Anxiety disorders are highly prevalent and are the second most common mental health presentation in Australian general practice after depression. GP registrars are likely to have had very limited experience in assessing and managing anxiety disorders during their hospital training, and the supervisor can play a key role in increasing their skills. Ideally, registrars should complete formal Level 1 Mental Health Training during their first term.
Atrial fibrillation (AF) accounts for just over 1.3 % of GP encounters according BEACH data and is a significant contributor to morbidity and mortality in Australia. It is a condition that is often missed. As our population ages AF is becoming more common and is the leading cause of strokes. The management of AF has changed over the last few years with the introduction of NOAC’s and point of care warfarin testing.
Coeliac disease has a prevalence of 1-2% in the Australian population, but as it commonly presents in an undifferentiated manner, most affected people remain undetected. Early diagnosis and appropriate management is essential to address its substantial impact on quality of life. Additionally, GPs are increasingly confronted with patients complaining of wheat or gluten sensitivity, many of whom have self diagnosed or sought alternative care. Clinical encounters can therefore be challenging. For these reasons, coeliac disease is an important condition for GP supervisors to educate their registrars.
Chronic Obstructive Pulmonary Disease (COPD) is a debilitating and progressive long-term lung condition characterised by dyspnoea, cough and sputum production. It is estimated to affect around half a million Australians. While the condition is incurable and often complex to manage, it is possible to slow progression and prevent exacerbations with accurate diagnosis and appropriate stepwise care. GP registrars need to develop a planned, patient-centred and evidence-based approach for managing COPD.
Depression is a common presentation in general practice. It is the 5th most common problem managed by GP registrars (2.5% of all problems) and an area that registrars often struggle with early on in training. Ideally, registrars should complete their Level 1 Mental Health Training during their first term.
Dyslipidaemia is a well-established risk factor for CVD and statins have proven benefits in CVD risk reduction. However, they are not without side effects and lipid-lowering drugs cost the PBS over $1 billion in 2014-15, more than any other class of medication. One of the major challenges for GP registrars moving from the hospital environment into general practice is the management of chronic disease, including risk factor modification. Management of dyslipidaemia as part of absolute CVD risk is a new area of practice for many registrars.
Gastro Oesophageal Reflux Disease (GORD) is estimated to occur in 10–15% of the population and is the most common GIT problem managed in Australian general practice. Typical symptoms of GORD include heartburn and regurgitation, but atypical symptoms also commonly occur. Chronic GORD poses the risk of serious pathology, including oesophageal stricture, Barrett’s oesophagus and adenocarcinoma. GP registrars need to develop a safe approach to the assessment and management of GORD.
Acute monoarthritis has numerous causes, but most commonly is related to crystals (gout and pseudogout), trauma and infection. Early diagnosis is critical in order to identify and treat septic arthritis, which can lead to rapid joint destruction. Joint aspiration is the gold standard method of diagnosis. For many reasons, managing gout, both acutely and as a chronic disease, is challenging. Registrars need to develop a systematic approach to assessing monoarthritis, and be familiar with the management of gout and other crystal arthropathie.
Haematuria is a relatively common symptom with a wide variety of possible causes. Investigation to exclude a serious aetiology e.g. bladder cancer, is usually required, but in roughly half of cases results in no identifiable cause. GP registrars need to develop a systematic approach to the patient presenting with either macroscopic or microscopic haematuria.