Australian Journal of General Practice最新文献

Background: Fractures account for approximately 1% of patient presentations in general practice. Uncomplicated, low-risk fractures rarely require orthopaedic intervention and can be treated exclusively in primary care by the general practitioner (GPs).

Objective: The aim of this paper is to improve the skill set of GPs to enable them to manage low-risk fractures in the primary care setting.

Discussion: Three key factors underpin the safe development and deployment of a primary care fracture clinic (PCFC) in primary care practices: (1) understand fracture healing; (2) acquire a deep understanding of initial examination and management principles; and (3) have a referral network. The right referral network includes orthopaedic surgeons; allied health practitioners such as physiotherapists; and appropriate handouts. Additional considerations are having the right medical insurance; online and hard copy academic and clinical references; and adequate consumables.

Background and objectives: A previous article presented stories of registrars' journeys through early general practice training. This paper aims to explore in detail two registrars' stories using the lenses of transformative learning theory and threshold concept theory to seek fresh insights into becoming a general practitioner.

Method: This study explored the experience of 12 registrars undertaking their first general practice term using a qualitative narrative enquiry approach. Two stories are examined in more detail to see if they resonate with the transformative learning and threshold concept theories.

Results: Both theories appear to have resonance with the experiences, as described by the two registrars.

Discussion: The transformative experience of early general practice training can be usefully described by transformative learning theory as a holistic change of 'meaning perspective', and also as learning key threshold concepts. This might help inform future registrars' learning and supervisors' teaching.

Background: General practitioners (GPs) are increasingly encountering patients treated with novel disease-modifying systemic treatments for chronic inflammatory conditions. The Janus kinase (JAK) signalling pathway has been strongly implicated as a key mediator in a broad cohort of chronic inflammatory conditions including rheumatoid arthritis, inflammatory bowel disease and, more recently, selective small molecule JAK signalling inhibitors have been used to treat inflammatory dermatoses such as atopic dermatitis and have led to promising outcomes.

Objective: This narrative review will discuss the role of JAK/signal transducers and activators of transcription (STAT) signalling in atopic dermatitis and other inflammatory skin conditions.

Discussion: A better understanding of the risks and benefits of JAK inhibitors, along with the recommended monitoring guidelines, will result in improved patient outcomes.

Background: Among the contributors to the wellbeing crisis facing medicine, a leading and somewhat hidden factor is medical culture.

Objective: This article seeks to highlight how certain aspects of medical culture are hazardous to doctors' health, and offer guidance for how general practitioners (GPs) can support cultural reform.

Discussion: The fundamental values of medicine are noble and worth preserving; however, they have become unrealistic. Specifically, expectations of excellence have become demands for perfection, while altruistic intentions have become self-sacrificial. The effects of these cultural shifts are evident in how doctors treat themselves, particularly in comparison to non-medical groups. Medical culture needs re-balancing. A useful approach for GPs to take is that of self-compassion, which advocates for kinder treatment of oneself. Embodying such a philosophy will not only support one's own wellbeing, but also serve as a catalyst for the cultural change necessary to bolster the sustainability of the profession.

Background: Doctors have struggled to practise effective self-care for a long time. This has been reinforced by attitudes of self-sacrifice embedded within medical culture. Messages encouraging self-care practices can be met with scepticism and go unimplemented.

Objective: This article argues for why general practitioners (GPs) need to engage in self‑care and outlines a new self-care package being offered by The Royal Australian College of General Practitioners (RACGP).

Discussion: GPs' wellbeing is inherently important. In light of a large body of evidence demonstrating the consequences for patient outcomes, GPs have a professional duty to monitor and support their own wellbeing. As such, GP wellbeing is a shared responsibility among individual GPs, practices and systems. Self-care needs to be undertaken in both preventive and reactive formats to optimise outcomes for GPs. The RACGP has developed a new package to guide GPs in confidentially assessing their wellbeing and preparing a 12-month self-care plan. This activity will be recognised as part of GPs' continuing professional development requirements.