How do GPs identify where the problems are?

Exactly how do GPs identify clinical problems? That is the question posed by one GP supervisor and RACGP researchers, whose award-winning study is examining how doctors work to identify the best course of action.
 
Earlier this month, the Australasian Association for Academic Primary Care (AAAPC) Annual Research Conference took place in Geelong, showcasing the nation’s leading research and promoting multidisciplinary collaborations.
 
Here, the RACGP’s Adele Kincses presented her work, How GPs identify and prioritise clinical problems: A systematic review, and was recognised with the AAAPC Award for the Early Career Researcher Best Paper.
 
Ms Kincses told newsGP she was shocked but excited about the win, and presenting at the conference was a ‘fantastic opportunity’ for the research team.
 
‘It’s about getting together people who are interested in primary healthcare research, largely from Oceania, but there was also a handful of researchers from the United Kingdom and someone from North America,’ she said.
 
‘Just having a really wide group to present this information to was fantastic, and then we had the plenary session with a lot of people and questions.
 
‘It was really great to be able to share it through this platform.’
 
The paper explores how GPs use varied information sources to interpret patient presentations, and how they then decide on the best course of action.
 
‘In a nutshell, we were trying to shine a light inside of a black box of how GPs identify the problems,’ said Dr Shaun Prentice, an RACGP research officer who led the project.
 
Dr Prentice said the idea from the research started with a conversation with Dr Andy Killcross, 2024’s RACGP South Australia GP Supervisor of the Year, at Sydney’s WONCA World Conference, which eventually led to the study’s key question – how do GPs identify problems in patient presentations?

‘For GPs, there’s all sorts of information that’s thrown their way and it’s very difficult to try and sift through that, to understand what’s most important, and then make sense of that as well,’ he told newsGP.
 
‘We went to the literature to try and find any possible skerrick of information about the topic that we could and then pulled it all together, which sounds straightforward, but that was an 18-month project that we had to undertake.
 
The team, which included Dr Killcross, reviewed 35 studies alongside cognitive psychology researcher Professor Carolyn Semmler and RACGP Senior Research Unit Academic Advisor Professor Parker Magin, before putting together the different pieces of information.
 
Ultimately, they found that how GPs identify problems is influenced by the ‘interplay between patient, doctor and contextual factors, including, amongst others, doctor and patient age, gender and ethnicity, the patient’s health context, and the doctor’s knowledge.
 
‘This reinforces the importance of trainee exposure to a diverse patient case mix in a variety of settings during training,’ the study found.
 
‘The factors identified may support GPs to reflect on their own heuristics to maximise the use of evidence-based practice and when instructing trainees.’
 
The study resulted in a preliminary model outlining steps in these processes, concluding that further research is required to better understand how GPs prioritise problems.
 
For Dr Killcross, he said that in the increasingly complex world of general practice, ‘GPs are frequently required to assimilate information from a multifarious array of sources’.
 
‘What often presents at face value as a simple request, “can I have a repeat prescription please doc?” is rarely that,’ he told newsGP.
 
‘It is more often representing the tip of a far greater “clinical problem iceberg”, of which the patient, and GP, may initially be unaware.
 
‘As such, this research aims to discover the cognitive processes that GPs undertake, when trying to identify and prioritise clinical problems in the consultation environment.
 
‘My hope is that once known, the findings will help to inform the future directions of clinician training and systems and IT design.’
 
The AAAPC conference also included a presentation by Associate Professor Louise Stone on her Australian General Practice Research Foundation funded project project ‘I love my job, but it’s time to go’: Wellbeing triggers for early retirement by female GPs, and several presentations from registrars from the RACGP’s AGPT Academic Post Program.
 
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