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Health checks in private practice

Discussion in 'Practice Management' started by Lizzy1so, Jul 13, 2010.

  1. Lizzy1so

    Lizzy1so Active Member


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    Just wondering if anyone currently provide basic screening for blood sugar, blood pressure and cholesterol. Our local chemist will check all the above for £15.00 and i wonder if it is a feasable ad on to an initial or annual assessment. Do you need specialist training to test blood sugar / cholestrol, how much do the kits cost? are they reliable? I am aware that our American collegues as Doctors are able to do this but any input would be appreciated.
     
  2. posalafin

    posalafin Active Member

    I don't see any problem with performing these tests at all. Any podiatrist who does ABI's is capable of taking a blood pressure and the BGL & cholesterol test machines are accurate and simple to use. My issue with it though is what is being achieved by doing this? A random, non fasted BGL or cholesterol test really tells you nothing. Some pharmacies here in Australia offer a similar service (although I'm not sure what they charge) for patients who are unable or unwilling to check their own BGL's or blood pressures.

    I could perhaps see a benefit in doing such assessments on patients who are a bit slack about seeing their GP but come in for routine foot care as an initial screening tool, and if the results are abnormal it might give you some more ammunition to get the patient to see their GP for a more thorough assessment.

    The test kits aren't that expensive but I'm not sure that there would be enough of a call for this service to justify purchasing & maintain the test kits (and replenish the test strips, lancets, batteries etc). Another factor would be whether the patients would be prepared to pay an extra amount on top of their podiatry fee to have service done by a podiatrist.
     
  3. Lizzy1so

    Lizzy1so Active Member

    I often send clients to see their GP if i suspect they have Type 2 diabetes and i would like to ensure my referals are appropriate, i would consider doing a quick blood test if i felt it would provide evidence for my case. I wonder if any one is already doing this or if it was worth while?
     
  4. wend0164

    wend0164 Member

    Hi,

    I have no idea, but it makes perfect sense.
    A client of mine could have been saved a very traumatic experience with Type II diabetes, if i knew we as Podiatrists are insured to carry out this test.

    When treating clients there are often tell tale signs of diabetes, this test could confirm.

    I have to email the SCP about an unrelated topic, will ask and come back to the forum when i recieve an answer.
    Regards Wendy
     
  5. kitos

    kitos Active Member

    I'm not sure of the value of pin prick tests on patients in surgery.

    Ok it is a guide but you would need to take into consideration post prandial readings and that probably most GP's would ignore readings taken as invalid but might request fasting test or even better still a HbA1c. For some reason or other they seem to mess around with a fasting test and then maybe a glucose tolerance test before actually ordering a full HbA1c plus LDL/HDL test.

    Plus what would happen if you got a low blood sugar level and said no that's fine but in fact they were still diabetic and simply not eaten for hours (it does happen).

    As a diabetic myself with real issues about how many health professionals 'beat up' on diabetics over blood sugar levels/cholesterol/health care/foot care/eye care/BP/ you name it as we are governed by numbers care....... the last thing any diabetic requires is yet another person having a pop at a high blood reading when they are quietly sitting there trying to get their nails cut.

    Understand the disease and the symptoms and ask your questions well and you will get a far better idea when to suggest that they see their GP.

    Nick
     
  6. Lizzy1so

    Lizzy1so Active Member

    Thanks Nick.
    I agree that proper testing is the ideal, but sometimes if you have someone in the chair who may be an undiagnosed diabetic, it would be helpful to have tools to support any diagnosis. As podiatrists we are taught to look out for signs of diabetes, ask relevant questions and to ensure proper care and attention for those that we treat. I can understand that nagging diabetics is not ideal, and I would expect any GP to take any chairside test performed by me as a guideline.
     
  7. G Flanagan

    G Flanagan Active Member

    Like the others have said, as im sure your aware. You cant diagnose diabetes via a BM.

    However as you note it is something you can add to your referral letter.

    If i were to do this i would also add in a urinalysis, which can pick up ketones + glucose in the urine (plus other things, leucocytes etc ). Urinalysis is cheap and simple to do, again its not a definitive test but gives you something to talk about.
     
  8. kitos

    kitos Active Member

    Hi Edward,

    Yes I am sure that many GP's would especially as testing for potential diabetics must win them a few more QUAFF points :)

    I tend to do a full neurovascular assessment on them and if there is any sign of neuropathy then this would give credence to your query about diabetes to any GP.

    I think the quoted figure now is that for a person to show a degree of neuropathy they will have been diabetic for something like 5-10 yrs or at least to have increased blood/glucose levels.

    Best wishes

    Nick
     
  9. posalafin

    posalafin Active Member

    Would you charge the patient extra for doing this test?
     
  10. Lizzy1so

    Lizzy1so Active Member

    Hmmmmmmm, not sure about charging, i suppose it would depend on how much it would cost me to bbuy the tests. I am open to advice and opinion on this. What do you think is appropriate?
     
  11. kitos

    kitos Active Member

    I don't charge anything for full neurovasc checks (with report to GP) for anyone.

    Kits would be tax deductable so if I were doing it I would do it at no extra charge and sit back and listen to them telling others what a jolly good person you are (hopefully !!!)
    :)
     
  12. cornmerchant

    cornmerchant Well-Known Member

    I do not see the point of doing tests that will have to be repeated and are not strictly within our scope of practice. I for one would not have time, and if I want to refer on to the GP the fact that I have concerns would be good enough, I really dont think GPs would appreciate us trying to get one upmanship by carrying out blood and urine tests. The patients are certainly not going to pay for something they can get for free.
    Cornmerchant
     
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