100 CASES IN GENERAL PRACTICE 2nd EDITION
100 CASES IN GENERAL PRACTICE 2nd EDITION chosen the following 100 cases in the hope that they are representative of the breadth and depth of general practice. People bring all kinds of matters to the general practitioner: those that pertain to health, illness and disease, and the physical, psychological, social and spiritual. As general practitioners we never know who will next come through our doors, and what they will bring.
When diagnosis is called for, our style is normally hypothetico-deductive and our questions sometimes ask you to decide on the differential diagnosis on the basis of the history we give you, and then to decide what line of further history-taking, focused examination, investigations and management you might take. Other scenarios are more classically inductive, presenting all the information first and then asking you to decide on the differential diagnosis and management; several are purely about management, communication or ethical considerations. We highlight the importance in our work of effective communication, continuity of care, team work and the necessity of placing patients’ health issues in the context of their community and their life circumstances and experiences.
We have ordered these scenarios on the basis of the presenting symptom or topic: however, be aware that the presentation may have very little to do with what actually tran-spires. General practice consultations have a habit of not being what they first seem.
In general practice, listening is the key and the cases that are related in the following pages are from our experience as general practitioners: each scenario is an aggregate of many patients and many situations, and none is attributable.
‘When I started in practice, the thing that gave me joy was the solving of clinical puzzles, the making of good diagnoses, thus impressing my colleagues. As time went on I found myself preoccupied more and more with the patients I had come to know. It was their joys and sorrows, their suffering and healing that moved me. Of course, clinical diagnosis and management did not cease to be crucial: simply that a patient’s illness or disability became interwoven with a life story. I came to see medicine as more complex, more context-dependent, more poignant, more a reflection of the human condition’.
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