By Daily Mail
London - General practitioners act as the gatekeepers when it comes to our health – they decide whether they should treat you or whether you need specialist attention. It is a challenging role, since a family doctor needs some understanding of a broad range of physical and psychological conditions.
With even specialists overwhelmed by the rate of medical developments, are there ways GP care could be improved?
Urologist Chris Eden said: “I struggle to remain current with the latest research in prostate cancer and can’t imagine trying to keep abreast of advances in all specialities.”
We ask some of the UK’s leading medical specialists to identify how doctors could enhance the care they provide.
Dr Glyn Thomas, a cardiologist at the Bristol Heart Institute, said: “People who suffer with atrial fibrillation – irregular heart rhythm – are five times more likely to have a stroke; and those strokes are also more likely to be fatal.
“Atrial fibrillation patients should be prescribed an anticoagulant such as warfarin to prevent the blood clotting.
“GPs often prescribe aspirin instead because they fear the risk of internal bleeding. This is nonsense. Not only does aspirin carry the same risks of bleeding, it’s ineffective as an anticoagulant.
“Warfarin reduces the risk of stroke by 64 percent; aspirin reduces it by 0 percent. The bleeding risk is the same.”
‘Warfarin does need careful monitoring, which perhaps is why GPs might not prescribe it, but I think the main reason is they are concerned, wrongly, about excess bleeding.”
Dr Peter Fairclough, Harley Street consultant gastroenterologist, said: “I see patients needlessly referred after an attack of upper abdominal pain, which their GP says is gastritis. They recommend investigation with an endoscopy.
“These patients have gallstones. They won’t be picked up through an endoscopy but with blood tests or ultrasound.”
Professor Gordon Jayson, oncologist and ovarian cancer specialist at The Christie Hospital in Manchester, said: “GPs need to listen carefully when a women in her 50s complains of abdominal pain and bloating. It’s easy to think it’s IBS (irritable bowel syndrome) – and in most cases, it will be.
“But the symptoms could be those of ovarian cancer. The difference is that whereas IBS pain will come and go, the pain from ovarian cancer will be progressive and constant.
“If it’s the latter, a GP needs to do a blood test for the chemical CA125.
“If it’s caught early, 95 percent of cases are treatable.”
“For a GP with only a few minutes to make a diagnosis, IBS is going to be faster and a far more likely diagnosis than ovarian cancer. A study by Target Ovarian Cancer found four in five GPs wrongly thought women with early-stage ovarian cancer had no symptoms.”
Dr Andrew Dowson, director of headache services at King’s College Hospital, London, said: “Many GPs will miss a diagnosis of migraine as they think this type of headache has to have an aura preceding an attack, but only one in 10 patients has an aura and only 40 percent of these will get them all the time.
“A GP needs to recognise the other main symptoms such as one-sided throbbing, nausea or light and sound sensitivity.”
Andrew Wright, dermatology professor at the University of Bradford, said: “The routine seems to involve the GP having a quick look, then prescribing a cream, but little direction is given about how much to use. A 30g tube may be given with a request to come back in two weeks if there’s no improvement.
“The patient thinks the cream must last two weeks, under-treats themselves, the eczema gets worse, they go back to the GP, who refers them to a specialist.
“If GPs could give proper direction, it would save us all a lot of time.
“GPs also shouldn’t prescribe aqueous cream – not even to wash with. It’s incredibly damaging to skin, especially children’s.”
“As a consequence, it breaks the skin down, making eczema worse. Very worryingly, many people are still given it as a moisturiser as it’s the cheapest option.
“Research has shown more than half of children who used it suffered an immediate bad reaction, such as stinging.”
Henry Sharpe, a consultant ear, nose and throat surgeon at East Kent Hospital, said: “About 5.2 million people see their GP with a blocked nose. Many will be given antibiotics or nasal spray on the assumption that the cause is congestion.
“But a blocked nose can be anything from complications of a deviated septum to polyps.
“I’d like to see referrals to an ENT department if the congestion goes on for over a month. Antibiotics won’t work if it is not a bacterial infection; steroid sprays can have side-effects.”
Professor Tony Kochhar, shoulder surgeon at South London Healthcare NHS Trust and BMI The Sloane Hospital, said: “GPs should refer patients with shoulder pain for an ultrasound scan before any other treatment.
“The anatomy of the shoulder is so complex. It’s very hard for a GP to find the cause.
“If there is a tear, and a GP sends the patient for physiotherapy – where they’ll often be told to work through the pain – that tear can get worse.”
Mucus in throat
John Rubin, an ear, nose and throat surgeon at the Royal National Throat, Nose and Ear Hospital in London, said: “I see a lot of patients who have suffered with a post-nasal drip and whose GP has referred them. In fact, it could be something as simple as acid reflux. So rather than referring to a specialist, I’d like GPs first to try a frontline treatment, such as Gaviscon.”
Dr Andrew Bamji, a rheumatologist at Chelsfield Park Hospital, Orpington, said: “Patients with rheumatoid arthritis do much better if they are referred quickly, within four weeks of diagnosis.
“I’d like to see GPs do better at spotting signs of the disease at its early stages – swelling with the joint pain, morning stiffness and generally feeling under the weather.
“And one red flag, which can get missed, is anaemia. Eight out of 10 sufferers have this.”
Eddie Chaloner, consultant vascular surgeon at Lewisham Hospital, says: “Patients with a swollen leg are often given antibiotics because they’re told they have an infection. It’s usually superficial phlebitis – where a vein becomes inflamed and a blood clot forms.
“Usually it goes away on its own. Antibiotics wouldn’t have any effect.
“If there hasn’t been any recent wound or surgery and there’s no pus, infection is unlikely to be the cause.”
Christopher Eden, a urologist and prostate cancer specialist at the Royal Surrey County Hospital in Guildford, said: “Many GPs will advise overweight men in their 40s and older to have a cholesterol test. But men in this bracket are also at risk of prostate cancer, so I wish GPs would offer them a PSA test, too.”
Dr Myles Black, an ear, nose and throat and thyroid surgeon at East Kent University Hospital, said: “GPs sometimes dismiss sudden hearing loss as ear wax or fluid from an ear infection or cold when it could be caused by sensorineural hearing loss, which requires immediate treatment to prevent permanent hearing loss.
“What distinguishes sensorineural hearing loss from the blocked-up feeling you get with a cold is that the hearing disappears completely, usually in one ear. With a cold, that hearing may just be muffled.
“Sensorineural hearing loss – caused when a cold, virus or infection travels to the inner ear – needs speedy treatment with steroids and it worries me that patients could be needlessly losing their hearing because GPs don’t get enough training at medical school to diagnose sensorineural hearing loss.
“Yet it can be picked up easily using a tuning fork.”’ (This is placed on the forehead and, if hearing is normal, the sound will be heard equally in both ears.)
Source: Daily Mail