Programme no. 423-OP
How to develop new skills and procedures.
1Praktiserende læge Mikkel Granlien, Allerød, Danmark,Allerød,Denmark
* = Presenting author
Objectives: As an example I will describe how I picked up the field of examination and treatment of skin cancer. I describe the steps that led from referring all suspected skin cancer cases to the present status, where diagnosis is carried out in my surgery and a substantially part of the patients are treated instead of being referred to dermatologist or hospital
In the daily work, we know quite well, when to refer a patient to hospital or to a specialist. Strong traditions are taught to us from the early study days, as a hospital employee and continues during our general practice throughout life. Referrals and procedures are to a high degree carried out based on traditions and on untold consensus, which rules the profession.
The aim is to describe how you can pick up examinations, treatments and skills, which for the moment isn’t a part of your regular repertoire or which might be considered as items that should be referred to a specialist.
For the last 10 years I have diagnosed 156 cases of skin cancer (10 melanomas, 138 basalcell cancers, 6 planocellulare cancers and 2 others). All melanomas have been referred to further examination (sentinel node diagnosis) and eventual re-excision.
Most off the basalcell cancers have been treated in the surgery; some has been referred to plastic surgery or other treatment. All of planocellulare cancers have been referred to irradiation or for further surgery.
Material/Methods: 10 steps that led to the present condition, where skin cancer and patients demand for a skin cancer check are handled in my surgery instead of being referred to a dermatologist.
Conclusion: Skin cancer can be diagnosed and treated in general practice as well as by dermatologists.
Points for discussion: : It is always challenging when you as a generalist decide to handle a topic, that traditional are handled by specialists. What are the benefits and might there be any disadvantages? Is there a need to prove your competence? Does it result in a conflict with the specialists? What is the outcome for your patients, the clinic, the specialist and yourself as a general practice doctor?