Orthopaedic Disorders in General Practice

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Chapter 1

A Framework for Orthopaedic Consultations

Publisher Summary

This chapter reviews the framework that a general practitioner should employ for orthopedic consultations. When patients present to their general practitioner with orthopedic problems, the basic techniques and process of consultation are no different from when they presented with nonorthopedic problems. The examination by the doctor is essentially a two-phase process: (1) the doctor has to define the problem, spelling out a diagnosis of the ailment that is affecting the patient and (2) defining the solution that will help deal with the patient’s ailment. While examining the patient, there are a few things that the doctor needs to do: (1) the doctor needs to explore the patient’s health beliefs, (2) considering at-risk factors, for example, job, sport, and other continuing problems, (3) carrying out the relevant examination, and (4) deciding whether the condition can be diagnosed accurately. Defining the solution requires a more comprehensive approach on part of the doctor. The doctor needs to explain the problems, in simple terms, to the patient, especially with regard to diagnosis, seriousness, the nature of treatment available, and the prognosis.

When patients present to their general practitioner with orthopaedic problems, the basic techniques and process of consultation are no different from if they presented with non-orthopaedic problems. The doctor is therefore, involved in:

1. Defining the problem by:

(a) Defining the reason for attendance.

(b) Exploring the patient’s health beliefs by determining

(i) the ideas that the patient has already formed of the nature, cause and significance of their symptoms;

(ii) the effect that their symptoms have had on them;

(iii) the implications of these beliefs on their future health and life-style.

(c) Considering ‘at risk’ factors, e.g. job, sport and other continuing problems.

(d) Carrying out relevant examination.

(e) Deciding whether he can diagnose the condition accurately, given the resources available to him, and whether the making of an accurate diagnosis will influence his immediate management.

2. Defining the solution by:

(a) Deciding whether he can by treatment, improve upon the natural history of the condition, and whether such treatment and the specialist referral which it may involve is needed urgently.

(b) Explanation of the problems, in terms understandable to the patient, especially with regard to diagnosis, seriousness, the nature of treatment available, and the