MEDICAL MATTERS:Continuing education for doctors is crucial, writes MUIRIS HOUSTON
NEXT WEEK marks the beginning of a new era in Irish medicine. From May 1st, doctors seeking to renew their professional registration will be legally required to complete an annual declaration that they have enrolled in, and are complying with the requirements of, a specific competence scheme. Of course, most have been doing this voluntarily for many years, but the statutory requirement brings a new dimension to postgraduate education.
Continuing professional development schemes are run by all specialist bodies; in the case of the Irish College of General Practitioners, its scheme has been running successfully for more than 25 years. And we can expect some new educational approaches in tandem with the new regulations.
I attended one such event recently. Rheumatology Toolbox is an innovative model for rheumatology education put together by three Galway consultant rheumatologists, Dr Robert Coughlan, Dr Ronan Kavanagh and Dr John Carey. It has been some three years in development. Dr Kavanagh says, “We identified some issues with regard to the care and treatment of patients with rheumatic diseases before referral to our different services. The ‘toolbox’ idea is the fruit of these discussions – if successful, it may prove to be a very important initiative in keeping primary care physicians up to date with developments in rheumatology”.
“The protocols and recommendations that have been developed by groups of rheumatologists and other interested therapists are the tools contained in the ‘toolbox’,” notes Dr Coughlan. “These protocols have been devised and refined using a combination of evidence based on published literature, clinical experience and consensus.”
When I arrived at the one-day event, I was actually presented with a toolbox rather than the usual conference pack. The format continued as we were updated on the latest “tools” for managing patients with various forms of arthritis, as well as osteoporosis, fibromyalgia and gout.
So what did I learn? Well I wouldn’t have readily associated gout with other conditions such as high blood pressure and high cholesterol, so the advice to check for co-morbidity in these patients was well received. Although it is caused by the accumulation of urate crystals in the affected joint, many people with elevated levels of uric acid in their blood never get an attack. And, while the link with alcohol and a rich diet is long known, the association of gout with a high intake of soft drinks and fructose was new.
Dr John Carey’s toolkit on fibromyalgia was a model in putting the patient first. Acknowledging the complexity of the condition, which caused chronic pain and other symptoms, he underlined the importance of telling sufferers what was wrong with them and what to expect as the illness waxed and waned. His advice on the ‘don’ts’ of prescribing were as valuable as the ‘dos’.
The availability of new treatments has revolutionised the management of acute inflammatory arthritis such as rheumatoid arthritis. Current treatments would have been unrecognisable some 15 years ago. They have changed the outlook for many patients thanks to the drugs’ ability to modify such diseases. Early referral is essential; anyone who develops arthritis in more than one joint should be assessed by a rheumatologist within six weeks of the onset of symptoms. And one of the disease-modifying anti -rheumatic drugs needs to be started in anyone considered at risk of persistent arthritis at the earliest opportunity in order to drive the inflammatory arthritis into remission.
Apart from being a welcome educational initiative, the Rheumatology Toolbox is likely to benefit the wider health service. By enhancing the management of rheumatic diseases in primary care, the use of hospital-based facilities can be optimised. And it certainly met one of the main criteria for professional competence: that doctors undergo formal continuing education with an emphasis on patient safety and the quality of patient care.