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College untroubled by registrars’ test ordering
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RACHEL WORSLEY THE RACGP has poured cold water on suggestions that GP supervision needs revamping following claims that registrars may be“ overordering” pathology tests.
The study, published in the Medical Journal of Australia, found that registrars increased their rate of pathology ordering by 11 % for each of the four GP training terms.
The authors noted that registrars had a“ large degree of clinical independence” and perhaps they needed greater access to supervisor advice in the later stages of their training.
“ As seeking in-consultation information or advice is associated with lower rates of ordering, structural changes to the supervisory model … may be indicated,” they concluded.
But RACGP president Dr Bastian Seidel said GP
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GPRA president Dr Smith isn’ t surprised by the rate of ordering, noting registrars often see patients who are new to a practice.
training was“ designed to decrease direct supervision as the registrar increases competency and confidence”.
“ They are the first point of specialist contact for the patient and take on the responsibility of undifferentiated diagnosis.
“ So given these increasing levels of autonomy, it
is hardly surprising that the ordering of tests increases.”
Dr Seidel said the level of supervision in the latter terms was appropriate based on“ a very low level of patient complaints and supervisor reports”.
General Practice Registrars Australia president Dr Melanie Smith agreed, saying registrars had adequate access
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to supervisor advice when required.
“ Supervision depends on the accessibility of the supervisor, especially with corridor advice … and GP registrars are perhaps transitioning to how a fellow GP will seek advice from their peers and seniors,” she said.
The higher rates of pathology testing found in the study might also reflect the registrars’ patient cohort, she said.
“ Registrars are often seeing new patients to the practice with new presentations. It is not unexpected that they may be ordering more tests than their supervisors who are seeing patients that they’ ve known for 20 years.
“ There may also be an increased awareness of what testing is available. There may be tests that they are ordering later on which they didn’ t know or didn’ t understand earlier in their training.” MJA 2017; online.
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ADVERTORIAL |
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IF WE COULD TURN BACK TIME What“ might have been” for a patient with diabetes
What could have been done for Christina? |
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WHAT WOULD IT BE LIKE IF YOU COULD GO BACK IN TIME AND SEE WHAT MIGHT HAVE BEEN?
Do you have patients that you would have treated differently? Instigated pharmacotherapy earlier? Switched to a different treatment regimen sooner?
In an online article, Dr Gary Kilov, director of the Launceston Diabetes Centre and a senior lecturer at the University of Tasmania, outlines the case of Christina *, a 60-year-old woman with type 2 diabetes who first presents with proliferative diabetic retinopathy( DR) that has resulted in substantial vision impairment.
Why DR needs to be top of mind DR is one of the top five causes of irreversible blindness among Australians. 1
People with diabetes often don’ t know they have it until the disease has become advanced. 1 Regular eye examinations are crucial – at least every two years for all people with diabetes not yet diagnosed with DR, and at least annually for those with existing DR or those at high-risk. 2
High-risk patient groups include Indigenous Australians, people from a non-English speaking
background, patients who have had diabetes for a long time, and patients with poor glycaemic and blood pressure control. 1
Disturbingly, 20 % to 50 % of Australians with diabetes don’ t have eye examinations as often as recommended, leaving them vulnerable not only to retinal deterioration but also a decreased quality of life. 1, 3, 4 People living with DR report:
• a restricted lifestyle due to their inability to drive 3
• difficulties of daily living such as eating, getting dressed and organising medications 3
• difficulties coping with the uncertainty of their future as their condition progresses. 3
Why GP intervention matters Patients with DR can be treated with laser therapy – although laser therapy alone rarely results in significant improvements in vision, it is a key treatment option to help reduce the risk of further vision loss, which is the goal of treatment. 1
For Christina in this case study, intervention came too late. What would Christina – and her GP – have done differently if they’ d known where she’ d end up?
Dr Gary Kilov
READ THE FULL CASE STUDY AND DR KILOV’ S CONCLUSIONS AT: www. australiandoctor. com. au / drcasestudy
* Hypothetical patient. Dr Kilov has provided education and advice to various pharmaceutical companies and organisations involved in diabetes management. Details available from the author.
References: 1. Baker IDI Heart and Diabetes Institute and Centre for Eye Research Australia. Out of Sight: a report into Diabetic Eye Disease in Australia, Melbourne 2013. 2. RACGP. General Practice Management of Type 2 Diabetes – 2016 – 18. Melbourne: The Royal Australian College of General Practitioners and Diabetes Australia 2016. 3. Fenwick EK. Qual Life Res 2012; 21: 1771 – 82. 4. Foreman J et al. Med J Aust 2017; 206( 9): 402 – 6.
Mylan Health Pty Ltd. ABN 29 601608 771. Level 1, 30 The Bond, 30-34 Hickson Road, Millers Point NSW 2000, Australia. Tollfree: 1800 314 527. Date prepared: June 2017. LIP-2017-0039.
2 | Australian Doctor | 28 July 2017 www. australiandoctor. com. au