Regional Head of Education update
A few weeks ago, I had the good fortune to attend the Diagnostic Error in Medicine Conference in Melbourne. Along with the added benefits of being able to catch up with three of my children, and do some great shopping, the conference gave me some interesting food for thought. I thought that I would share just a couple of the pearls from this conference with you.
One strategy that was repeatedly reinforced at the conference was that of using frameworks. Diagnostic frameworks, frameworks for history, a framework for your physical examination, and a framework for management. In this way, the chance of making a diagnostic error is reduced significantly, as we use cognitive checks and balances to work through the patient’s problem.
Diagnostic frameworks are being particularly promoted. Sometimes it can be difficult to generate differential diagnoses. This is one ‘weak’ spot where diagnostic error can occur, with others being history taking, examination, and investigations. If diagnostic frameworks are used, a wider range of differentials can be generated, thus decreasing the risk of error, and decreasing the risk of missing any red flag diagnoses. This is important for lifelong practice. It is also important as you start to prepare for the exams. In the South Eastern area, we have started doing small group work as part of our education program, with an emphasis on case-based learning so that we can practice using the diagnostic frameworks. The most useful seem to be PROMPT (as per Murtagh’s textbook) and VINDICATE (surgical sieve).
The other concept that was presented at the conference was the significance of language in medicine. A linguist from Macquarie University presented one of the sessions. She told us that in English, we ‘take’ a history from a patient. In German, the history is ‘received’. The word actually means ‘receiving the memory’. It is a subtle difference, but an interesting one. There can also be very subtle differences in the way we describe patients. For example, ‘He is not tolerating the oxygen mask’ vs ‘He is refusing his oxygen mask’ or ‘He spent yesterday afternoon with his friends’ vs ‘He spent the afternoon hanging out with his friends at the video arcade’. The way we describe patients to a colleague, or write about them in the notes, can make a big difference to the way they are perceived in the future. This can create a bias, which can then stick. The bias then becomes stickier and stickier as it is passed on from one colleague to another. I’m sure I am guilty of this at times. Something to ponder!
The OSCE is over for another cycle. I hope it went well for all of those who participated. For those of you who are digging in for the writtens in a few weeks’ time, study hard and broadly, and read the questions!
Dr Allison Miller | Regional Head of Education South Eastern NSW
Medicare provider number reminder
Deadline for 2019.2 Medicare paperwork:
The deadline to submit an application for Medicare provider numbers for the 2019.2 term is Friday 21 June. All Medicare initial provider number applications and other Medicare paperwork need to be sent directly to Medicare (not GP Synergy).
Medicare provider number check:
Once you have received your Medicare provider number, you must check your letter to confirm you have been issued with a provider number with full billing rights before you commence billing patients. Registrars with refer and request rights will only be able to refer patients and request investigations, until a provider number with full billing rights is received.
2019.2 term dates:
5 Aug 2019 – 2 Feb 2020
What's it like being a rural generalist?
Procedural GP registrar Dr Uri Harrington, and his supervisor Dr David Harwood, had very different journeys to becoming rural GPs.
Both now enjoy living and working in the Western NSW town of Parkes - Uri as a GP Anaesthetist and David as a GP Anaesthetist and Obstetrician.
Clinical pearl: All that wheezes is not asthma!
According to ReCEnT, of the many consultations GP registrars see in practice a significant portion of these are children aged 10 years or younger. Of these consultations approximately 3.4% involve a new presentation of wheeze, asthma or bronchitis/bronchiolitis-like illness.
Asthma is identified as a National Health Priority illness, however in these consultations it is also important to consider other less common but significant diagnoses such as an inhaled foreign body or a cardiac issue.
Suspect inhalation of a foreign body if the wheeze is asymmetrical or unilateral. Or if there has been a history of an episode of choking while feeding or playing.
Suspect a cardiac issue if the patient has associated symptoms and signs associated with heart failure, such as failure to thrive, or difficulty or diaphoresis with feeding, or hepatosplenomegaly (in infants and younger children), or swelling in their legs and/or abdomen or weight gain from fluid retention.
2019.2 key training dates
Stay on top of the key training dates for the 2019.2 term.
RACGP fellowship assessments
Key information for exam enrolment and exam dates can be found on the RACGP website.
ACRRM fellowship assessments
Key information for assessment support program dates can be found on the ACRRM website.