The future of primary care: when, who and how to test
CanTest researchers have contributed a whopping 3 editorials to the July edition of the British Journal of General Practice! All three pieces focus on different aspects on diagnostic testing in primary care.
First, CanTest Director Prof. Willie Hamilton, discusses how diagnosis in primary care is changing as the availability of point of care tests and access to imaging increases. He argues that the advantages, particularly in difficult to diagnose patients such as those with co-morbidities or vague symptoms, are counterbalanced by the risk of overdiagnosis and overtreating. Therefore, a core skill for GPs remains understanding when not to test, as well as when to test.
On a similar line, Dr Dan Jones and colleagues focus on the conundrum that GPs and relatives face when presented with an elderly and frail patient with symptoms suggestive of cancer. In the absence of clear guidelines, the choice of whether the patient should undergo potentially invasive diagnostic investigations even when aggressive curative treatment is not a feasible option is often left to personal preference and discretion. Although the final decision is likely to be heavily influenced by personal circumstances, the authors argue that more should be known on the diagnostic experience and wishes of this category of patients to inform and facilitate shared decision making.
Finally, Dr Erica di Martino and colleagues look at the exciting possibility that point of care ultrasound could help GPs triage patients with cancer symptoms. With hand-held units becoming more affordable and medical students increasingly exposed to training during their studies, GPs in other European countries are beginning to use ultrasound to support diagnostic decisions for a variety of conditions. The authors discuss challenges and opportunities of its implementation in UK primary care and whether it could find some niche applications for cancer diagnosis, possibly aided by remote interpretation. This article stems from an earlier CanTest Travel Fellowship which allowed the author to travel to Aalborg, Denmark and learn from the experience of Prof Jensen and colleagues.
In addition to the editorials there’s also a research paper from Dr Sarah Bailey and Prof. Willie Hamilton plus colleagues, on microcytosis as a marker for possible cancer. A total of four articles in a single edition of BJGP marks a truly terrific effort from the CanTest team!