Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patientsA significant part of the practice of an infectiousdiseases physician is to provide consultation advice forother specialists, ranging from general medicinethrough to surgery, obstetrics and gynaecology,neurology and intensive care. Infectious diseasesphysicians also play a major part leading on infectioncontrol issues in hospital trusts.Sources of referralThe majority of acute admissions (about 80%) comestraight from GPs or the hospital’s emergencydepartment. Others may be referred from other hospitalservices or be admitted as tertiary referrals fromoutlying DGHs. A few, such as those with HIV, mayself-refer. Some of the more vulnerable patients may bereferred by social services, the voluntary sector or fromprisons.Locality-based and/or regional servicesWhile infectious diseases units provide servicesprimarily for the hospital trust in which they are sited,most also provide a regional infection and tropicalmedicine service for more distant DGHs and GPs.Locally, the infectious diseases ward provides isolationfacilities for infectious patients, such as those with TB,and provides specialist advice for other clinicians, suchas those on intensive therapy units (ITUs). Suchfacilities and expertise can be put to use for patientstransferred from other hospitals, including theprovision of negative-pressure isolation facilities orspecialist tropical diseases opinions andinvestigations.Community models of careAlthough most infectious diseases units focus on thecare of acutely ill inpatients, there are increasinginteractions with community care. Many units havedeveloped programmes to provide intravenousantibiotic therapy outside hospital (outpatientantibiotic therapy (OPAT)) to enable medically stablepatients to receive necessary intravenous therapy athome. In addition, HIV care involves communityliaison with social workers and community nurses toprovide holistic care. Finally, some patients withchronic fatigue syndrome (CFS) are treated bycommunity therapists. Increasingly, because of theimportance of healthcare-associated infections, thereneed to be clear links between hospitals and thecommunity to prevent and manage these infections.Infectious diseases physicians take a lead in this area,along with medical microbiologists.Complementary servicesComplementary therapies do not play a role in themanagement of infections. However, some patients withHIV can avail themselves of various complementarytherapies provided by voluntary services with links tothe infectious diseases unit.3 Working with patients: patient-centredcarePatient choice: involving patients in decisionsabout their treatmentPatients are routinely involved in decisions regardingtheir treatment. Many outpatient referrals are nowmade by ‘Choose and book’, allowing patients to see thephysician of their choice, guided by their GP. In HIVcare, patient participation in decisions about treatmentoptions is essential to maintain trust and to increase thelikelihood of adherence to often difficult, long-termtherapies. Before being considered for OPAT, patientsare consulted as to whether or not they want toparticipate in such out-of-hospital care.Ethical and religious considerationsDue to the type of patient groups involved, great store isplaced on the religious and cultural context of patientdecision-making. In infectious diseases and tropicalmedicine, many patients come from non-UKbackgrounds and cultures. Efforts must be made toengage them in their own healthcare. Particular caremust be taken with HIV patients from other cultures,many of whom may have particular concerns abouttheir immigration status. Physicians need to be aware ofthe ethical aspects of decision-making in such difficultcircumstances. Similar issues may arise with patientsinfected with TB or hepatitis viruses.Opportunities for education and promotingself-carePatient information and education are fundamental toall aspects of medical care but are especially importantfor the vulnerable groups that are seen by infectiousdiseases physicians. Education improves patientinvolvement and helps patients to make their owndecisions about aspects of their medical care. This isclearly important in HIV disease so that individualsunderstand the need to take medication, inform theirsexual partners and practise safe sex. Similarly,education and self-help are important aspects of travelmedicine so that travellers can protect themselves fromvarious hazards associated with tropical travel.146 C○ Royal College of Physicians 2013