By Kilburn, J.
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Explanation of the test. Evidence-based decision on whether to offer it. Issues for the practice • • • • Consider developing practice guidelines on performing blood test. Decide how to act on results. Availability of practice nurse phlebotomy. GP role in researching the value of testing. PRACTICE QUESTIONS 45 Follow-up • Review and explanation of test result if necessary. • Discussion of ongoing concerns. Evidence base • No randomized controlled trial has shown that routine PSA (prostate-specific antigen) screening improves lifespan or quality of life.
Issues for or the doctor • Need for empathetic consultation skills. • Awareness of current evidence. g. maintenance of physical activity and adequate calcium intake, BP, smoking, lifestyle. • Time-consuming consultation. • Medical assessment. Issues for the practice • • • • Use of clinical nurse for education and monitoring/lifestyle risk factors. Use of written material, videos etc. Practice formulary for prescribing. Prescribing costs. Information-sharing • • • • • Explanation of physiology. Risk-benefit assessment.
One recent study showed that less than 50% of women knew to take folic acid, despite awareness improving in recent years. • No need for routine iron supplement; measure haemoglobin if suspected. Diet • Avoidance of slimming and aim for appropriate weight gain. g. liver products. • Low alcohol intake. Work • Advice on statutory maternity pay. • Advice on risk avoidance in the workplace. Risk of infections • Checking of rubella antibodies and need for vaccination. • Assess previous history of chickenpox and discuss controversial area of varicella vaccine or need for zoster immunoglobulin in case of recent contact.
Answer Plans for the MRCGP by Kilburn, J.