GP Management Plan (MP)

I think that all GPs are aware sometimes patients bring an agenda of issues to their 10-20 minute consultations. Upon checking their Medical Records (MR), I notice issues that must be discussed and cannot be left for later consultation.

Unfortunately, sometimes the time is not enough to discuss these issues efficiently.

Considering the best medical care that the patient needs and the resources available to me and the surgery staff, I sometimes decide not to delay dealing with more than one medical problem in a 10 to 20-minute consultation.

In this kind of consultation, some essential things must be covered, including the patient should understand everything discussed during consultation and retaining enough information so that they will be able to act upon the plan we agree on.

The information the patient has to retain is likely considerable, and as expected, sometimes it is difficult for the patient to decide immediately on something unfamiliar.

Another important thing is that the consultation should be documented appropriately.

My solution to these challenging consultations has been the Management Plan (MP)

The principle of the MP is to create a document that will contain the information that helps the patient remember what was discussed during the consultation and the plan we agreed on.

The MP is usually a list of explanations and information about the medical plan agreed upon during the consultation.

This Management Plan is given to the patient so that the patient can review any time.

At this point, look at an example of an Management Plan that would help to understand using this principle. You can find it in the "Videos - how I create MP under the name: "Example of Management Plan".

Let us imagine I see a patient who has many and/or complex health problems that I have to deal with at that consultation. I inform the patient, in my opinion, they will likely have many questions and it is difficult to cover everything during the short time of that consultation. At that point of consultation, I offer the Recommend 2 options:

Option 1 offered at consultation

The patient lets me explain my opinion about their problem(s), answer their question(s) and discuss a plan I suggest or recommend.

I advise the patient that, if they choose this option, there is no need to memorise everything because, at the end of the consultation, I will write up the MP in bullet points, and the patient will have it. I explain to the patient how I would give them the MP. 

I advise the patient that I will mention the key points of each step of the investigation, medications, follow-up consultations and so on. 

I stress that the most important part, at that time, is for the patient to understand what is going on with their health. They also should understand some of the important principles of their current and future investigations(s), treatment, and future management of their health conditions.

A key point of this option is that I ask the patient to agree for me to write on the computer a draft of this MP during the consultation.

Option 2 offered at consultation

I will explain and answer their most important questions and discuss and agree on a plan to address the most important problem the patient came to see me for that time.

I will invite the patient to make another appointment(s) for other medical problems that might need to be discussed.

In my experience, most patients will choose Option 1 offered at the consultation.

The essence of creating the MP is that I need a set of templates that I would copy and paste into the MP. These templates are about the most often medications, investigations, treatment schemes, how to monitor different treatments or disease progressions and so on. Each clinician can and should create their own templates or copy templates that, in their clinical judgment, include the information they consider appropriate to be delivered to the patient

I describe below how I practically create an MP

You can watch the video that describes the technical support of MP

There are three main ways to create MP

a. using an MP "word" working page

b. using an MP "pdf" working page

c. creating MP using clinical speech recognition software.

I am 100% sure anyone can create the Word and pdf working pages - it is very simple.

a) using an MP "word" working page

I created a word page with 2 tables.

On top of the document is a table with the alphabet

The letters in the alphabet table have a links to the second table.

In the second table, there are different titles organised in alphabetical order.

The titles have links to the subjects that contain the information that I want the patient to remember. I copy and paste the text into the MP.

I would like to mention that it is easier to work with 2 monitors so that on one monitor you have the MR and on the other monitor you have the MP "word" working page.

I recommend you look at an example of a word working page.  This is a sample of the MP "word" working page.  You can download it and see how it works. I hope you will find it easy to check with no more explanations.

b) using an MP "pdf" working page

Using MP "pdf" working page for creating an MP is similar to the Word document. The main differences are: 

       - the links are opened left-click on the link instead of pressing "ctrl" key and left-click.

       - you cannot write in the pdf

I recommend you look at an example of a pdf working page. This is a sample of the MP "pdf" working page. You can download it and see how it works. I hope you will find it easy to check with no more explanations.

c) creating MP using clinical speech recognition software

When I create MP using Dragon Medical One, I use the same information recorded in MP "Word" or "pdf" working page.

There is a function in clinical speech recognition software named "Auto-text". This is a voice command for inserting specific text into a document.

I practically created "Auto-text commands" for all the templates/subjects that I recorded in "word" and "pdf" working pages. When I use clinical speech recognition software, there is no need to search and click on links to open the templates.

For example, if I want to add on the MP information regarding QRISK using clinical speech recognition software, I say the command "explanation QRISK" and the clinical speech recognition software will insert the text regarding QRISK.

Now, I think it is useful for you to have a look at short videos illustrating how I create some short MP. You can find these videos in the section "videos - how I create MP"