|Advanced life support
||The provision of effective airway management, ventilation of the lungs and production of a circulation by means of techniques additional to those of basic life support. These techniques may include, but are not limited to, advanced airway management, vascular/drug therapy and defibrillation according to the most current version of the Australian Resuscitation Council guidelines.
Refs: Australian Resuscitation Council. Australian Resuscitation Council guidelines 2021. East Melbourne, Vic: ARC, 2021. [Accessed 20 April 2020].
The Royal Australian College of General Practitioners. Basic life support and advanced life support guidance document. East Melbourne, Vic: RACGP, 2020. [Accessed 20 April 2022].
|Basic life support
||The preservation of life by the initial establishment, and/or maintenance, of airway, breathing, circulation and related emergency care, including use of an automated external defibrillator, according to the most current version of the Australian Resuscitation Council guidelines.
Refs: Australian Resuscitation Council. Australian Resuscitation Council guidelines 2021. East Melbourne, Vic: ARC, 2021. [Accessed 20 April 2022].
The Royal Australian College of General Practitioners. Basic life support and advanced life support guidance document. East Melbourne, Vic: RACGP, 2020. [Accessed 20 April 2022].
||A holistic clinical approach to assessment, diagnosis and management that considers biological, psychological and social contributing factors and their complex interactions that impact how individuals may present for care.
Ref: Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137(5):535–44. doi: 10.1176/ajp.137.5.535
||A high-level ability required of a GP.
||Knowledge that can be described and understood with language.
||Professionals with whom the doctor directly works within the same practice, or indirectly works or collaborates with through the broader healthcare system, including other GPs, nursing and administrative staff, allied health professionals and non-GP specialists.
||‘A natural consequence of working with people who have experienced stressful events’. This develops because of a doctor’s exposure to their patients’ experiences combined with their empathy for the patient. Symptoms include helplessness, feelings of overwhelm and confusion, isolation, exhaustion with consequent dysfunction, and concerns about own capacity.
Ref: Benson J, Magraith K. Compassion fatigue and burnout: The role of Balint groups. Aust Fam Physician 2005;34(6):497–98.
||‘An observable ability of a health professional, integrating knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed. Competencies can be assembled like building blocks to facilitate progressive development.’
Ref: Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency based education in medicine: A systematic review of published definitions. Med Teach 2010;32(8):631–37. doi: 10.3109/0142159X.2010.500898
|Conflicts of interest
||Refers to the importance of acknowledging and addressing any biases an individual doctor may have that may impact the quality or safety of care delivered. For example, prescribing habits that are not in line with evidence-based guidelines (eg the GP having a pecuniary interest in a particular treatment being prescribed, or being incentivised through other means to prescribe a particular treatment).
|Continuity of care
||The quality provision of care over time, including the individual patient’s experience of a ‘continuous caring relationship’ with an individual doctor over time, as well as multidimensional models where different providers provide a ‘seamless service’ by integrating, coordinating and sharing information.
Ref: Guilford M, Naithani S, Morgan M. What is ‘continuity of care’? J Health Serv Res Policy 2006;11(4):248–50. doi: 10.1258/135581906778476490
||Consultations in which the doctor has a different cultural and/or linguistic background to the patient. The emphasis is on the need for the doctor to be culturally aware and provide culturally safe care.
||The basic premise of cultural assessments is that patients have a right to their cultural beliefs, values and practices, and these factors should be understood, respected and considered when giving culturally competent care.
A comprehensive cultural assessment allows the practitioner to gain an understanding of how embedded the individual is in their culture and its belief system, which may provide insight into perceptions of cause, meanings of illness, and expectations of treatment and care.
||Cultural awareness is sensitivity to the similarities and differences that exist between two different cultures and the use of this sensitivity in effective communication with members of another cultural group. Cultural awareness education is the first building block towards cultural safety.
Cultural awareness education is defined as, ‘An understanding of how a person’s culture may inform their values, behaviours, beliefs, and basic assumptions ... [It] recognises that we are all shaped by our cultural background, which influences how we interpret the world around us, perceive ourselves and relate to other people. The focus of cultural awareness education is on outcomes for the participant or learner – that is, self-reflection leading to enhanced cultural awareness. It is introductory in nature, and through increased awareness, the learner can enhance their skills in working effectively with Aboriginal and Torres Strait Islander people.’
Ref: The Royal Australian College of General Practitioners. Cultural awareness education and cultural and safety training. East Melbourne, Vic: RACGP, [date unknown]. [Accessed 20 April 2022].
||Cultural bias may be defined as interpreting and judging phenomena by standards inherent in one’s own culture. In healthcare, this can contribute to misunderstandings that impact diagnosis and consequent management, power imbalances in the patient–doctor relationship, as well as bring up issues of class in some cultures.
||The doctor’s unique personal worldview influenced by the cultures that nurtured them. This lens may influence the way a health professional judges and makes assumptions about patients from a different background. Recognising this cultural bias is a necessary step for clinical effectiveness.
A patient’s cultural lens shapes beliefs about illness causation, the nature of a particular illness, and the appropriate treatment and expected outcome; it is therefore important for health professionals to factor this in when developing a collaborative therapeutic relationship.
Ref: Klein HA. Cognition in natural settings: The cultural lens model. In: Kaplan M, editor. Advances in human performance and cognitive engineering research. Vol, 4, Cultural ergonomics. Bingley, UK: Emerald Group Publishing Ltd, 2004; p. 249–80. doi: 10.1016/S1479-3601(03)04009-8
||Cultural safety is an important part of the spectrum of cultural competency and is defined not by the clinician but by the individual patient’s experience. The emphasis for cultural safety is on reflective practice, and acknowledgement and respect for differences rather than awareness of culturally specific beliefs or practices. Cultural safety involves the development of awareness of power imbalances in the therapeutic relationship that can negatively impact the quality of care, and the development of strategies to minimise this.
Practitioner safety is another important aspect of cultural safety. Every clinician should feel safe in their clinic environment, regardless of their cultural or linguistic background.
Ref: The Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute. National Safety and Quality Health Service Standards user guide for Aboriginal and Torres Strait Islander health. Sydney: Australian Commission on Safety and Quality in Health Care, 2017.
|Culturally and linguistically diverse
||This term is typically used to describe individuals in Australia who were born overseas, have a parent born overseas, or speak a variety of languages other than English.
In the Profile, this term is used more inclusively, acknowledging that we are on the lands of Aboriginal and Torres Strait Islander peoples, the longest surviving culture in the world. The term describes individuals who have a different cultural and/or linguistic background to the doctor, regardless of the doctor’s cultural or linguistic background. The emphasis is on the need to be culturally aware and to provide culturally safe care.
Ref: Australian Institute of Health and Welfare. Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW, 2018.
||Refers to a physical, sensory, intellectual or psychological impairment that causes some level of restriction or limitation to activities or to an individual’s ability to participate in everyday activities.
|Duty of care
||The legal and ethical obligation for doctors to adhere to standards of quality care in therapeutic relationships with patients.
Ref: Dean J, Mahar P, Loh E, Ludlow K. Duty of care or a matter of conduct: Can a doctor refuse a person in need of urgent medical attention? Aust Fam Physician 2013;42(10):746–48.
|Effective health education
||Refers to the provision of accurate and timely evidence-based, quality health information and decision aids to patients by means most appropriate to their individual context (taking into account sociocultural factors and level of health literacy).
|Effective therapeutic relationship
||GPs often develop a comprehensive understanding of their patients through providing quality continuity of care across the lifespan. By using effective communication and delivering confidential and holistic care focused on the biopsychosocial-cultural perspective and priorities of the individual, GPs are uniquely situated to establish trust and to work as a team with individuals, their families and/or carers, to enable patient-centred quality diagnosis and management, and improved health outcomes. This is termed an ‘effective therapeutic relationship’.
||Ethical issues may arise when there are apparent contradictions between the elements of a GP’s ethical code and that of the patient and broader society.
||The capability to make decisions about the quality of one’s own work and that of others. It has been shown to be an effective way for learners to continually improve their work and to drive self-directed learning.
||Consideration of an individual’s preference to consult a GP of the same gender, particularly for intimate examinations. This preference may be related to personal factors, such as gender or sexual diversity, or cultural or religious beliefs.
||This relates to both healthcare and social programs that provide support to individuals, including unemployment benefits, workers compensation and transport accident schemes, and Medicare-funded programs (including chronic disease management plans and access to allied health visits, mental health care plans, Aboriginal and Torres Strait Islander health assessments).
||‘The feelings in the pit of your stomach when a specific patient’s name is seen on the appointment list.’ This traditionally pejorative term has been used to refer to the response a doctor has to patients with a variety of complex presentations that trigger feelings of frustration, distress or inadequacy in the doctor that are typically related to transference and countertransference.
These responses should identify a need for reflection by the doctor and consideration of strategies to manage these interactions to optimise the care provided.
Ref: O'Dowd TC. Five years of heartsink patients in general practice. BMJ. 1988;297(6647):528–30. doi: 10.1136/bmj.297.6647.528
|Holistic person-centred care
||A core value of general practice that is based on trust and a therapeutic relationship, and that relates to:
Ref: Thomas H, Best M, Mitchell G. Whole-person care in general practice: The nature of whole person care Aust J Gen Pract 2020;49(1–2):54–60.
- treating each individual as a multidimensional person (considering multiple personal and contextual factors that influence health and treatment) according to their needs
- length, depth and breadth of scope: ‘cradle to grave’, multisystem care that is tailored to the individual, is integrated and provides a range of treatment modalities and opportunistic and preventive care beyond the presenting complaint and within the context of a healthcare team.
|Hypothetical deductive reasoning
||A process of clinical reasoning where hypotheses are considered for potential diagnoses based on clinical findings that are presented sequentially.
Ref: Barrows HS. Practice based learning: Problem-based learning applied to medical education. Springfield IL: Southern Illinois University, School of Medicine, 1994. Linn A, Kildea H, Tonkin A, Khaw C. Clinical reasoning: A guide to improving teaching and practice. Aust Fam Physician 2012;41(1):18–20.
||A cognitive phenomenon related to metacognition, in which individuals recognise the limitations of their own thinking, beliefs and attitudes and are open to learning from the experience of others. This method of thinking is about being actively curious in regard to intellectual blind spots.
Ref: Leary MR. The psychology of intellectual humility. Duke University. September 2018. [Accessed 20 April 2022].
||The ways in which different aspects of a person’s personality expose them to overlapping forms of discrimination and marginalisation.
||An unplanned event that had the potential to cause harm but did not actually result in harm.
|Patient’s agenda and priorities
||A patient’s agenda relates to the list of issues that the individual wishes to cover within the consultation that are usually clearly expressed; for example, accessing an opinion on a new symptom, review of an ongoing symptom, a repeat script or a certificate for work.
A patient’s priorities relates to the broad set of issues in an individual’s life, beyond their immediate agenda for the consultation, that may impact their presentation, ability to communicate about and/or manage their health, and/or their access to the care required.
Priorities may not always be obvious or discussed, but within the continuity of care provided in general practice, GPs are often aware of these issues and need to integrate consideration of these into person-centred care. An example of an important priority to consider may be an individual’s socioeconomic situation with pressure to work long hours to support their family or provide care to a dependent family member, which impacts their ability to prioritise their health by creating barriers to exercising regularly or attending appointments.
||Refers to GP colleagues who are at a similar level of experience and/or training as the doctor.
||The PICO framework can be used to build clinical questions that are directly relevant to the problem at hand to assist in undertaking a review of guidelines and/or the broader literature that guides evidence-based care:
P – Patient, population or problem being addressed
I – Intervention being considered, which may include exposure to a risk factor, diagnostic test, therapy or patient perception
C – Comparison intervention or exposure or considering the alternative(s); for example, do nothing, surgery, different pharmacological or non-pharmacological therapy, placebo effect
O – Clinical outcome of interest; for example, morbidity, complications, mortality.
Ref: Schardt C, Adams MB, Owens, T, Keitz, S, Fontelo, P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 2007;7(16). doi: 10.1186/1472-6947-7-16
||Privileging (a concept from the entrustment literature) is the act of granting a registrar a privilege to a scope of clinical practice after an assessment of their competency.
The milestones of the Profile are privileging points. They define the entitlement to work within a specific scope of practice that gradually expands as competencies are attained with progression across the milestones of training. These privileges are linked with varying levels of supervision and include entering a general practice training program, working in a general practice setting under direct, indirect then ad hoc supervision, admission to Fellowship and ongoing status as a Fellow.
||Encompasses a broad range of considerations, including specific signs and symptoms considered in combination with individual risk factors that may indicate the presence of a serious health condition that requires intervention.
||‘The ability to reflect on one’s actions so as to engage in a process of continuous learning.’ The ongoing process of a doctor critically reviewing their experiences and thought processes to gain an understanding of themselves, their behaviour and clinical knowledge and skills, in their interactions with patients and colleagues, to inform ongoing learning.
Ref: Schon, DA. The reflective practitioner: How professionals think in action. New York: Basic Books,1983.
||A professional’s ability to be reflective and develop a clear perception of their own personality, communication style, knowledge base, thoughts, beliefs, possible biases, motivation, values and emotions. This enables insight into how they may be perceived by others and how to minimise risks of problems with communication or professional and therapeutic relationships.
||The ability of individuals to promote their own health by maintaining healthy behaviours, lifestyle choices and concordance with recommended treatments, as well as, where relevant, self-monitoring strategies to minimise impacts of existing chronic diseases. Effective self-management is based on an individual having a good understanding of their condition and when to access healthcare.
Ref: Nichols T, Calder R, Morgan M, et al. Self-care for health: A national policy blueprint. Policy paper 2020–01. Melbourne: Mitchell Institute, Victoria University, 2020. [Accessed 20 April 2022].
||Social determinants are the conditions of the environment where people live, learn, work, play and worship, and their age, that affect their health, ability to function and the quality of their life outcomes.
|Stages of change
||An intentional change model developed by Prochaska and DiClemente that focuses on the decision-making and motivation stages of an individual in regard to behaviour change.
||‘Transference’ refers to the phenomenon by which individuals ‘unconsciously transfer feelings and attitudes from a person or situation in the past on to a person or situation in the present. The process is at least partly inappropriate to the present’. This process is unconscious and can occur in either direction in the patient–doctor relationship. Risk factors for transference include mental health diagnosis or vulnerable personality, particularly individuals with experience of previous trauma (eg complex post-traumatic stress disorder, severe depression or anxiety), perceptions of dependence, associated anxiety about physical or psychological safety, and frequency of contact (inside or outside of the clinic).
‘Countertransference’ refers to the response elicited in the GP by the patient’s transference communications. It is important for GPs to recognise when this is occurring and to address it empathically and respectfully, and to reach agreement with the patient on clear therapeutic boundaries. A potential consequence of unclear boundaries is the development of unreasonable patient expectations that are unable to be met, and that may put the patient at risk or raise the possibility of legal action.
Ref: Hughes P, Kerr I. Transference and countertransference in communication between doctor and patient. Advances in psychiatric treatment. Cambridge University Press, 2000;6(1):57–64. doi: 10.1192/apt.6.1.57
||An approach to clinical practice that acknowledges that doctors need to have a holistic view of the individual’s life situation to provide effective healthcare, including recognising the broad impact of trauma and understanding paths to recovery that avoid retraumatisation.
Ref. Trauma-Informed Care Implementation Resource Centre. What is trauma-informed care? Hamilton, New Jersey: Center for Health Care Strategies, 2021. [Accessed 28 March 2022].
||The process of change resulting from empathic engagement with trauma survivors. Anyone who engages empathically with survivors of traumatic incidents, torture or material relating to their trauma, is potentially affected, including doctors.
Ref: British Medical Association. Vicarious trauma: Signs and strategies for coping. Bloomsbury, London: BMA, 2022. A [Accessed 28 March 2022].