Consultant physicians working with patients 5th edition - FSEM

Consultant physicians working with patients
British Tinnitus Association (BTA), British Deaf
Association (BDA), Royal Association for the Deaf
(RAD), SignHealth (the National Society for Mental
Health and Deafness; previously called Sign),
Council for the Advancement of Communication
with Deaf People (CACDP), Usher’s Society, Sense
and Afasic) should be readily available in outpatient
departments.
� It is good practice to copy patients and parents into
clinical correspondence to ensure that they are aware
ofthecareplanandareinformedaboutresultsof
investigations.
� Some services already use adult role models, local
self-help groups or patient volunteers as expert
patients.
AVPs are trained to be highly effective communicators.
Relevant professional interpreters must be available for
both the family and the patient during medical
consultations, recognising that communication needs
may be different, eg a BSL interpreter for the patient
and a mother-tongue interpreter for parents/carers for
medical consultations.
4 Interspecialty and interdisciplinary liaison
Multidisciplinary team working
Both adult and paediatric AVM services are delivered by
MDTs that include other health professionals, education
and social services. MDTs may include community
paediatricians, audiologists, specialist nurses, speech
and language therapists, hearing therapists, teachers of
the deaf, psychologists, behavioural therapists,
educational audiologists, physiotherapists, social
workers and occupational therapists. Each has a specific
but overlapping role to play and successful teamwork is
based on mutual recognition and respect.
The patient and their family are an integral part of this
team.
Working with other specialties
Closely linked specialties include otology, neurology
and neurosurgery, paediatrics and child health (working
both in the community and in acute paediatrics and
neonatology), clinical genetics, radiology, immunology
and allergy, old age medicine and ophthalmology. There
will be a number of patients who are common to these
groups, where diagnosis or care is shared depending on
the patient’s symptoms at any one time.
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The wide-ranging prevalence of audiovestibular
symptoms in other conditions means that AVPs will
be in contact with or receiving referrals from many
different disciplines.
Working with GPs and GPwSIs
Some GPwSIs in otolaryngology are concerned with
aural care and simple audiovestibular disorders in
adults and this area could be usefully expanded.
Other specialty activity beyond local services
Multiagency working is fundamental to AVM.
Education services share the care of children with
permanent childhood hearing impairment while social
services and job centres are important in terms of both
employment for adults and appropriate domestic
support for children and adults.
5 Delivering a high-quality service
What is a high-quality service?
AVPs are medically trained professionals with the
highest level of skills and competencies in the field and
deliver effective and efficient assessment, diagnosis and
management of disorders through an MDT in as few
visits as possible.
The British Association of Audiological Physicians
(BAAP) policy document 2002 13 contains
recommendations for the staff and details of the
equipment (less than five years old) required for a
population of 500,000 patients (Tables 1 and 2). It
covers paediatric and adult vestibular and hearing
services in both community and hospital sites. It also
refers to the staff required for a team based at a main
unit working across several sites. Since it was published,
interdisciplinary standards for specific activities have
been implemented, eg NHSP 14 and Modernising
Children’s Hearing Aid Services (MCHAS). 15
Maintaining and improving the quality of care
Maintenance and improvement of service quality is
ensured by clinical governance, which includes:
� development of patient-care pathways, systems and
processes to improve the efficiency of patient flow
� appraisal and peer-review system
� revalidation
C○ Royal College of Physicians 2011