Top 30: Check 1, 2…

Als bike

Before I ride my mountain bike I check the head stem, the front and rear brakes, suspension, wheels, tyres and for any odd noises when I drop it to ensure nothing is loose. Much better to fix it before the ride, than discover it half way down the hill, right?

On a regular basis, it goes to the mechanic (bike doctor) for a service; and then occasionally it gets dragged into the mechanic in an emergency when I’ve busted something I can’t fix.

Bodies are like bikes. Treat them well, they only need the occasional work; but treat them badly and you’ll be up for a rough ride and they’ll break down on you along the way.

What sort of analogies do you use with your patients, so that they understand the importance of their health check?


 

Presenting for a ‘check up’ is the most common reason for encounter in General Practice. Sometimes it is hard to remember that the majority of the population live with relatively good health, and otherwise don’t need to see their GP that frequently.

The must know resource for check ups is The Red Book

The Red Book, formally called ‘Guidelines for preventive activities in general practice’ is now in its 8th edition, and provides clear guidance on what the patient’s check up should involve, depending on their gender, age, and risk factors such as family history and lifestyle.

It provides further information about the evidence for doing or not doing various checks, with a bit of guidance on how to interpret the data in the front of the book if you are a bit rusty with levels of evidence.

It can prove a useful resource in educating patients on why or why not, they should be checked for various things. Because as we know Choosing Wisely is important: Choosing Wisely II

That’s easy- you say… just hold on a second. You need to know a little bit about the Medicare Health Assessments Does your patient qualify for one of these health assessments? Who in your team can assist you with this?

800px-Sleeping_baby_with_arm_extended

 

Mum brings bub in for their first GP visit and says ‘The paediatrician is away, so they said to come and see you for their 6 week check. I’ve noticed that thy have these funny pimples on their nose.’ Its been 2 years since your paediatric rotation (if you could get one), and you just need a little refresher on the 6 week check: AFP: The 6-week check. An opportunity for continuity of care

 

 

The next parent brings in their teenager saying ‘I don’t know what’s wrong- they won’t talk to me!’ You remember a table that will make sure you don’t forget to ask anything important:

http://www.kidsfamilies.health.nsw.gov.au/media/284370/ahct_template_final-revised.pdf

It’s school holidays, so everyone is taking the opportunity to get their pap smears up to date. You are sure there are other things involved in women’s health: Jean Hailes might have something to say about that.

File:MovemberPL.jpegMovember has just been and you wonder what you can do to engage men with your practice… The University of Western Sydney has published a booklet to assist you with that.

http://www.mengage.org.au/MENGAGE/media/MediaLibraryOne/UWS-GP/GP-Resource-Kit.pdf

And finally, the government has decided to release children from detention (well they haven’t yet- but lets hope they do soon!) so you look for a resource to make sure you do your best by those new to Australia: Refugee health assessment

http://www.swslhd.nsw.gov.au/refugee/pdf/rha_714.pdf

You realise you do more health checks than you think, and that it does really help keep people healthy, and pick things up early. Today it feels good to be a GP.

These are only a few of the resources available to you to assist with ‘Check ups.’

What else do you use?

Acknowledgement: This part of a series of posts that will address the 30 most common reasons for encounter in General Practice, based on a series of A4 handouts created by Tropical Medical Training.

1. Check up


 

Are you exam ready?

File:Dr. Thomas Dwight lecturing students.jpeg

Check ups

The MCQ/AKT (like) Questions:

  1. Peter Parker is a 60 year old man who comes to ask you about Prostate Screening. His father died from prostate cancer and he is concerned of developing the same condition. He is asymptomatic.

What screening would you recommend for Peter?

  • A) None
  • B) I would fully counsel Peter on the pros and cons of prostate screening and tell him screening is not recommended
  • C) I would just add a PSA to his lipids and fasting glucose
  • D) PSA and DRE
  • E) I would fully counsel Peter on the pros and cons of prostate screening, then decide together whether to screen. If screening I would perform both PSA and DRE

2. Pap smear testing is NOT recommended for which of the following patients?

  • A) 35yo lady with LSIL on pap smear 12 months ago
  • B) 64yo widow of 10 years with no abnormal past pap smear history
  • C) 56yo lady with past history of total hysterectomy secondary to fibroids
  • D) 19yo lady who has been sexually active for 3 years
  • E) 30yo lady presenting with positive pregnancy test and 2 years since last pap smear

3. Grace brings Bobby in for his 6 week check.

Which of the following would NOT be an indicator for paediatric hip ultrasound

  • A) Positive Barlow’s test
  • B) Breech presentation
  • C) Sibling with developmental dysplasia of the hip (DDH)
  • D) Birthweight >5kg
  • E) Negative Ortolani’s test

The KFP Case:

Yo Gorilla is a 52yo detective who presents for a check up to make sure he can continue to be seriously smooth. He is usually well and quite an active fellow.  He tells you about a recent day in his life.

Q1. Name 8 health issues you will discuss with Yo Gorilla today:

Yo Gorilla’s BMI falls in the overweight range. He reports he eats a whole congo pack on a twice daily basis. You assess he is ready to change, and go on to advise him on his diet.

Q2. List 5 pieces of dietary advice you could give Yo Gorilla:

Yo Gorilla is motivated and ready to forgo the yogo.

Q3. Name 3 services that may be able to assist Yo Gorilla achieve his dietary change goals:

The answers are below this line


Answers:

AKT

  1. E- Prostate cancer screening is not recommended unless the patient requests screening and is fully counselled on the pros and cons (RACGP Red Book- Prostate Cancer)
  2. C- Pap test screening is recommended every 2 years for women who have ever had sex and have an intact cervix, commencing from age 18–20 years (or up to 2 years after first having sexual intercourse, whichever is later). (RACGP Red Book- Cervical Cancer)
  3. E – Negative Ortolani’s test does not indicate the need for hip ultrasound. (Neonatal Handbook- Developmental Dysplasia of the Hip) For more information on Ortolani’s and Barlow’s tests see Wheeless Textbook of Orthopaedics- Physical exam of DDH

KFP – (all of the following answers would earn 1 mark – If more than one answer on any one line then marks will be deducted from the entire paper)

1. Health issues to discuss with a 52 year old male in a check up (Red Book- Preventive activities in middle age)

  • Smoking
  • Nutrition
  • Alcohol
  • Physical Activity
  • Diabetes/AUSDRISK
  • Depression
  • Osetoporosis
  • Weight
  • BP
  • Colorectal cancer screening
  • Vaccination
  • Absolute cardiovascular risk

2. Dietary advice- (Red Book- Nutrition)

  • 5 portions of vegetables daily
  • 2 portions of fruit daily
  • 3 portions of cereal daily
  • 1-2 portions of lean meat or alternate protein daily
  • at least 2g per day of alpha-linoleic acid daily
  • drink water
  • limit saturated fat
  • limit salt intake
  • limit alcohol intake
  • consume moderate amounts of sugar

https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55a_australian_dietary_guidelines_summary_131014.pdf

3. 3 services to assist with dietary change

  • practice nurse
  • dietician
  • health or fitness coach

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s