.4.2).
  • Identify opportunities in consultations for person-centred health education to empower patients and promote behaviour change to reduce future disease risks. This may include:
    • provision of accurate, timely and evidence-based quality health information and decision aids to patients in the most appropriate way considering their individual context (taking into account sociocultural factors and level of health literacy)
    • verbal and written information on diagnoses and/or management options
    • electronic or paper-based health promotion resources to educate and empower, as well as assist in developing rapport with patients.
  • Avoid blame and acknowledge that substance dependence is a treatable disease and that behaviour change for healthier lifestyle choices can be challenging.
  • Identify mutual goals to minimise risk of harm and align with stages of change, from pre-contemplative through action to maintenance.
  • Collaboratively develop a management plan that may include:
    • education (eg safe injecting techniques for patients who use intravenous drugs)
    • options for therapeutic intervention programs, including behavioural treatments or referral for non-GP specialist or allied health support to address behaviour change or substance dependence
    • prescribing medications or providing referrals to access appropriate medications to enable cessation or reduction in use of addictive substances; for example: methadone, naltrexone or buprenorphine for opiate addiction; use of naltrexone, acamprosate and disulfiram in individuals who are alcohol-dependant; benzodiazepine withdrawal regimens using diazepam.

Know

  • Understand normal psychology, physiology and anatomy at different life stages and provide clear explanations, education and reassurance, as appropriate, to patients to distinguish variations from normal and to promote good health.

Do

  • Identify useful resources, in different formats, about normal life stage topics and maintaining good health that cater to the needs of a diverse range of individuals to support education provided in consultations (competencies 7.4.1 and 6.4.2.)
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