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College untroubled by registrars ’ test ordering
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Dr Margaret Hamilton , of Sydney , won $ 1000 .
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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