DIAGNOSTICS DURING RECEPTION. TEAM-WORK IN PRAXIS
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1 DIAGNOSTICS DURING RECEPTION. TEAM-WORK IN PRAXIS FRIENDSHIP MEETING AFTER SKARABORG PROJECT LAULASMAA Madis Veskimägi FAMILY PHYSICIANS`CENTRE OF TÕSTAMAA ESTONIA CONCEPTIONS Lack of time, waiting and delay in modern medicine Development of diagnostical equipment in two main direction: CT, MRI, PET etc for hospitals Flexible, accurate, with rapid results for office reception, so called point of care ideology Rapid development in field of information technology and telecommunication New possibilities than ever before In Estonia during primary care reform is possible to arrange job by own taste, be guided by regulations and laws DIAGNOSTICAL WORK DURING RECEPTION. MAIN CONCEPTIONS Point of care ideology Simultaneous reception by family doctor and doctor`s assistant Doctor`s special interest Main diagnostical equipment in one room, in handy location and ready for use IT and digital report an digital output of equipment for documentation and archive During reception, it is possible to do during one reception 2-4 different investigation and making more exact plan for further management. It is possible to discover more serious condition quickly in patients who does not looks like very ill
2 X ray X ray unit Flexible cassette holder Developing machine Certificate Dry film in negatoscope in 4-5 minut, during reception Family doctor`s special interest, training in primary interpretation Collaboration with radiologist Mainly chest x ray, limbs, scull ( paranasal sinus) About 1-2 patients per day
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4 Sonography Mysono 201 Compact, digital, new model ( 2001) Compatibility with computer 1-2 investigation per day Abdominal pain, hydrothorax, prostata, call stones, pregnancy, swollen area, Baker cyst 1-2 interesting findings per week REAL SUPPORT IN EVERYDAY WORK!!!
5 LABORATORY Tests during reception Clinical blood ( 9 parameters ) CRP Urine analyzator, 10 parameters Sedimentation reaction Blood glucose Occult blood Blood film Strep A Uricult Tympanometria MT 10 Compact, easy to use in reception and homevisits Result during seconds Approbation by ear-nose-throat doctors: this investigation help to select efectively true specialist patient
6 BLOOD PRESSURE MONITOR ABPM 04 Easy to use VERY informative investigation in hypertension, for diferentation white coat hypertension, anxiety disorder and pure organical hypertension Great satisfication of patient and doctor
7 Panic disorder True organic hypertension WHITE COAT HYPERTENSION STRESS-TEST Veloergometer, step-box Pulse-reader Sfygmomanometer ECG Training-course in sportmedicine Patient group: health diagnostics; tiredness due to probably psychogenic origin, young patient`s fear of serious cardial pathology Spirometry Part of investigation in cases of dyspnoe, wheezing, panic disorder, smoker, monitoring, etc Combination stress-test, 6 min running test Spirometer ready for use, basic values, predicted values, program interpretation
8 TEAM-WORK IN PRAXIS Simultaneous reception by family doctor and doctor`s assistant In team is also nurse of physical therapy and home-care nurse Timeschedule for both worker Doctor`s assistant job is working with chronically ill patients, education, giving prescriptions, lab tests, helping in smallsurgery Internal telephone, call forwarding REVIEW TO LAST WEEK, patient in reception, 3 home visits 8 X ray: 3 chest, 4 of knee and hip pathology 2 Stress-test ( hypertonic reaction, health diagnostic in 37 y man) 1 blood pressure monitoring 9 ultrasound examination 14 whole blood test, 11 blood sugar, 11 CRP 1 telemedicine consultation ( 75 y patient with coxarthrosis indication for endoprothesis ) Result of consultation Tervitan Paremal väljendunud artroos acerabulumi olulise lamenemise ja caput femori deformatsiooniga. TEP --haiglasse Op /Regards. Rightside severe arthrosis, deformation caput femoris and flattening of accetabulum. Indicated total endoprothesis, patient is invited to hospital , operation /
9 Hypothesis of malignant tumor of kidney, metastasis in liver 67 y women, previously healthy Primary reception History of fever 37,5 C 10 day, weak pain in right chest, soreness of throat In general examination lungs normal, rednes of throat, BP 130/80. Patients general appearance suspicious. Body veight reduced approx 15 kg during 6 month. Abdomen palpation painful RUQ Ultrasound examination: enlarged liver, in left lobe round-shaped nodule 5x4 cm. Abnormal left kidney: size 13x6 cm, nodular structure. Lab: Hgb 108, CRV 126; SR 60 mm/h; urine: ery 250; Bil 18; Ubg 70 Chest X ray: reduced transparency in right lower lobe, suspicious right hilus Hypothesis: Renal malignant tumor, liver metasthasis. Right pneumonia. Further management: Initial antimicrobial treatment, phone call to oncologist in centre of oncology Estonia, appointment to reception, investigation and consilium in
10 CONCLUSION AND DISCUSSION In reception is possible to do basic investigation and get ideas for next step We save a lot of patient time and pain Doctor can work by evidence based medicine conception, save time from further visits In cases of serious findings we can send patient to most right institution, without waiting We can prevent delays and waitings for relative easy investigation or repetitive investigation Very important part is collaborative work in praxis Most important is quality, continuous education and active everyday work, investigation of results and feed-back Every workday give new experiences, the work is really interesting, so we can prevent burn-out syndrome We all are winners: patient, medical workers and taxpayer Thank you for attention!!! AND WELCOME AGAIN TO ESTONIA...
Monitoring course of illness 20% Unclear condition. Respiratory infection 50% Unclear pain (chest, back, abdomen, extremities)
CRP RAPID TEST DURING THE VISIT OF FAMILY DOCTOR Madis Veskimägi ESTONIA FAMILY PHYSICIANS`CENTRE OF TÕSTAMAA 17 th World Conference of Family Doctors October 13-1717 2004 ORLANDO, FLORIDA, USA Contents
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