By Kilburn, J.
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Additional resources for Answer Plans for the MRCGP
36 PRACTICE QUESTIONS • Personal need for refining consultation skills. • Use of “active listening” while taking charge of the session. Issues for the practice • Appropriate selection of patients for counsellor. • Requires available room for private use. • Recognized accreditation of counsellor. Resources • Cost of hiring counsellor. • Need to audit the benefit to the practice. • Possibility of prescribing savings (evidence inconclusive). Evidence issues—key points • • • • Lack of clear evidence of efficacy.
Encouragement and advice on benefits of stopping. ). Helping smokers stop • The four A’s—Ask (about smoking at every opportunity), Advise (all smokers to stop), Assist (the smoker to stop), Arrange (follow-up). • Specific techniques—naming the day, removing temptation, enlisting help etc. Evidence issues Of the proven benefits of stopping • Excess risk of serious heart disease halved within a year of stopping. • Risk of stroke halves by 5 years following cessation. • Ex-smokers can restore their life expectancy to that of non-smokers.
Back-up from Macmillan nurses or Marie Curie nurses. 52 PRACTICE QUESTIONS Legal/ethical issues • Awareness that doctors are not able to end life at patients’ request. • Euthanasia is illegal in the UK at present although in some countries is not prosecuted if performed according to protocol. • Consider personal ethics if asked for advice on how to take own life. RELEVANT LITERATURE ABC of Palliative Care: Communication with patients, families and other professionals. Faulkner A, BMJ 316:130–132, 1998.