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

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2 Specialties Audiovestibular medicineHealth services forelderly peopleChild health anddevelopmentLearning disabilityservicesAudiovestibular medicineSpeech and languagetherapyNeurologyAdultsPaediatricsNewborn hearingscreening programmeAcute paediatricsGeneral medicineGPNeonatologyENTFig 1 Sources of referral to audiovestibular medicine from primary, secondary and tertiary levels.ENT = ear, nose and throat specialists; GP = general practitioners.These feed into secondary audiovestibular provisionin either the hospital or the community. Not allcommunity audiology services are led by AVPs;some may be delivered by paediatricians in childhealth who have gained additional competencies inaudiology.Successful moves of services into alternative healthcaresettings will depend largely on the provision of facilitiesand space for interdisciplinary teamwork, which is attheheartofpatientcareinthisfield.Complementary servicesAVPsworkcloselywithawidevarietyofservices.Theseinclude old age medicine, neurology, otology,paediatrics, ophthalmology, psychiatry, oncology,endocrinology, acute medicine, cardiology, speech andlanguage therapy, clinical psychology, audiology,rehabilitation services, NHSP, social work and thevoluntary sector.3 Working with patients: patient-centredcareInteraction with patientsThe basis of all clinical work is careful history anddetailed medical examination, supported byconventional medical investigations. Selection andinterpretation of specialist assessments by otherhealthcare professionals supports the physician toproduce both a diagnosis and a management plan,incorporating active treatment where appropriate.Audiovestibular disorders are often chronic andsuccessful management requires effectivecommunication with patients and carers/families aboutthe nature of the disorder and the possible managementoptions. Clinical activity needs to be delivered by anMDTinanacousticallyandpatient-friendlyenvironment with interpreters for both sign language(British Sign Language (BSL) and other sign support)and English as a second language, as needed.Patient-centred care AVPs are careful to provide unbiased information toenable patients and parents/carers to make informeddecisions about their investigations andinterventions. This enables the patient to have aninput in their care plan. Knowledge of and respect for the varied attitudes todeafness and disability in different ethnic andcultural groups enables informed discussion. Forexample: community attitudes to deafness thatdiffer in relation to genetic testing; disquiet in thedeaf community about the use of cochlearimplants or hearing aids; and the use of signlanguage.C○ Royal College of Physicians 2013 37
Consultant physicians working with patients Each consultation provides an opportunity toeducate the patient and to check theirunderstanding of their condition. All members ofthe MDT have an important contribution to makein this area. In order to promote self-care, there should beunderstanding of the condition. Perseverance andcommitment from patients and their families areessential for successful auditory and vestibular(re)habilitation as well as compliance withpharmacological and other treatments. AVPs and the MDT have a key role in reinforcing theimportant task of parents and carers incontributing to and implementing care plans forpatients. Local services for children should all have aChildren’s Hearing Services Working Group(CHSWG) in which (trained) parents participatewith multiagency professionals to ensuredevelopment of effective local services. Voluntary bodies, including Action for Deafness(AFD), the National Deaf Children’s Society(NDCS) and the Ménière’s Society provide easilyaccessible information for patients as well asdeveloping criteria for good practice. Information on audiovestibular disorders isavailable from websites, special libraries, and writtenmaterial produced by educational, clinical andpatient support groups. Information about relevant support groups(such as AFD, NDCS, Hearing Concern,Ménière’s Society, British Tinnitus Association(BTA), British Deaf Association (BDA), RoyalAssociation for the Deaf (RAD), SignHealth (theNational Society for Mental Health and Deafness;previously called Sign), Council for theAdvancement of Communication with DeafPeople (CACDP), Usher’s Society, Sense and Afasicshould be readily available in outpatientdepartments. It is good practice to copy patients and parents intoclinical correspondence to ensure that they are awareofthecareplanandareinformedaboutresultsofinvestigations. Some services already use adult role models, localself-help groups or patient volunteers as expertpatients.AVPs are trained to be highly effective communicators.Relevant professional interpreters must be available forboth the family and the patient during medicalconsultations, recognising that communication needsmay be different, eg a BSL interpreter for the patientand a mother-tongue interpreter for parents/carers formedical consultations.4 Interspecialty and interdisciplinary liaisonMultidisciplinary team workingBoth adult and paediatric AVM services are deliveredby MDTs that include other health professionals,education and social services. MDTs may includecommunity paediatricians, audiologists, specialistnurses, speech and language therapists, hearingtherapists, teachers of the deaf, psychologists,behavioural therapists, educational audiologists,physiotherapists, social workers and occupationaltherapists. Each has a specific but overlapping role toplay and successful teamwork is based on mutualrecognition and respect.The patient and their family are an integral part of thisteam.Working with other specialtiesClosely linked specialties include otology, neurologyand neurosurgery, paediatrics and child health(working both in the community and in acutepaediatrics and neonatology), clinical genetics,radiology, immunology and allergy, old age medicineand ophthalmology, and many subdisciplines of generalinternal medicine. There will be a number of patientswho are common to these groups, where diagnosis orcare is shared depending on the patient’s symptoms atany one time.The wide-ranging prevalence of audiovestibularsymptoms in other conditions means that AVPs willbe in contact with or receiving referrals from manydifferent disciplines.Working with GPs and GPwSIsSome GPwSIs in otolaryngology are concerned withaural care and simple audiovestibular disorders inadults and this area could be usefully expanded.Other specialty activity beyond local servicesMultiagency working is fundamental to AVM.Education services share the care of children withpermanent childhood hearing impairment while socialservices and job centres are important in terms of both38 C○ Royal College of Physicians 2013
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