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

Consultant physicians working with patientsCentre. Our national audits against the above standardshave already provided key evidence on which to basefurther cost-effective service improvements andimprovements in patient outcomes.6 Clinical work of consultantsHow a consultant works in this specialtyConsultant cardiologists increasingly work in teams toprovide a specialised cardiology inpatient servicewithout involvement in acute medicine commitmentsother than the care of patients in the predominantlycardiac portion of the emergency ‘take’ of the cardiaccare unit and the continuing care and heart failurewards. Importantly, they provide a consultation serviceto other specialists (as described in sections 2 and 4).Their patient numbers exceed 500 per annum, and wardor front-door emergency consultations may beunderestimated.Outpatient workMost cardiologists will hold one to two outpatientclinics per week. These will include new patients andfollow-up patients, with numbers as recommended bythe RCP and BCS. They will also hold specialistoutpatient clinics, increasingly on a one-stop basis, fornew patients who present with chest pain,breathlessness or suspected heart failure, murmurs andvalve disease, arrhythmia or syncope. Specialistoutpatient follow-up clinics will also carry out thefollowing activities (see Table 1): follow-up of patients with pacemakers and otherdevices, arrhythmias, valvular disease and cardiacdisease in pregnancy follow-up of patients after myocardial infarction andPCI (an opportunity to integrate with cardiacrehabilitation – see section 7) monitoring heart failure requiring specialist input.Specialist investigative and therapeuticproceduresMost consultant cardiologists will directly undertake,supervise and report laboratory procedures (seeTable 1).Specialist on callProvision of an on-call consultation service requires aminimum of six consultants. Ten are preferred to coverleave. The provision of a cardiac catheterisationlaboratory service around the clock, 7 days a week (as isneeded for PPCI) also requires specialised cardiacnurses, physiologists and radiographers.Other specialist activity and activities beyond thelocal servicesMost cardiologists have developed an area of specialinterest, such as imaging, heart failure, GUCH,electrophysiology or PCI. They are expected to provideevidence of the quality of such work through appraisal,CPD and membership, and by contribution to therelevant affiliated groups of the BCS. Attendance atregional, national and international meetings isexpected. Appropriate engagement in clinical senates tosupport networks is advised.Clinically related administration: timely andappropriate communicationWorking in a multidisciplinary environment andcontributing to local cardiac networks and patientpathways to improve healthcare delivery are all part ofthe clinical duty of a cardiologist. The interdisciplinaryliaisondetailedinsection4isanobligation.Balance of clinics, wards, acute and specialty careMost consultant cardiologists undertake all of theseactivities, and therefore will have an individualisedbalance of these activities in their personal job plans.They will make allowance for on-call duties and theneeds of the particular trust and cardiology service.Some consultants may be designated with responsibilityfor certain interdisciplinary work.Direct work compared with supervisionand teamworkCardiology is fundamentally a team-based specialty.Consultants provide leadership to trainees, physiologistsand extended-role practitioner nurses who may delivercertain aspects of the service, but consultants engagedirectly in many activities themselves.Work in hospitals and the communityCardiac network pathways have developed to span thecommunity, the primary/secondary care interface andsecondary/tertiary inter-hospital transfers, and sharegood practice. Cardiologists need to clinically manageacute pathways, adult and paediatric coronary careunits, cardiac wards, cardiac physiology departments,cardiac catheter laboratories and rehabilitation services.They may be engaged in community clinics to ensuresafe referral practice, with cardiovascular disease stillrepresenting the most common cause of mortality.There are also cardiac networks in place in Wales andNorthern Ireland.56 C○ Royal College of Physicians 2013