Putting self care into your consultation
An algorithmic approach towards enabling GPs to encourage self care and self-medication in the consultation, by Dr Catti Moss, FRCGP.

Self Care In Your Consultation

When a GP sees patients with minor ailments there are two priorities:
SPEED and SAFETY.
A doctor only has a ten minute consultation time and, in that time, he or she has to make sure they have identified anyone with a serious problem, while at the same time reassuring most people that there is nothing seriously wrong with them and they are going to get better in a relatively short period of time.

This issue is often resolved by treating nearly everything in case it is a significant illness, and by using the writing of a prescription to “close down” the consultation. This results in over prescribing,
PAGB defines self care as the actions people take for themselves and their families to promote and maintain good health and wellbeing and to take care of their self-treatable conditions.
mostly of antibiotics, which not only causes overspending on drug budgets, but also gives an unacceptable level of drug side-effects and other drug-related morbidities.

More importantly, it reinforces dependence on the doctor, making patients more likely to return to the GP for treatment of minor illness. In order to control drug spending and to use medicines wisely and appropriately, GPs have been urged to break the cycle of dependency, and develop new habits.

The Medical Model for Minor Ailments
One model the GP can use to distinguish speedily between patients with significant problems and others, without prescribing unnecessarily, is the Medical Model for Minor Ailments. In this model, the doctor uses the presence of “red flag” symptoms to alert him or her to the need for a more intensive search for significant illness.

Each doctor probably has their own list of red flag symptoms, but they include: haemoptysis, pleuritic pain, and a history of diabetes.

The Medical Model works well at distinguishing the serious from the minor ailment. Where many GPs find difficulty is with the “reassure and educate” part, which terminates the consultation. Both doctor and patient have been trained to use the writing of a prescription to mark the ending of a session, so GPs find that reassuring and educating takes longer than the writing of a prescription and they start to run late.

The other person whose needs may not be met is the patient. Patients frequently come to the doctor for a “cure”, when appropriate symptomatic relief is relevant and readily available in the community pharmacy.

The Self-Medication Aware Model for Minor Ailments
This model (on the left) has two small adaptations from the Medical Model. The first is that the doctor not only finds out what the patient presents with, but also finds out what the patient has already done concerning self-medication.

The doctor also finds out what the patient wants from the visit and, in the process, they may discover that fewer patients want a prescription than they had thought.

The doctor then proceeds with the medical side of the consultation, finding or eliminating any serious illness. Now, at the end of the consultation, the doctor has what he or she needs to end the proceedings without an unnecessary prescription.

If the patient only wanted reassurance, the doctor will feel happy to do so briefly, without feeling that the patient is dissatisfied. If the patient wanted symptom relief, the doctor can now recommend a trip to the pharmacy to get something appropriate. This can take into account the OTC treatments that have already been tried.

If the patient gets free prescriptions and does not have enough money to buy symptom relief, many of these items are available on prescription and are not expensive. Most people, however, would prefer to buy their medicines, especially if it saves them a prescription fee. For this model to be truly effective, the GP must be familiar with OTC medicines.

Questions to ask
Before recommending an OTC medicine, it is important to determine the patient’s attitude to self-medication by asking the following questions:
What form of self-medication have you tried already?
This will establish if the patient is self-medicating correctly.
How long have you had the symptoms?
This will establish whether the patient is presenting too early.
What medicines do you normally keep at home?
By asking this, you will reinforce the benefits of keeping a well-stocked medicine cabinet.

Symptom sorter

This is intended to help doctors who feel uncomfortable with the idea of recommending specific medicines to patients but want to say something a little more specific than “go to your pharmacist for some medicine”.

Symptom Treatment
Cough Cough suppressant / linctus
Blocked nose Decongestant
Face pain Decongestant / painkiller
Headache Painkiller
Earache Decongestant / painkiller
Sore throat Pastilles / linctus / aspirin
Fever Paracetamol / aspirin / ibuprofen