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

2 Specialties Metabolic medicinemetabolic medicine according to their domains ofspecialisation and whether they work in chemicalpathology or general internal medicine. Table 1 showsan example of the types of activities that might beincluded in the job plan of a MM physician with thenumber of programmed activities (PAs) relevant toeach.10 Key points for commissioners1 Metabolic medicine (MM) encompasses fivedomains:• abnormalities of lipid metabolism andcardiovascular risk assessment• disorders of calcium metabolism and bone(eg osteoporosis)• diabetes• nutrition• IMD, particularly in adults.2 Most metabolic medicine specialists are also trainedas chemical pathologists and have an important rolein providing clinical and professional leadershipwithin the clinical biochemistry laboratory.3 Ensuring appropriate management of dyslipidaemiais essential to lowering cardiovascular morbidity andmortality and the MM physician has particularexpertiseinthisarea.4 MM physicians are trained to provide care forpatients with metabolic bone disease includingosteoporosis, an increasing problem as thepopulation ages.5 MM physicians have the appropriate skills andknowledge to provide outpatient and communitycare for patients with diabetes mellitus.6 Nutritional care is often ignored. MM physicianscan assist in improving the quality of care deliveredin this area.7 Obesity is a major public health problem andMM physicians are able to advise on its managementin the community and to deliver a specialistservice.8 Due to improvements in diagnosis and treatment,children with IMD are now surviving to adulthood.MM physicians are specifically trained to providecare for this group of patients.References1 Training curriculum for the sub-specialty of metabolicmedicine, August 2010. www.jrcptb.org.uk/specialties/ST3-SpR/Documents/2010%20Metabolic%20Medicine%20Curriculum.pdf2 Nightingale J, Woodward JH. Guidelines for managementof patients with a short bowel. Gut 2006;55(Suppl 4):iv1–12.3 National Society for Phenylketonuria. Management ofphenylketonuria. London: NSPKU, February 2004. www.nspku.org/Documents/Management%20of%20PKU.pdf4 National Institute for Health and Care Excellence.www.nice.org.uk5 Young KV, Humphries SE, Grant R. National clinicalaudit of the management of familial hypercholesterolaemia2009: pilot – full report. London: Clinical Effectivenessand Evaluation Unit, RCP, June 2009.6 Healthcare Quality Improvement Partnership. Nationaldiabetes audit. www.ic.nhs.uk/nda7 Burnett D.A practical guide to accreditation in laboratorymedicine. London: ACB Venture Publications, 2002.8 National Pathology Benchmarking Service. www.keele.ac.uk/pharmacy/general/npbs9 Department of Health. National service frameworks.www.dh.gov.uk10 Kodner DL, Kyriacou CK. Fully integrated care for frailelderly: two American models. Int J Integr Care 2000;1:e08.11 The Association for Clinical Biochemistry and the RoyalCollege of Pathologists. Consultants in clinicalbiochemistry: the future. London: ACB, RCPath, 2009.www.rcpath.org/resources/pdf/g088consultantsinclinbiomay09.pdfNote to readers: This chapter has not been updated for the revised 5th edition 2013. The text has been reproduced from the 2011 edition.C○ Royal College of Physicians 2013 171