MICGP CKT key terms

A consultation approach that explores the patient's ideas, concerns and expectations alongside the clinical agenda, agreeing shared management. It improves satisfaction, adherence and safety-netting compared with a purely doctor-led, biomedical interview.

Openly negotiating at the start of a consultation which problems to cover, in what order, and within what time. It reduces 'doorknob' late disclosures and unmet concerns, and protects the clinician's need to address urgent items.

Advice given at the end of a consultation explaining which symptoms should prompt the patient to seek further help, how quickly, and how to do so. It is a documented risk-management tool when diagnosis is uncertain.

The normal situation in primary care where symptoms do not yet fit a single diagnosis. Safe practice involves acknowledging it, arranging timed review, and giving clear return advice rather than premature reassurance or over-investigation.

A planned period of observation without immediate treatment or investigation, used when symptoms are likely self-limiting or when intervention carries more risk than benefit. It requires explicit review criteria and documentation.

The extent to which a patient sees the same clinician or team over time, allowing accumulated knowledge and trust. It is associated with better preventive care, fewer hospital admissions and higher patient satisfaction in general practice.

Deliberately organising a patient's care across clinicians, settings and time so that information and responsibility are shared. In primary care it includes referral letters, discharge summaries, medication reconciliation and named care leads for complex patients.

The presence of two or more long-term conditions in one person. It complicates guideline-driven care because single-disease protocols may conflict, so priorities should be set with the patient rather than applied condition by condition.

The concurrent use of multiple medicines, often defined as five or more regular drugs. It may be appropriate or problematic; structured medication review should weigh benefit, burden, interactions and the patient's goals.

The planned, supervised withdrawal of medicines that no longer provide net benefit, are causing harm, or conflict with the patient's goals. It requires tapering where relevant and monitoring for recurrence of symptoms.

A state of reduced physiological reserve making a person vulnerable to disproportionate deterioration after minor illness or stress. Recognised clinically by exhaustion, slow gait, low activity, weakness and weight loss, it alters targets for screening and treatment.

An ongoing conversation recording a person's values, goals and preferences for future care, including treatments they would refuse. It supports decision-making when capacity is lost and should be reviewed as circumstances change.

A legal document in which a person nominates someone to make decisions on their behalf if they lose capacity, covering property and finance and, separately, health and welfare. It must be registered before it can be used.

The legal ability to make a specific decision at a specific time, assessed by whether the person can understand, retain, weigh and communicate relevant information. It is presumed unless shown otherwise, and unwise decisions do not prove incapacity.

A collaborative process where clinician and patient discuss options, benefits, harms and the patient's values, then agree a plan together. It is particularly relevant where evidence shows closely balanced alternatives, such as screening or anticoagulation.

The number of patients who must receive an intervention for one additional person to benefit over a defined period; the reciprocal of absolute risk reduction. It communicates benefit size more usefully than relative risk alone.

The probability that an outcome occurs in a person or group over a stated time, expressed as a percentage or per thousand. It differs from relative risk and is the basis for meaningful decisions about prevention and treatment.

A validated tool estimating the ten-year probability of a cardiovascular event from factors such as age, sex, smoking, blood pressure, lipids and diabetes. It guides statin and antihypertensive decisions but should be interpreted with clinical judgement.

An inherited disorder of LDL cholesterol clearance causing markedly raised LDL from birth and premature atherosclerotic disease. Suspect it with very high LDL, family history of early coronary disease, or tendon xanthomas; use validated criteria and refer for genetic testing.

Treatment given after a disease event to reduce recurrence, such as antiplatelet therapy, statin, blood pressure control and lifestyle change after myocardial infarction. It differs from primary prevention, which addresses people without established disease.

A clinical syndrome of breathlessness, fatigue and fluid retention with left ventricular ejection fraction typically below 40 percent. Guideline therapy combines renin-angiotensin blockade, beta-blockade, mineralocorticoid antagonism and SGLT2 inhibition.

An irregularly irregular supraventricular rhythm with absent P waves, causing palpitations and predisposing to cardioembolic stroke. Management addresses rate or rhythm control, anticoagulation by stroke risk score, and correction of reversible triggers.

A scoring system estimating stroke risk in atrial fibrillation from factors including heart failure, hypertension, age, diabetes and prior stroke. Higher scores support anticoagulation, which should be weighed against bleeding risk.

A lung function test measuring how much and how quickly air is exhaled. A reduced post-bronchodilator FEV1/FVC ratio indicates airflow obstruction, distinguishing obstructive from restrictive patterns when interpreted with history and transfer factor.

Persistent, largely irreversible airflow obstruction, usually from tobacco smoke, with breathlessness, cough and exacerbations. Confirmation requires post-bronchodilator spirometry; management combines inhaled bronchodilators, smoking cessation, vaccination and pulmonary rehabilitation.

The extent to which asthma symptoms, reliever use, night waking and activity limitation are minimised. Poor control warrants checking inhaler technique and adherence and stepping treatment up or down according to a structured pathway.

A written, personalised document telling a patient with asthma or COPD which symptoms signal deterioration, what treatment to start, and when to seek urgent help. It reduces admissions when rehearsed and reviewed.

Symptoms or signs suggesting serious underlying disease rather than a benign self-limiting cause, such as weight loss, rectal bleeding, dysphagia or iron deficiency anaemia. Their presence changes investigation thresholds and referral urgency.

An urgent suspected-cancer referral pathway used when defined criteria are met, aiming for specialist assessment within a short target. Correct use depends on recognising alarm features and relevant age or risk thresholds.

A stool test detecting human haemoglobin, used to triage symptomatic patients with lower gastrointestinal symptoms and in screening programmes. A negative result in low-risk patients can support watchful waiting rather than immediate colonoscopy.

Glycated haemoglobin reflecting average blood glucose over roughly the preceding two to three months. It diagnoses and monitors diabetes but is unreliable in haemoglobinopathies, pregnancy, recent transfusion and some anaemias.

A state of raised blood glucose below the diagnostic threshold for diabetes, indicating increased future risk. Intensive lifestyle intervention and structured education can delay or prevent progression to type 2 diabetes.

A clustering of central obesity, raised blood pressure, dyslipidaemia and impaired glucose regulation that together markedly increases cardiovascular and diabetes risk. Management targets weight, activity and each component rather than one single abnormality.

Guidance to temporarily stop certain medicines, particularly ACE inhibitors, diuretics, metformin and NSAIDs, during acute dehydrating illness. The aim is to reduce risk of acute kidney injury, with clear instructions on when to restart.

A degenerative joint disease with pain, stiffness and reduced function, typically worse with use. Diagnosis is clinical when typical; management centres on exercise, weight loss, analgesia and education, with imaging reserved for atypical features.

An inflammatory condition of older adults causing bilateral shoulder and hip girdle pain with marked morning stiffness and raised inflammatory markers. It responds rapidly to low-dose corticosteroids; giant cell arteritis symptoms must be sought.

A large-vessel vasculitis of older people causing headache, scalp tenderness, jaw claudication and visual loss. It is an emergency: start high-dose corticosteroid immediately and arrange urgent specialist assessment to protect sight.

Compression of the lumbosacral nerve roots causing saddle anaesthesia, bladder or bowel dysfunction, and bilateral leg symptoms. It is a surgical emergency requiring immediate same-day referral for imaging to prevent permanent deficit.

A nine-item self-report questionnaire scoring depressive symptom severity over the previous two weeks. It supports assessment and monitoring but does not replace clinical interview, and it must be paired with suicide-risk enquiry.

A structured psychological therapy targeting unhelpful thoughts and behaviours maintaining distress. It is first-line for many anxiety and depressive disorders and is often delivered in guided self-help or digital formats in primary care.

A potentially life-threatening toxidrome from serotonergic excess, with agitation, tremor, clonus, hyperreflexia and fever. It is precipitated by combinations such as SSRIs with tramadol, triptans or MAOIs, and requires stopping the agents and urgent care.

A pregnancy disorder of new hypertension with proteinuria or maternal organ dysfunction after 20 weeks. It threatens mother and fetus, so suspected cases need urgent assessment, blood pressure control and delivery planning.

Depressive illness occurring in the weeks to months after childbirth, with low mood, guilt, sleep disturbance and impaired bonding. It is distinguished from brief baby blues and puerperal psychosis, and treated with psychological therapy and sometimes antidepressants.

A programme of tests offered in pregnancy to estimate the chance of conditions such as chromosomal anomalies, anaemia and infectious disease. Results are probabilistic, so counselling about false positives and diagnostic confirmation is essential.

The commonest skin cancer, typically a pearly nodule with telangiectasia, rolled edge or ulceration on sun-exposed skin. It rarely metastasises but locally destroys tissue; suspected lesions are referred for confirmation and excision.

A malignant tumour of melanocytes, assessed using asymmetry, border irregularity, colour variation, diameter and evolution. Early recognition and urgent excision are critical, and any changing pigmented lesion should be referred without delay.

Examination of skin lesions with a magnifying device and light, revealing pigment network and vascular patterns invisible to the naked eye. It improves diagnostic accuracy for pigmented lesions when used by trained clinicians.

Direct inspection of the ear canal and tympanic membrane to identify wax, discharge, perforation, retraction or effusion. Correct technique, including gentle pinna traction, is essential before interpreting findings or prescribing drops.

Fluid in the middle ear without acute infection, causing conductive hearing loss and often detected as speech delay in children. Most resolve spontaneously; persistent bilateral cases with hearing impact may need referral.

Conjunctival redness that may be benign or sight-threatening. Features such as pain, photophobia, reduced vision, contact lens use or a fixed pupil suggest keratitis, uveitis or acute glaucoma and require urgent ophthalmological assessment.

A structured team review of an incident or near miss, examining what happened, why, and what should change. It is a learning tool in clinical governance, distinct from disciplinary investigation, and should produce documented actions.

A quality-improvement cycle comparing current practice against an agreed standard, implementing change and re-measuring. It differs from research because it evaluates existing care rather than generating new generalisable knowledge.

A professional and statutory obligation to be open and apologise when care has caused harm, explaining what happened and what will be done. It applies promptly and honestly, and is not an admission of legal liability.

A patient's voluntary and informed agreement to examination or treatment, based on adequate information about purpose, risks and alternatives. Valid consent requires capacity; where it is absent, decisions follow legal frameworks and best interests.