DIAGNOSTICS DURING RECEPTION.

DIAGNOSTICS DURING
RECEPTION.
TEAM-WORK IN PRAXIS
FRIENDSHIP MEETING AFTER
SKARABORG PROJECT
LAULASMAA 10.03.2006
CONCEPTIONS
Lack of time, waiting and delay in
modern medicine
n Development of diagnostical equipment
in two main direction:
n
– CT, MRI, PET etc for hospitals
– Flexible, accurate, with rapid results for
office reception, so called point of care
ideology
Madis Veskimägi
FAMILY PHYSICIANS`CENTRE OF TÕSTAMAA
ESTONIA
DIAGNOSTICAL WORK
DURING RECEPTION. MAIN
CONCEPTIONS
Rapid development in field of
information technology and
telecommunication
n New possibilities than ever before
n In Estonia during primary care reform is
possible to arrange job “by own taste”,
be guided by regulations and laws
n
n
Point of care ideology
Simultaneous reception by family doctor and
doctor`s assistant
n Doctor`s special interest
n Main diagnostical equipment in one room, in
handy location and ready for use
n IT and digital report an digital output of
equipment for documentation and archive
n
During reception, it is possible to do
during one reception 2-4 different
investigation and making more exact
plan for further management.
n It is possible to discover more serious
condition quickly in patients who does
not looks like very ill
n
1
X ray
X ray unit
Flexible cassette holder
n Developing machine
n Certificate
n Dry film in negatoscope in 4-5 minut,
during reception
n
n
Family doctor`s special interest, training
in primary interpretation
n Collaboration with radiologist
n Mainly chest x ray, limbs, scull (
paranasal sinus)
n About 1-2 patients per day
n
2
3
Sonography
n
n
n
n
n
n
n
“ Mysono 201”
Compact, digital, new model ( 2001)
Compatibility with computer
1-2 investigation per day
Abdominal pain, hydrothorax, prostata, call
stones, pregnancy, swollen area, Baker cyst
1-2 interesting findings per week
REAL SUPPORT IN EVERYDAY WORK !!!
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LABORATORY
Tests during reception
n
n
n
n
n
n
n
n
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Clinical blood ( 9 parameters )
CRP
Urine analyzator, 10 parameters
Sedimentation reaction
Blood glucose
Occult blood
Blood film
Strep A
Uricult
Tympanometria
MT 10
n Compact, easy to use in reception
and homevisits
n Result during 15-20 seconds
n Approbation by ear-nose-throat
doctors: this investigation help to
select efectively true specialist patient
n
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BLOOD PRESSURE
MONITOR
ABPM 04
Easy to use
n VERY informative investigation in
hypertension, for diferentation white
coat hypertension, anxiety disorder and
pure organical hypertension
n Great satisfication of patient and doctor
n
n
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Panic disorder
True organic hypertension
WHITE COAT HYPERTENSION
STRESS-TEST
n
n
n
n
n
n
Veloergometer, step-box
Pulse-reader
Sfygmomanometer
ECG
Training-course in sportmedicine
Patient group: health diagnostics; tiredness
due to probably psychogenic origin, young
patient`s fear of serious cardial pathology
Spirometry
Part of investigation in cases of
dyspnoe, wheezing, panic disorder,
smoker, monitoring, etc
n Combination stress-test, 6 min running
test
n Spirometer ready for use, basic values,
predicted values, program interpretation
n
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TEAM-WORK IN PRAXIS
n
n
n
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Simultaneous reception by family doctor and
doctor`s assistant
In team is also nurse of physical therapy and
home-care nurse
Timeschedule for both worker
Doctor`s assistant job is working with
chronically ill patients, education, giving
prescriptions, lab tests, helping in
smallsurgery
Internal telephone, call forwarding
REVIEW TO LAST WEEK,
06.03-11.03.2006
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51 patient in reception, 3 home visits
8 X ray: 3 chest, 4 of knee and hip pathology
2 Stress-test ( hypertonic reaction, health
diagnostic in 37 y man)
1 blood pressure monitoring
9 ultrasound examination
14 whole blood test, 11 blood sugar, 11 CRP
1 telemedicine consultation ( 75 y patient with
coxarthrosis indication for endoprothesis )
Result of consultation
n
Tervitan Paremal väljendunud artroos
acerabulumi olulise lamenemise ja caput
femori deformatsiooniga. TEP --haiglasse
10.10.2006 Op 11.10.2006
n /Regards. Rightside severe arthrosis,
deformation caput femoris and flattening of
accetabulum. Indicated total endoprothesis,
patient is invited to hospital 10.10.2006,
operation 11.10.2006/
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Hypothesis of malignant tumor of
kidney, metastasis in liver
n
n
n
n
67 y women, previously healthy
Primary reception 10.03.2006
n History of fever 37,5 C 10 day, weak pain in
right chest, soreness of throat
n In general examination lungs normal, rednes
of throat, BP 130/80.
n Patients general appearance suspicious.
Body veight reduced approx 15 kg during 6
month.
Abdomen palpation painful RUQ
Ultrasound examination: enlarged liver, in left
lobe round-shaped nodule 5x4 cm. Abnormal
left kidney: size 13x6 cm, nodular structure.
n Lab: Hgb 108, CRV 126; SR 60 mm/h; urine:
ery 250; Bil 18; Ubg 70
n Chest X ray: reduced transparency in right
lower lobe, suspicious right hilus
Hypothesis: Renal malignant tumor,
liver metasthasis. Right pneumonia.
n Further management: Initial
antimicrobial treatment, phone call to
oncologist in centre of oncology
Estonia, appointment to reception,
investigation and consilium in
16.03.2006
n
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CONCLUSION AND
DISCUSSION
n
n
n
n
n
In reception is possible to do basic
investigation and get ideas for next step
We save a lot of patient time and pain
Doctor can work by evidence based medicine
conception, save time from further visits
In cases of serious findings we can send
patient to most right institution, without
waiting
We can prevent delays and waitings for
relative easy investigation or repetitive
investigation
n
Very important part is collaborative work in
praxis
n Most important is quality, continuous
education and active everyday work,
investigation of results and feed-back
n Every workday give new experiences, the
work is really interesting, so we can prevent
burn-out syndrome
n We all are winners: patient, medical workers
and taxpayer
Thank you for
attention !!!
…AND WELCOME AGAIN TO ESTONIA
.....
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