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ReferralAndConsultation

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Language checks for nurses proposed - BBC News

Nurses, pharmacists, dentists and midwives could face language skills checks to make sure they are fluent in English, under plans being put out to consultation.  
BBC News
over 6 years ago
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1
20

Education Articles. Medical Students Articles | Patient

The same info as provided by GPs to patients during consultations,health/disease leaflets,patient support orgs,all about medicines,book GP appts online,interactive patient experience forum  
Patient.co.uk
over 6 years ago
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1
10

Multicystic Renal Dysplasia Treatment & Management: Medical Care, Surgical Care, Consultations

Multicystic dysplastic kidney (MCDK), a variant of renal dysplasia, is one of the most frequently identified congenital anomalies of the urinary tract. This article reviews the definition, embryology, epidemiology, etiology, pathology, clinical manifestations, associated malformations, natural history, differential diagnosis, complications, e...  
emedicine.medscape.com
about 6 years ago
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1
16

Respiratory Alkalosis Treatment & Management: Medical Care, Consultations

Respiratory alkalosis is a disturbance in acid and base balance due to alveolar hyperventilation. Alveolar hyperventilation leads to a decreased partial pressure of arterial carbon dioxide (PaCO2).  
emedicine.medscape.com
about 6 years ago
Preview
4
46

Communication skills for medicine-training - YouTube

This playlist contains a number of simulated doctor-patient consultations which take place in a primary care context. The scenarios demonstrate both good and...  
YouTube
about 6 years ago
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1
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Tachypnoea in a well baby: what to do next? -- Balfour-Lynn and Rigby -- Archives of Disease in Childhood

It is not uncommon to see babies in clinic who have been referred because they are persistently tachypnoeic. Sometimes this has been noticed by the parents, but more often, especially if it is the parents’ first baby, they do not realise anything is amiss, and it is the midwife, health visitor or general practitioner who brings it to their attention. Occasionally it has been noted as early as the postnatal ward. This article outlines a management approach to a term baby with tachypnoea in an outpatient setting, and is not focusing on acutely unwell infants (figure 1). It is taken from the perspective of a referral to a general paediatric clinic, although these babies are also often referred straight to a respiratory clinic.  
adc.bmj.com
about 6 years ago
Www.bmj
1
5

Pedometers for older people can increase physical activity, research shows

A sustained increase in physical activity among older people can be achieved by consultations with a practice nurse and the use of a pedometer, research published in the journal PLOS Medicine has shown.1  
bmj.com
about 6 years ago
Www.bmj
1
3

Nearly a fifth of cancer patients in England miss 62 day target for starting treatment

Nearly one in five patients does not start treatment for cancer within the 62 day target of a first urgent referral for suspected cancer, and the NHS in England failed to hit the operational standard for this cancer treatment target for a fourth consecutive quarter, figures have shown.  
bmj.com
about 6 years ago
Www.bmj
1
4

“Angelina effect” led to more appropriate breast cancer referrals, research shows

When the US actress Angelina Jolie announced that she had tested positive for the breast cancer gene BRCA1 and had undergone a double mastectomy, referrals for genetic counselling and testing in the United Kingdom more than doubled, remaining higher than usual for at least six months.  
bmj.com
about 6 years ago
Www.bmj
1
9

Authors’ reply to Foster and colleagues

We thank Foster and colleagues for their comments.1 2 Projections of disease progression that are based on natural history studies from tertiary referral centres may exaggerate hepatitis C virus (HCV) related morbidity and mortality. Inception cohort and epidemiological data suggest that only a minority of infected people will progress to end stage liver disease over their lifetime.1  
bmj.com
about 6 years ago
Www.bmj
1
5

Nearly a fifth of cancer patients in England miss 62 day target for starting treatment

Nearly one in five patients does not start treatment for cancer within the 62 day target of a first urgent referral for suspected cancer, and the NHS in England failed to hit the operational standard for this cancer treatment target for a fourth consecutive quarter, figures have shown.  
bmj.com
about 6 years ago
13
0
50

Why do we get referred pain?

I was reading about this the other day and understand the difference between visceral and somatic innervation, but don't understand how this theory with dermatomes relates to periumbical somatic referral in appendicitis. Why is a whole dermatome not affected?  
Hannah Pickford
over 8 years ago
10
0
58

Maximum duration for heart attack?

In my own experience of GPs and stories from others, the widest variation in practice I have seen is of one particular type of patient. Middle aged/elderly, maybe a few cardiac risk factors, often with a history of reflux disease - presenting to GP with mild/moderate cardiac-sounding chest pain of days duration, which they are not generally concerned about. +/- equivocal histories of SOB, nausea, or sweating if pressed. My question is - is it sensible to send these people in via 999 blue lights? How will it help them? They are often taking aspirin already, and presumably after days of ischaemia the myocardium is well and truly dead if it was MI and so they wouldn't be candidates for PCI or thrombolysis. It would seem to me that the cardiac problem to rule out in these patients is unstable angina, not MI. Is there anything to be done for this presentation cardiac-wise other than aspirin and referral to chest pain clinic, if not happy to send home with reassurance re: oesophageal spasm?  
Jamie McPherson
about 8 years ago
Foo20151013 2023 7owyf5?1444773963
3
158

Benchmarking Outpatient Referral Rates

Introduction GPs for a little while have been asked to compare each other’s outpatient referrals rates. The idea is that this peer to peer open review will help us understand each others referral patterns. For some reason and due to a natural competitive nature of human behaviour, I think we have these peer to peer figures put to us to try to get us to refer less into hospital outpatients. It’s always hard to benchmark GP surgeries but outpatient referral benchmarking is particularly poor for several reasons It's Very Difficult to Normalise Surgeries Surgeries have different mortalities morbidities ages and other confounding factors that it becomes very hard to create an algorithm to create a weighting factor to properly compare one surgery against another. There Are Several Reasons For The Referral I’ll go into more detail on this point later but there are several reasons why doctors refer patients into hospital which can range from: doctors knowing a lot about the condition and picking up subtle symptoms and signs lesser experienced doctors would have ignored; all the way to not knowing about the condition and needing some advice from an expert in the condition. We Need To Look At The Bigger Picture The biggest killer to our budget is non-elective admissions and it’s the one area where patient, commissioner and doctor converge. Patients want to keep out of hospital, it’s cheaper for the NHS and Doctors don’t like the lack of continuity when patients go in. For me I see every admission to hospital as a fail. Of course it’s more complex than this and it might be totally appropriate but if we work on this concept backwards, it will help us more. Likewise if we try to reduce outpatient referrals because we are pressurised to, they may end up in hospitalisation and cost the NHS £10,000s rather than £100s as an outpatient. We need to look at the bigger picture and refer especially if we believe that referrals will lead to less hospitalisation of patients further down the line. To put things into perspective 2 symptoms patients present which I take very seriously are palpitations in the elderly and breathlessness. Both symptoms are very real and normally lead to undiagnosed conditions which if we don’t tackle and diagnose early enough will cause patients to deteriorate and end up in hospital. Education, Education, Education When I first went into commissioning as a lead in 2006 I had this idea of getting to the bottom of why GPs refer patients to outpatients. The idea being if we knew why, we would know how to best tackle specialities. I asked my GPs to record which speciality to refer to and why they referred over a 7 month period. The reason for admission was complex but we divided them up into these categories: 2nd care input required for management of the condition. We know about the condition but have drawn the line with what we can do in primary care. An example of this is when we’ve done a 24 hour tape and found a patient has 2sec pauses and needs a pace maker. 2nd care input required for diagnosis. We think this patient has these symptoms which are related to this condition but don’t really know about the diagnosis and need help with this. An example of this is when a patient presents with diarrhoea to a gastroenterologist There could be several reasons for this and we need help from the gastroenterologist to confirm the diagnosis via a colonscopy and ogd etc. Management Advice. We know what the patient has but need help with managing the condition. For example uncontrolled heart failure or recurrent sinusitis. Consultant to Consultant Referral. As advised between consultants. Patient Choice. Sometimes the patient just wants to see the hospital doctor. The results are enclosed here in Excel and displayed below. Please click on the graph thumbnail below. Reasons For Referrals Firstly a few disclaimers and thoughts. These figures were before any GPSI ENT, Dermatology or Musculosketal services which probably would have made an impact on the figures. There are a few anomalies which may need further thought eg I’m surprised Rheumatology for 2nd input for diagnosis is so low, as frequently I have patients with high ESRs and CRPs which I need advise on diagnoses. Also audiology medicine doesn’t quite look right. The cardiology referral is probably high for management advise due to help on ECG interpretation although this is an assumption. This is just a 7 month period from a subset of 8-9 GPs. Although we were careful to explain each category and it’s meaning, more work might need to be done to clarify the findings further. In my opinion the one area where GPs need to get grips with is management advice as it’s an admission that I know what the patient has and need help on how to treat them. This graph is listed in order of management advice for this reason. So what do you do to respond to this? The most logical step is to education GPs on the left hand side of this graph and invest in your work force but more and more I see intermediary GPSI services which are the provider arm of a commissioning group led to help intercept referrals to hospital. In favour of the data most of the left hand side of the graph have been converted into a GPSI service at one point. In my area what has happened is that referrals rates have actually gone up into these services with no decline in the outgoing speciality as GPs become dis-empowered and just off load any symptoms which patients have which they would have probably had a higher threshold to refer on if these GPSI services were not available. Having said that GPSI services can have a role in the pathway and I’m not averse to their implementation, we just have to find a better way to use their services. 3 Step Plan As I’m not one to just give problems here are my 3 suggestions to help referrals. To have a more responsive Layered Outpatient Service. Setting up an 18 week target for all outpatients is strange, as symptoms and specialities need to be prioritised. For example I don’t mind waiting 20 weeks for a ENT referral on a condition which is bothering me but not life threatening but need to only have a 3 week turn over if I’m breathless with a sudden reduction in my exercise tolerance. This adds an extra layer of complexity but always in the back of my mind it’s about getting them seen sooner to prevent hospitalisation. Education, education, education It’s ironic that the first budget to be slashed in my area was education. We need to education our GPs to empower them to bring the management advice category down as this is the category which will make the biggest impact to improving health care. In essence we need to focus on working on the left hand side of this graph first. Diagnose Earlier and Refer Appropriately The worst case scenario is when GPs refer patients to the wrong speciality and it can happen frequently as symptoms blur between conditions. This leads to delayed diagnosis, delayed management and you guessed it, increased hospitalisation. The obvious example is whether patients with breathlessness is caused by heart or lung or is psychogenic. As GPs we need to work up patients appropriately and make a best choice based on the evidence in front of us. Peer to peer GP delayed referral letter analysis groups have a place in this process. Conclusion At the end of the day it's about appropriate referrals always, not just a reduction. Indeed for us to get a grip on the NHS Budgets as future Clinical Commissioners, I would expect outpatient referrals to go up at the expense of non-elective, as then you are looking at patients being seen and diagnosed earlier and kept out of hospital.  
Raza Toosy
about 8 years ago
Foo20151013 2023 9huqgh?1444773995
4
271

Full Disclosure

I read a BBC article today about a doctor who had filmed examinations of women for voyeuristic purposes. One quote in particular stood out: "We had the challenge of identifying and locating a large number of women and explaining to them that their examinations had been secretly recorded by Bains for the purpose of his sexual gratification. It was horrendous. They were unaware that they were victims and this dated back over a three-year period." At least 30 women have been contacted to be told they were victims of someone's perversion. Until they were told, they had no idea they were victims. Only upon being told will they feel disgust and violation, not to mention distrust over future consultations. It reminded me of a discussion recently on here where a student was telling us about an experience where they saw a patient with horrific stitching and scarring after surgery. The doctor told the patient that it all looked like it was healing fine, then after the patient left, commented to the student that the stitching was some of the worst they'd ever seen. Was the doctor lying or being compassionate? Should the police tell the perverted doctor's victims, or leave them in peaceful ignorance? As I patient - I think I'd just rather not know, but I believe many doctors would argue that full disclosure is essential, especially in light of the Francis Report. I would be interested in medics' views, from ethical, procedural and "real-world" points of view.  
Jeremy Walker
about 8 years ago
Foo20151013 2023 gc6z71?1444774005
7
279

Worst Medical Experience Ever

Worst experience ever? - this is pretty difficult as I've worked in some of the poorest countries in the world and seen some things that should never happen like children dying of dehydration and malaria. But this recent experience was definitely the worst. It was midnight and I was trying to get my 16 month old to sleep having woken up after vomiting in his cot. Despite paracetamol, ibuprofen, stripping to nappy, damp sponging and having the window open he went rigid and started fitting. It only lasted a minute or two yet felt like an eternity as he was unable to breathe and became progressively blue as my mind raced ahead to brain damage or some other horrible sequalae. The fitting stopped and my mind turned to whether I was going to have to start CPR. I lay him on the floor and put my ear to his chest and was glad to hear a strong heartbeat but he was floppy with a compromised airway so I quickly got him in the recovery position. The ambulance arrived in 8 minutes and after some oxygen and some observations he was strapped in and ready to go. He had been unconscious for about 15 minutes but was starting to come round, much to my relief. The ambulance crew were great and their quick response made all the difference but then they took nearly half an hour to get to A&E in the middle of the night because they took the most awkward route imaginable. I don't know if it was a deliberate delaying tactic or just a lack of local knowledge but even without a blue light I could have done it in half the time! Why do ambulances not have GPS - ideally with local traffic info built in? We arrived in A&E and were ushered to a miserable receptionist who took our details and told us to have a seat. I noticed above her head that the wait time was 3.5 hours, though we did see a junior nurse who took his observations again. Not long after the screen changed to a 5 hour wait and a bit later to a 6 hour wait! I am glad to say that by about 3 hours my little man was back to his usual self (as evidenced by his attempts at destroying the department) and so after getting the nurse to repeat his obs (all normal) we decided to take him home, knowing we had a few more hours to wait for the doctor, and that the doctor was now unlikely to do anything as he was now well. I tell the story in such detail in part for catharsis, in part to share my brief insight into being on the other side of the consultation, but also because it illustrated a number of system failures. It was a horrible experience but made a lot worse by those system failures. And I couldn't help but feel even more sorry for those around me who didn't have the medical experience that I had to contextualise it all. Sickness, in ourselves or our loved ones, is bad enough without the system making it worse. I had 3 hours of walking around the department with my son in my arms which gave me plenty of time to observe what was going on around me and consider whether it could be improved. I did of course not have access to all areas and so couldn't see what was happening behind the scenes so things may have been busier than I was aware of. Also it was only one evening so not necessarily representative. There were about 15 children in the department and for the 3 hours we were there only a handful of new patients that arrived so no obvious reason for the increasing delay. As I walked around it was clear to me that at least half of the children didn't need to be there. Some were fast asleep on the benches, arguably suggesting they didn't need emergency treatment. One lad had a minor head injury that just needed a clean and some advice. Whilst I didn't ask anyone what was wrong with people talk and so you hear what some of the problems were. Some were definately far more appropriate for general practice. So how could things have been improved and could technology have helped as well? One thing that struck me is that the 'triage' nurse would have been much better as a senior doctor. Not necessarily a consultant but certainly someone with the experience to make decisions. Had this been the case I think a good number could have been sent home very quickly, maybe with some basic treatment or maybe just with advice. Even if it was more complex it may have been that an urgent outpatient in a few days time would have been a much more satisfactory way of dealing with the problem. Even in our case where immediate discharge wouldn't have been appropriate a senior doctor could have made a quick assessment and said "let's observe him for a couple of hours and then repeat is obs - if he is well, the obs are normal and you are happy then you can go home". This would have made the world of difference to us. So where does the technology come in? I've already mentioned Sat Nav for the ambulance but there are a number of other points where technology could have played a part in improving patient experience. Starting with the ambulance if they had access to real time data on hospital A&E waiting times they may have been able to divert us to a hospital with a much shorter time. This is even more important for adult hospitals were the turnover of patients is much higher. Such information could help staff and patients make more informed decisions. The ambulance took us to hospital which was probably appropriate for us but not for everyone. Unfortunately many of the other services like GP out of hours are not always prepared to accept such patients and again the ambulance crews need to know where is available and what access and waiting times they have. Walk-in patients are often also totally inappropriate and an easy method of redirection would be beneficial for all concerned. But this requires change and may even require such radical ideas as paying for transport to take patients to alternative locations if they are more appropraite. The reasons patient's choose A&E when other services would be far more appropriate are many and complex. It can be about transport and convenience and past experiences and many other things. It is likely that at least some of it is that patients often struggle to get an appointment to see their own GP within a reasonable time frame or just that their impression is that it will be difficult to get an appointment so they don't even try. But imagine a system where the waiting times for appointments for all GPs and out of hours services were readily available to hospitals, ambulances, NHS direct etc. Even better imagine that authorised people could book appointments directly, even when the practice was closed. How many patients would be happy to avoid a long wait in A&E if they had the reassurance of a GP appointment the next day? And the technology already exists to do some of this and it wouldn't be that hard to adapt current technology to provide this functionality. Yet it still doesn't happen. I have my theories as to why but this is enough for one post. In case you were wondering my son appears to have made a full recovery with no obvious ongoing problems. I think I have recovered and then he makes the same breathing noises he made just before the fit and I am transported back to that fateful night. I think it will take time for the feelings to fade.  
Dr Damian Williams
about 8 years ago
Foo20151013 2023 1f9109k?1444774063
2
2679

Criticizing the NHS - Can students do this productively?

In this month’s SBMJ (May 2013) a GP called Dr Michael Ingram has written a very good article highlighting some of the problems with the modern NHS’s administrative systems, especially relating to the huge amount of GP time wasted on following up after administrative errors and failings. I personally think that it is important for people working within the NHS to write articles like this because without them then many of us would be unaware of these problems or would feel less confident in voicing our own similar thoughts. The NHS is a fantastic idea and does provide an excellent service compared to many other health care systems around the world, but there is always room for improvement – especially on the administrative side! The issues raised by Dr Ingram were: Histology specimens being analysed but reports not being sent to the GP on time or with the correct information. Histology reports not being discussed with patient’s directly when they try and contact the hospital to find out the results and instead being referred to their GP, who experiences the problem stated above. GP’s are being left to deal with patient’s problems that have nothing to do with the GP and their job and have everything to do with an inefficient NHS bureaucracy. These problems and complaints often taking up to a third of a GP’s working day and thereby reducing the time they can spend actually treating patients. Having to arrange new outpatient appointments for patients when their appointment letters went missing or when appointments were never made etc. Even getting outpatient appointments in the first place and how these are often delayed well after the recommended 6 week wait. Patients who attend outpatient appointments often have to consult their GP to get a prescription that the hospital consultant has recommended, so that the GP bares the cost and not the hospital. My only issue with this article is that Dr Ingram highlights a number of problems with the NHS systems but then does not offer a single solution/idea on how these systems could be improved. When medical students are taught to write articles for publication it is drummed into us that we should always finish the discussion section with a conclusion and recommendations for further work/ implications for practice. I was just thinking that if doctors, medical students, nurses and NHS staff want to complain about the NHS’s failings then at least suggest some ways of improving these problems at the same time. This then turns what is essentially a complaint/rant into helpful, potentially productive criticism. If you (the staff) have noticed that these problems exist then you have also probably given some thought to why the problem exists, so why not just say/write how you think the issue could be resolved? If your grievances and solutions are documented and available then someone in the NHS administration might take your idea up and actually put it into practice, potentially reducing the problem (a disgustingly idealist thought I know). A number of times I have been told during medical school lectures and at key note speeches at conferences that medical students are a valuable resource to the NHS administration because we visit different hospitals, we wander around the whole hospital, we get exposed to the good and bad practice and we do not have any particular loyalty to any one department and can therefore objective observations. So, I was thinking it might be interesting to ask as many medical students as possible for their thoughts on how to improve the systems within the NHS. So I implore any of you reading this blog: write your own blog about short comings that you have noticed, make a recommendation for how to improve it and then maybe leave a link in the comments below this blog. If we start taking more of an interest in the NHS around us and start documenting where improvements could be made then maybe we could together work to create a more efficient and effective NHS. So I briefly just sat down and had a think earlier today about a few potential solutions for the problems highlighted in Dr Ingram’s article. A community pathology team that handles all of the GP’s pathology specimens and referrals. A “patient pathway co-ordinator” could be employed as additional administrative staff by GP surgeries to chase up all of the appointments and missing information that is currently using up a lot of the GP’s time and thereby freeing them to see more patients. I am sure this role is already carried out by admin staff in GP practices but perhaps in an ad hoc way, rather than that being their entire job. Do the majority of GP practices get access to the hospitals computer systems? Surely, if GPs had access to the hospital systems this would mean a greater efficiency for booking outpatient appointments and for allowing GPs to follow up test results etc. In the few outpatient departments I have come across outpatient appointments are often made by the administration team and then sent by letter to the patients, with the patient not being given a choice of when is good for them. Would it not be more efficient for the administrative staff to send the patients a number of appointment options for the patient to select one appropriate for them? Eliyahu M. Goldratt was a business consultant who revolutionized manufacturing efficiency a few years ago. He wrote a number of books on his theories that are very interesting and easy to read because he tries to explain most of his points using a narrative – “The Goal” and “Critical Chain” being just tow. His business theories focussed on finding the bottle neck in an industrial process, because if that is the rate limiting step in the manufacturing process then it is the most essential part for improving efficiency of the whole process. Currently, most GPs refer patients to outpatient appointments at hospitals and this can often take weeks or months. The outpatient appointments are a bottle neck in the process of getting patients the care they require. Therefore, focussing attention on how outpatient appointments are co-ordinated and run would improve the efficiency in the “patient pathway” as a whole. a. Run more outpatient clinics. b. Pay consultants overtime to do more clinics, potentially in the evenings or at weekends. While a lot may not want to do this, a few may volunteer and help to reduce the back log on the waiting lists. c. Have more patients seen by nurse specialists so that more time is freed up for the consultants to see the more urgent or serious patients. d. An obvious, yet expensive solution, hire more consultants to help with the ever increasing workload. e. Change the outpatient system so that it becomes more of an assembly line system with one doctor and a team of nurses handling the “new patient” appointments and another team handling the “old patient” follow up appointments rather than having them all mixed together at the same time. I am sure that there are many criticisms of the points I have written above and I would be interested to hear them. I would also love to hear any other solutions for the problems mentioned above. Final thought for today … Why shouldn’t medical students make criticisms of inefficiencies and point them out to the relevant administrator? If anyone else is interested in how the NHS as a whole is run then there is a new organisation called the Faculty of Medical Leadership and Management that is keen to recruit interested student members (www.fmlm.ac.uk).  
jacob matthews
almost 8 years ago
Foo20151013 2023 5jd630?1444774107
4
80

Do hacks really work?

Well I think they do. In 2012 I attended the #digidoc2012 conference in London. This was a conference aimed at bringing clinicians and technology enthusiasts together to learn how better to use technology to help in a clinical setting. Part of the day included tutorials and lectures, but my favourite part was the ‘hack’ session. In groups, we pitched ideas about potential apps which could be created to help different groups i.e. clinicians, patients, providers etc. From this session the initial concept of PhotoConsent was formed. The problem: Medical photography in a hospital setting can be relatively straight forward. A clinician can call up the medical photography department, get them to sort out the forms and details, patient consented, picture taken...done. The main issue with this is the time taken to access the medical photography department. Medical photography in a moderately acute setting or primary care is considerably less straight forward. Issues on how you document the consent, what methods used (verbal or written) and how this is stored need to be considered. There exists some guidance on the matter (see Good Medical Practice: Making and using visual and audio recordings of patients), however actual practice is variable. The added issue of social media and the ease of which images can now be shared can add to the confusion. The solution - PhotoConsent: I am involved in several on-line forums and governance groups. With seeing interactions about patient images in social media and various online clinical groups, I felt a more complete solution was needed which gave better protection and governance for both patients and clinicians. Following the #digidoc12 conference (https://thedigitaldoc.co.uk/), I met some innovative colleagues including Ed Wallit (@podmedicsed). We took this brainstormed idea further and now we have a finished product- PhotoConsent app. PhotoConsent is a new application designed to help you as a clinician to safely and easily take photos of a patient and then obtain the relevant consent for that photo quickly and efficiently. It is currently available on iOS. How does it work? Upon opening the app you can take a photo from the home screen. Once you have confirmed you have the best possible image, you and the patient are shown the consent options. Using PhotoConsent you can choose to obtain consent to use the photo for assessment, second opinion or referral, educational use or publication. In real time with the patient you can then select each consent option to explore in more detail to allow informed consent. This consent can then be digitally signed and emailed to the patient instantly. The image and consent can then be used by the clinician in accordance with GMC guidance. This can be via the app, email or via the online portal: PhotoConsent.co.uk. What makes PhotoConsent unique is that the consent is digitally secure in the metadata of the image. So proof of consent is always with the image. Why should I use PhotoConsent? It is important if taking a medical image of a patient, that consent is obtained and recorded. Written consent is considered the best option. PhotoConsent allows you to take consent with the patient in real-time, forward the patient a copy of the consent so they can stay informed, and be safe in the knowledge that consent is secure within the image metadata. All this is possible through your own iOS device making it convenient and effective for all involved. What is next for PhotoConsent? The first release of PhotoConsent is out, but there can always be progression. In the future I hope to bring the app to the Android platform to make it more accessible to a wider audience. We are also working on expanding the app to include consent for non-medical use. We have a few other ideas but time will tell if these are possible. About the owner: Dr Hussain Gandhi (@drgandalf52) is a GP and GP trainer working in the Nottingham area. He is a RCGP First5 lead, Treasurer of RCGP Vale of Trent faculty, co-author of The New GPs Handbook, owner of PhotoConsent and egplearning.co.uk – an e-learning portal; and a member of Tiko’s GP group on Facebook (@TheVoiceofTGG). All Images taken via PhotoConsent.  
Hussain Gandhi
over 7 years ago