Patients frequently present to the GP with abdominal pain. The presentation of abdominal pain is often undifferentiated, and the challenge for registrars is managing the uncertainty of a wide range of causes, including potentially serious conditions in the community setting. It is important that supervisors feel confident that their registras are competent in managing abdominal pain.
Heavy, prolonged and/or irregular menstrual bleeding is a common presentation in general practice. Most causes are benign but serious disease needs to be excluded. Many GP registrars are known to have limited exposure to women’s health in the hospital setting and this presentation can be very challenging for many.
Low back pain (LBP) is the third most common presentation to Australian GPs. The cause of acute LBP is nonspecific in about 95% of people and serious conditions are rare. However, recurrences are frequent and chronic back pain can occur in some patients. GP registrars need to develop an effective approach to the assessment and management of acute LBP, as well as develop confidence in managing patients with chronic back pain.
Breast lumps are common and usually benign, but understandably may cause significant anxiety for the patient. Comprehensive assessment, involving clinical examination, imaging and biopsy, are required for definitive diagnosis. For two reasons – breast lumps are a high risk presentation, and registrars are likely to have limited clinical experience during their hospital training –supervisors must ensure registrars are competent in the assessment and management of breast lumps. Additionally, registrars need to know the benefits, risks and practicalities of breast cancer screening.
Chest pain has multiple possible causes, ranging from trivial to life-threatening. GP registrars are likely to have seen many patients presenting with chest pain in the ED setting, but the epidemiology and approach to chest pain in general practice is significantly different. As a high risk presentation, supervisors must ensure that registrars have a safe approach to the assessment and management of chest pain.
‘Coughs and colds’ are the archetypal conditions seen in general practice – indeed cough is the most common symptomatic presentation to Australian GPs. Cough usually has a benign aetiology, but can be the first symptom of serious disease. GP registrars need to develop a systematic approach to the assessment and management of cough, including appropriate investigation where indicated.
“I feel dizzy Doc”. This is often a difficult consultation for a GP registrar. Dizziness incorporates a wide range of possible causes, ranging from benign to potentially life threatening. Appropriate work-up involves comprehensive history taking and examination, followed by selective use of appropriate investigations. Dizziness is a frequent presentation in general practice, and is a common cause of falls in the elderly.
“I’m really tired, doctor”. A statement to make your registrar’s heart sink. Registrars encounter patients complaining of fatigue at a rate of 1.1 per 100 encounters. Fatigue is the most commonly presenting undifferentiated problem in general practice, and often leads to multiple investigations. Fatigue is a particularly challenging presentation for registrars, as it is ambiguous and potentially associated with serious disease.
The febrile child is a very common presentation in general practice, but can be highly challenging for many reasons – parental distress, uncertainty, potential for serious illness and rapid deterioration, and a need to minimise investigation. Registrars have generally seen a lot of acute presentations of febrile children in ED, but assessment and management is different in the GP setting. It is vital that supervisors are confident that registrars are competent in managing the febrile child.
Foot and ankle problems are the fourth most common musculoskeletal reason for presentation in Australian general practice (after back, knee and shoulder complaints). There are multiple causes of foot and ankle pain, reflecting the complex anatomy of the region. GP registrars will be familiar with common traumatic presentations of foot and ankle pain from their ED experience, but will likely be less comfortable managing more chronic problems. GP supervisors can teach their registrars about the common foot and ankle pathologies, including the approach to history, examination, appropriate investigations, and practical management.