Optimal Care Considerations in General Practice Scenarios
A/Prof Justin Tse presents two intriguing GP case studies involving patients with concerning symptoms and management challenges. One case features a 65-year-old male with potential metastatic disease, while the other involves a 55-year-old female with a history of breast cancer and a suspicious thyroid nodule. The scenarios highlight the importance of early detection, multidisciplinary care, and patient follow-up in optimizing patient outcomes within the healthcare system.
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Presentation Transcript
Setting the scene GP case presentations A/Prof Justin Tse - Clinical Dean St Vincent s Clinical School, CCV Research Fellow and General Practitioner The University of Melbourne OFFICIAL
Case 1 Mr RP 65-year-old retired gentlemen who presents with scapular pain (worse at night), associated sweats and loss of appetite. Due to COVID pandemic, reduction in GP contact over 2020-2021. Last cancer screening / testing review back in June 2019, with normal PSA test result. September 2021 presents to GP, PSA test 35 . Initial imaging indicates likely metastatic disease - scapular bilaterally and R 6/7thribs. OFFICIAL
Urgent referral undertaken to tertiary hospital. Linked up with oncology, urology and radiation oncology for an opinion June 2023 quarterly review with oncology team, 6 monthly urology = PSA below 1.0 - Monthly injections Zoladex (ADT) and Xgeva (Denusumab) = GP involvement - Chronic pain managed with medication and supportive symptom action plan OFFICIAL
Case 2 55-year-old women presents 12 month s ago for review of multinodular goitre. Regular 12-monthly US via GP. 2022 referral to tertiary hospital for follow up and seen in December as concern over US report of increase size of nodule on L side 2023 cancelled appointments February / March no follow up from the local hospital OFFICIAL
May 2023 GP required to follow up to re-engage with hospital service and now planned for next week, an urgent fine needle aspirate biopsy (FNAB). Further US done shows further change in L sided thyroid nodule. Patient concerned given she has a history of breast cancer and upset with loss to follow up and possible new cancer diagnosis OFFICIAL
Considerations for optimal care Considering our two cases - Patient factors - General practice factors - Hospital system factors OFFICIAL
Early detection saves lives OFFICIAL
Links - - https://www.cancervic.org.au/get-support/for-health- professionals/optimal-care-pathways - optimal care pathways resource - https://vcccalliancelearn.org.au/implementing-pathways- cancer-early-diagnosis-i-paced-prostate-cancer - prostate cancer resource OFFICIAL
