What's the second rule of three in general practice?

#GPFUQ 73 What’s the GP-patient communication formula? Effective communication with a patient is proportional to your understanding and respect of that patient.

#GPFUQ 74  What’s the formula for a patient following a recommended treatment? A patient’s adherence to a recommended treatment is equal to the patient’s preference plus the treatment’s relevance multiplied by its perceived effectiveness divided by the sum of the effort required to adher and the adverse side effects

#GPFUQ 75  What’s the 4+2 formula for successful GP management. The GP management includes the four essentials - good strategy, execution, culture and structure plus at least two of the secondary management practices- good talent, innovation, leadership and partnerships.

#GPFUQ 76 What’s the formula  for living with bureaucracy? If a problem is impossible to solve, you have to handle it where it lies.

Any large organization has arcane practices that need to be challenged. The NHS and the rest of the bureaucracy asks us for lots of meaningless information, and often refuses to process our requests unless all the information is supplied. Much of the requested information is of no practical use other than to establish who we are, what we say we’ve done, and that we are compliant. The aim is to reduce the  micromanagement of work that results in more time spent on  paperwork and less time for clinical work. It's best to work with the NHS and others to reduce unnecessary bureaucracy. Agree a ‘can do’, ‘no blame’, ‘have patience’ approach to improvement and stopping requests for unnecessary information. Always question non-evidence based work e.g. work related to unvalued target chasing

#GPFUQ 77   What’s the first rule of three in general practice? A patient (and the GP) are only likely to remember three things from any consultation. Decide what are the most important three things to remember in each consultation.

#GPFUQ 78  What's the second rule of three (or the three strikes rule) in general practice? If a patient returns three times with the same problem and you haven’t been able to solve it then you should refer the patient to someone else to help solve the problem e.g. refer to a specialist.  

#GPFUQ 79  What's the third rule of three  in general practice? Heaven in general practice is 3 patients in a row one with diabetes, one with depression one with asthma. Hell is 3 patients in a row with the same problem depression, or diabetes or asthma 

#GPFUQ 80 How long is the attention span of a GP? It varies throughout a career. It may start at about 20-30min but after a  lifetime of dealing with problems in 10-15 minutes slots  it becomes about 10-15 minutes.