Dear David
This is my hot of the press attempt at structuring a similar problem. see
attachment
Comments and please feel free to use as much or as little of it as you
wish.
Roger Leary
-----Original Message-----
From: David Evans <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 09 May 1998 13:06
Subject: Re: Nurse protocols for Contaception etc
On Fri, 8 May 1998 19:30:54 +0100, Jel Coward
<[log in to unmask]> wrote:
>
>So what's yhour grumble? Too much maternity leave?
>
Seriously, we have always avoided a specific family planning clinic,
preferring to provide contraception in ordinary surgeries. This means
that women tend to always come to the doctor for every routine pill
check etc. We are employing a lot of locum doctors while the nurses
often have free appointments. Now, at long last we are trying to
encourage more women to see the nurses for contraception and the
nurses want to have something in writing to say what they should refer
back to us.
Our problem with CVS screening is slightly different. We have a lot of
patients who go to the nurses asking for Cholesterol checks. In some
cases pts book in directly with our non-nursing phlebotomists because
they fancy a cholesterol check, despite our efforts to prevent it.
Inevitably, these are always pts who are in the lowest risk groups and
I am uncertain what our response to them should be. Obviously it is
pointless to measure lipids unless you also consider other risk
factors and counsel the pt and my instinct is to strongly discourage
lipid screening altogether in people with no risk factors, but the
nurses feel pressured by the pts and say it's difficult to resist. The
end result is me being presented with a set of lipid results from a
healthy middle aged pt, with the receptionist saying the pt is on the
phone wanting to know "if it's normal". Clearly we need to get
ourselves better organised.
David
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Dr David Evans
Cardiff
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