Consultant physicians working with patients 5th edition - FSEM

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Consultant physicians working with patients 2 Gupta R, Sheikh A, Strachan DP, Andersen HR. The burden of allergic disease in the UK. Clin Exp Allergy 2004;34(4):520–6. 3 Royal College of Physicians. Allergy: the unmet need. A blueprintforbetterpatientcare.AreportoftheRoyal College of Physicians working party on the provision of allergy services in the UK. London: RCP, 2003 (pp 1–93). 4 House of Commons Health Committee. The provision of allergy services. London: Stationery Office, 2004. 5 Department of Health. Areviewofservicesforallergy. The epidemiology, demand for and provision of treatment and effectiveness of clinical interventions. Gateway ref 6835. London: DH, 2006. 6 Department of Health. Specialised services national definitions set. Specialised services for allergic diseases (all ages) – definition no. 17, 3rd edn. London: DH, 2010. 7 British Society for Allergy & Clinical Immunology. www.bsaci.org 8 National Allergy Strategy Group. www.nasguk.org 34 C○ Royal College of Physicians 2011
Audiovestibular medicine 1 Description of the specialty Audiovestibular medicine (AVM) is the specialty concerned with prevention, investigation, diagnosis and management of adults and children with disorders of hearing, balance and tinnitus. 1 Some specialists also include developmental disorders of speech and language. This is a small specialty with an uneven distribution across the UK. There is some unmet need that is only partially met by other specialties. Audiovestibular physicians (AVPs) play a key role in the multidisciplinary team (MDT) involved with assessment and management of patients. Competencies in general medicine, paediatrics and child health underpin the practice of AVM. Knowledge of the pathophysiology of diseases and disorders that affect the audiovestibular system throughout life is essential. Who are the patients? Hearing loss and dysequilibrium are widespread in the UK adult population, especially as the population ages: � Approximately 17% of adults will have current problems with balance, 2 and balance problems are the most common cause of presentation to primary care in patients over 74 years of age. � AVPs are involved in complex cases of hearing loss and assessments for cochlear implants. � Many patients have other complex needs, eg 45% of deaf adults under the age of 60 have additional disabilities. 3 � 1% of the adult population have tinnitus that significantly affects their quality of life. 3 Balance disorders are less common in children, affecting only 8%, 4 but may be difficult to assess and manage. � Approximately 1:1000 children are born with bilateral permanent hearing impairment each year 5 and 2:1000 will have a unilateral hearing impairment. 6 � 25% of all children up to the age of four years suffer from otitis media with effusion at any one time7 and 80% of children under eight years of age have experienced temporary deafness due to glue ear. 8 Current best management of this includes the use of amplification rather than surgery. 9 � Approximately 10% of children have some degree of auditory processing disorder. 10 � Approximately 6% of children have speech and language disorders. 11 Main disease patterns Permanent childhood hearing impairment can be congenital or acquired and syndromic or non-syndromic and is often accompanied by other symptoms and disabilities. AVPs are involved in the diagnosis (from newborn hearing screening and beyond), aetiological investigation and (re)habilitation. Hundreds of conditions are involved and it is important for families to fully understand their child’s problem(s). Other conditions are mentioned earlier. Balance disorders including those of vestibular origin provide the bulk of most AVPs’ adult-patient load but patients with complex, progressive, unknown or asymmetric hearing problems are also seen. Conditions range from the common benign paroxysmal positional vertigo (BPPV) and migraine-associated vertigo through to complex neurological problems. Those with chronic balance disorders from whatever cause suffer significant social, occupational, emotional and economic disability. They are best managed by a team that will include balance retraining, AVP and counselling. 2 Organisation of the service and patterns of referral A typical service There are areas of the country where there are no AVPs and the service of each consultant varies. There is no typical service. C○ Royal College of Physicians 2011 35
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Page 3 and 4: Contents Acknowledgements iv Forewo
Page 5 and 6: Foreword Consultant physicians work
Page 7 and 8: 1 Physicians in the NHS today The u
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Page 15 and 16: Physicians have a duty to keep good
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Page 19: Confidential Enquiries into Materna
Page 33 and 34: Allergy 1 Description of the specia
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Page 37 and 38: Table 1 Guidelines and audits for a
Page 39: Calculation of national consultant
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Consultant physicians working with
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Gastroenterology and hepatology 1 D
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� provide consultant input into c
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The BSG have published documents on
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2 Specialties Gastroenterology and
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10 Key points for commissioners 1 G
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Genitourinary medicine 1 Descriptio
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staff. Many clinics have websites p
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and scientific research into STIs a
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� 20 minutes per appointment for
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Geriatric medicine 1 Description of
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Promoting health and self care Spec
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Work to maintain and improve the qu
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6 Geriatricians are essential in th
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Immunology 1 Description of the spe
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Considering the propensity of antib
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ange of duties including clinical l
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4 Patients with C1-inhibitor defici
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Intensive care medicine 1 Descripti
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Neurology 1 Description of the spec
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patients with LTNCs. Clinical nurse
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How a consultant works in this spec
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Rehabilitation medicine 1 Descripti
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4 Rehabilitation medicine requires
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Renal medicine 1 Description of the
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they can be involved in decisions a
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community. Specialised wards are al
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2 Royal College of Physicians. Chro
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Sport and exercise medicine 1 Descr
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3 The Royal College of Physicians:
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careers. It is focused increasingly
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Clinical management guidelines To p
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numerous academic papers published
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have a dedicated RCP regional offic
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