Search

The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written examination, Part A of the FCFP(SA) examination. The series aims to help Family Medicine registrars prepare for this examination. Model answers are available online.Keywords: FCFP(SA) examination, Family Medicine registrars

THE PURPOSE OF THE STUDY is to explore the experiences of pregnant women doctors working in public sector health facilities in the Western Cape and to ascertain whether occupational health laws and guidelines are being implemented for pregnant women doctors. This is being done in order to provide feedback to Western Cape department of health, so that if found necessary, recommendations for the improved occupational health of pregnant doctors can be implemented. THE OBJECTIVES are to conduct an internet-based survey of woman doctors who have experienced pregnancies while working in the public sector. The three main objectives are: 1. To describe the demographics of the respondents 2. To explore the experiences of the respondents with regard to working while pregnant 3. To assess the knowledge of occupational and other laws that relate to pregnant women at work. HYPOTHESIS: There is currently poor implementation of occupational health laws and services for pregnant doctors in the various government health facilities in the Western Cape SIGNIFICANCE OF THIS RESEARCH: "The progress of women in medicine is a long and continuing journey," AMA Women Physicians section (Anon.2013). The number of women graduating as doctors has increased. Many of these women form the mainstay of the public-sector workforce. Attention needs to be focused on ensuring the safety of pregnant women doctors and the safety of their unborn babies. METHODOLOGY OF STUDY: Study Design: This is a retrospective, survey-based, descriptive study using an electronic survey/ questionnaire as a tool. The survey includes both set answer options from which to choose as well as areas for respondents to give comments, which will add a qualitative element to the research. CHARACTERISTICS OF THE STUDY POPULATION: The study population consists of women doctors who took maternity leave while working in the state sector in the Western Cape from 2009-2015. INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria: All women who complete and submit the survey will be included in the sample. No exclusion criteria are envisioned.

Includes bibliographical references, The group studied were elderly people who had recently experienced an unexpected deterioration in their functioning, and who seemed to be coping well. It has been noted in the literature that many elderly continue to "age well" despite a setback to their health. The aim of this study was to understand and describe factors that participants had found useful in adapting to deterioration in health, so as to inform others going through a similar process, and health care workers who work with the elderly. This was a qualitative study conducted in a General Practice setting in Southern Suburbs of Cape Town. Nine semi-structured interviews were conducted. These were recorded and transcribed. Transcriptions were analyzed using Thematic Analysis. Analysis revealed a Core Theme, "In search of a new normal life", which described a process of transformation of aspects of themselves which participants needed to undergo in order to successfully deal with their new circumstances. Additionally, four Themes were identified that facilitated this transformation. These were "Groundwork" (preparation for old age), "Support" (family, friends and accepting help) , "Spirituality" (religious as well as existential wellbeing) and "Character" (key traits and attitudes). Overall, this study suggested that in order to continue to "successfully age" when health fails, a process of transformation of self seems to be necessary. Furthermore, it identified facilitating factors that may be able to be taught and learned. Importantly, the study also highlighted the shortcomings of the prevalent "Pathological Model" of health with respect to care of the elderly. The following implications for practice in caring for the elderly emerged from this study. One: Health care practitioners need to look beyond the biomedical model and remember the importance of spiritual, social and psychological dimensions that contribute towards living a meaningful life in older age. Two: Health care practitioners need to be aware of a transformative process that the elderly undergo in dealing with deteriorating function, and to assist in this process. Further research in this area to develop practical interventions, is recommended. Three: Based on the factors identified that facilitate transformation, health care practitioners need to educate their younger patients about what measures they can put in place to prepare for older age.

Includes abstract., Includes bibliographical references., Type 1 diabetes is an important chronic endocrine illness of adolescence. It presents a range of unique and difficult to manage problems by virtue of the developmental challenges that face adolescents. Medical services are often ill equipped to deal with this patient group while the complicated management regimes necessary for glycaemic control has far ranging and potentially adverse psychosocial effects on the adolescent and their family. These challenges are experienced directly by the family, arguably the most important proximate influence in the adolescents’ life. Psychosocial factors are pivotal in not only managing metabolic control but also in determining healthy family function and quality of life. This compels health workers who treat diabetic adolescents to comprehensively understand the families they work with. While there has been much research into the psychosocial aspects of adolescents with Type 1 diabetes, there is far less on the way that families and specifically parents experience this chronic illness in family life. Mothers are usually the most important caregivers within this context, taking the lead in co-ordinating and managing the health care needs of their families. The aim of this study is to gain further understanding of how families, specifically mothers make sense and incorporate their experiences into their broader comprehension of how Type I diabetes has affected themselves and their families.

Includes summary., Booth Memorial Hospital (BMH), situated at the foot of Table Mountain in urban Cape Town, South Africa, is an NGO-run hospital in a Public- Private Partnership with the Western Cape Department of Health. The essential service being offered is sub-acute health care, with state hospitals referring patients needing terminal, rehabilitation or convalescent care for a variety of illnesses. Post-acute stroke rehabilitation forms an integral part of the general service being offered by BMH. This dovetails with the state-run rehabilitation hospital in the sense that younger patients able to undergo intense rehabilitation are sent to the state-run hospital, while BMH generally cares for those patients who may not be able to withstand the rigours of an intense rehabilitation program. In our setting, this means that most of the patients seen at BMH for post-stroke rehabilitation are elderly. The elderly patient who has suffered a stroke is vulnerable in many respects. The most obvious vulnerability refers to the physical, emotional and psychological derangements that follow strokes in this age group. In addition, due to rampant poverty prevalent in the community we serve, social and economic factors place this group of patients at an even greater disadvantage. It is an imperative for social survival and an acceptable quality of life that this group of patients retain as much of their independence and empowerment after the stroke as is possible. The current situation of overflowing old-age homes, increasing prevalence of elder abuse and neglect, and the deficiency of community structures to care for the elderly compel health care providers to ensure that a post-stroke rehabilitation service operates with maximal efficiency, given the paucity of resources endemic in our health system. The above factors provided an impetus for this study. A need arose to assess the quality of the stroke rehabilitation services at BMH, as the starting point to what is hoped will be a continuous Quality Improvement Cycle. An additional factor compelling the examination of the quality of service being offered is that the Geriatric population is underserved in the present health system, competing for scarce resources with other vulnerable groups such as children, Cancer patients, and people living with HIV/AIDS. By focussing on a service that is almost exclusively aimed at the elderly, we hope to be able to advocate for greater resource allocation to this age group, given that receiving good health care is essential to the quality of life of the ageing population. This assessment of the current services looked at the Structure, Process of care and Clinical Outcomes of stroke rehabilitation services being given to patients over the age of 65 years. The findings were evaluated against internationally accepted norms of post-acute stroke care, and are presented in this study.

Background: By 2005 an estimated 5. 5 million South Africans were living with HIV and the peak prevalence of HIV/AIDS occurs in young people aged 15-24 years. In order to develop prevention strategies aimed at young people, it is important to determine risk behaviours for HIV in this age group. As VCT has been shown to impact on risk behaviours, it is important to determine the accessibility of these services to youth. Aim: This study assessed the knowledge, attitudes, beliefs and practises (KABP) of young adults, 15-24 years of age attending a private general practise, regarding risks for HIV and accessibility of HIV Voluntary Counselling and Testing (VCT) services. Methods: This was a cross-sectional study. A self-administered questionnaire was completed by a sample of 100 patients attending a general practice located in Athlone. Results: Thirty-six of respondents were male and 64 were female. The age range was 15 to 24 years, with a mean age of 20.2 years. The demographic profile of the study population was typical of a formal urban settlement in a traditionally coloured area. Sixty four percent of respondents reported current or previous sexually activity, of which 89% reported that they had one sexual partner over the preceding three months and 58%, reported not using a condom at their last sexual encounter. The mean age of sexual debut was 16 years. Most respondents could identify safer sexual practices. While 97% of respondents had heard of HIV, only 33% knew someone who had died of HIV/AIDS. Most respondents knew how HIV was transmitted and 74% felt that they had never put themselves at risk of contracting HIV. Seventy five percent of respondents had heard of VCT, and 60% had considered having a test. Knowledge regarding the location of VCT testing sites, methods of testing and waiting period for results was generally poor. Most respondents had a favourable impression of staff in the clinic/CHC setting and would return to these facilities for HIV VCT. However, 71 % reported that they were prepared to pay for a HIV test. Respondents reported that having an HIV test would have a positive effect on sexual behaviour; however, only a third would disclose their HIV test result. Discussion: Respondents had high levels of awareness of HIV prevention strategies but these did not always translate into the adoption of appropriate behaviours. This disparity between awareness of HIV prevention strategies and actual risk taking sexual behaviour could reflect inadequacies in current HIV education programmes. Knowledge regarding most aspects of HIV VCT was inadequate, but there was a high willingness to test for HIV. Respondents indicated that they were prepared to pay for VCT. VCT could be used to engage with young adults and impact on behaviour changes. Further studies may be useful to illustrate the potential of VCT as a prevention strategy and to promote the allocation of more resources for this purpose.

Includes bibliographical references., AIM OF THIS STUDY: To describe how doctors are prescribing low dose antidepressants at Heideveld Community Health Centre. OBJECTIVES: 1. To determine how many patients are being prescribed low dose antidepressants at Heideveld Community Health Centre. 2. To see what sort of dosages are being prescribed as low dose most frequently. 3. To see if indications for the use of low dose tricyclic antidepressants are being recorded. 4. To identify the indications for the use of low dose tricyclic antidepressant. METHOD: A total of 500 patient folders were reviewed. 50 patient folders, (10 folders each from five medical officers), were systematically sampled, per day, for ten days over a two week period. Records were reviewed and data was captured on a data capture sheet. Demographic data: age and gender was recorded. The dose of the antidepressant per patient was recorded. The indication for its use was recorded. Where the indication of its use was not recorded, this was also documented. RESULTS: 1. Of the 500 folders reviewed, a total of 153 (30,6%) of the patients were prescribed low dose tricyclic antidepressants at the consultation, during the time that the study took place. 2. The minimum dose used was 10mg and the maximum dose used was 75mg of tricyclic antidepressant. The median dose used was 25mg. 3. 83% of the folders had reasons for the use of low dose tricyclic antidepressant recorded. 17% of the folders had no reason recorded. 4. The reasons for using low dose tricyclic antidepressants, were for chronic pain syndromes, insomnia, somatic symptoms and for psychological or psychiatric reasons (anxiety or depression related symptoms). CONCLUSION: Low dose tricyclic antidepressants were justifiably prescribed for the many non-psychiatric and psychiatric conditions that respond to it, at Heideveld Community Health Centre.

Includes bibliographical references., Woman abuse is now well recognised as a local and international concern that has serious repercussions for women's health and well-being. Little however is known about what it feels like to be abused by someone you love. How does a woman make sense of a life of physical and psychological abuse? Why does she stay in the abusive relationship? To gain more understanding of this complex dynamic, a qualitative study of five women's experiences of violence by an intimate partner was performed. The first part of this paper, a literature review, examines women's accounts of their experiences in abusive relationships by looking at common themes across these studies. The second part details the research process. The knowledge uncovered by the women's stories, can provide family physicians with valuable insights for devising strategies to identify and intervene in domestic violence.

Prayer and spirituality are aspects of patient care that are not often addressed in modem medical practice. Controversy surrounds the family practitioner's role regarding prayer. The patient's belief system and religion are neglected psychosocial variables. Prayer is accepted as an integral aspect of therapeutic counselling, by pastoral counsellors. This is a qualitative study of a purposeful sample of 10 adult patients, selected by the author and three other family practitioners of different religious persuasions. All the participating doctors practise in the "township" areas of the Cape Peninsula. The intention is to gauge the patients' opinion on the family doctors' role regarding prayer and to determine whether differences in religion between the doctor and patient affects the patients' choice of doctor or their religious enquiry or discussion. The individual semi structured interviews are summarised in Venn diagrams. Results, after analysis, are presented collectively. The results confirm other studies and literature, viz. that there is a lack of religious inquiry, initiated by doctors. All respondents had, however, indicated that they would attend doctors of different religious persuasions. Most respondents felt that they would not discuss religious or spiritual issues and would only attend those practitioners for biomedical needs. The positive reinforcement of the doctor patient relationship, for respondents who shared spirituality or prayer with their practitioners, is a significant finding. A sample spiritual inquiry and respondents' suggestions to facilitate the introduction of spirituality into the family practice consultation are presented.

Introduction: In 1994 the Bonteheuwel and Valhalla Park clinics in Cape Town started a pilot project for the care of patients with chronic disorders. Patients in Bonteheuwel and Valhalla Park with chronic disorders who were previously under the care of Day Hospital or Hospitals in other suburbs, can now receive treatment and follow-up at the local authority clinic. There are currently nearly two thousand patients under Bonteheuwel clinic and nearly two hundred patients under Valhalla Park Clinic. Aim: To see if decentralising the care of patients with chronic medical conditions to local clinic level results in altered patient satisfaction. Objective: To look at patient satisfaction with clinic care compared to satisfaction with care at the previous place of service through administration of a comparative questionnaire. Methods: Data was collected by administering a questionnaire to a systematic sample of patients. The questionnaire was administered to 271 clients at Bonteheuwel and 43 clients at Valhalla Park clinics whilst they were waiting to see the doctor or to collect medication. The questionnaire asked patients to assess the clinic service in comparison to their previous place of service by asking whether various aspects of the service are better at the clinic, were better at their previous place or service or are much the same. Patients were also asked what they like best and least about the clinic's service and that of their previous place of service. Results: Results showed a high level of satisfaction with the clinic service compared to the previous place of service, especially in terms of access, cost, surroundings and waiting times. 95% of patients at Bonteheuwel and 98% of patients at Valhalla Park preferred being under the care of the clinic rather than under the care of their previous place of service. Patients felt there was not much difference in the doctor's technical or communication skills at the clinic compared to their previous place of service. Some patients at Bonteheuwel Clinic voiced concerns about the lack of facilities available at the clinic and felt that the clinic needed to be expanded to become a day hospital. Conclusions: Decentralising the care of patients with chronic medical conditions to local clinic level has resulted in increased satisfaction of patients. With the restructuring of health services in the Western Cape at present, decentralising the care of patients with chronic medical conditions to local clinic level may be an option for some communities.