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

2 Specialties Audiovestibular medicineAcademy of Audiology (BAA), the Department ofHealth (DH), the Royal College of Physicians (RCP)and NDCS encouragement by BAAP through appointment of asecond AVP where possible in areas where there is asingle-handed AVP education and training ensuring publication ofcross-discipline information, conferences, teachingand learning opportunities, both locally andinternationally, especially through the InternationalAssociation of Physicians in Audiology (IAPA),which publishes Hearing Balance andCommunication research in conjunction with healthcareprofessionals, basic scientists and patients into thepathophysiology and management ofaudiovestibular disorders.Specialty and national guidelinesTable 3 gives details of AVM guidelines and audits.6 Clinical work of consultantsOutside academic units, all AVPs work exclusively intheir specialty, almost entirely with outpatients. In unitswhere there are no trainees, work is direct rather thansupervisory but is always as part of an MDT.Inpatient workAVPs do not have dedicated inpatient beds, but in anaverage DGH approximately four inpatients per weekare likely to be referred from other specialties fordiagnostic consultation.Outpatient workA consultant AVP working alone in an adult outpatientclinic may see 4–6 new patients or 8–12 follow-uppatients per programmed activity (PA). In a paediatricoutpatient clinic, a maximum of six new or follow-uppatients may be seen. The number will depend on theconsultant’s experience, the complexity of the problemsand the availability of support staff. In some highlyspecialist services fewer patients may be seen.When supervising trainees, the numbers of patients inclinics should be adjusted to allow for teaching anddiscussion of cases.Specialist activities beyond thelocal servicesSome clinical work can be undertaken by telephoneconsultation and email.Specialist investigative and therapeuticproceduresWhenever possible, audiovestibular investigationsshould be carried out at the same attendance as theclinic appointment; this might be combined withassessment and advice from other professionals withinthe MDT. However, this makes the timing of clinicsunpredictable as some patients will inevitably takelonger to assess than others, especially the very youngor the very old.Most investigative and therapeutic procedures arecarried out by other professionals but the coordinationand interpretation is often by AVPs.Specialist on callThere is no on-call requirement for AVM nor doconsultants and trainees participate in the on-call rotafor acute general internal medicine. They may, however,be closely involved in the management of two acutepresentations: sudden hearing loss and acute intractablevertigo. Both conditions require urgent admission,investigation and management in collaboration withotology and/or neurology.Other specialist activityMany AVPs undertake clinical work and teaching inmore than one site, including outreach clinics in DGHs,community clinics, primary-care groups, schools for thedeaf or learning disabled, and domiciliary visits toprivate homes or residential accommodations.An AVP’s work encompasses duties in clinicalgovernance, professional self-regulation, CPD, andeducation and training of others. For many consultantsat various times in their careers it may include research,serving in management, and providing specialist adviceat local, regional and national levels. In a small specialty,work for the RCP, government, specialist societies,patient groups, deaneries and other national bodies is agreater burden than in larger specialties where themajority of consultants may not be involved if they arenot so inclined.Clinically related administrationThe specialist nature of the work, lack of generalknowledge about audiovestibular disorders, tertiary,interdisciplinary and multiagency working, and thepersonal approach to management inherent in the field,result in the generation of a considerablecommunication burden for AVPs and A&C staff.Preparation of complex reports may take half as long asC○ Royal College of Physicians 2013 41