MBChB Curriculum Map

Dr Grey, a gastroenterologist, and Mr Black, a gastrointestinal surgeon, have noticed that their waiting lists for endoscopy have increased. Mrs Blue, the chief executive of the hospital trust, has also recently met with the chairs of the local primary care trusts (PCTs), who expressed concerns about these waiting-lists and suggested an open-access endoscopy service. Mrs Blue asks Dr Grey and Mr Black to develop a costed Proposal for PCT funding. She highlights the recent population health care needs assessment published by the PCT, in which descriptive epidemiology illuminated local population need/demand related to the clinical iceberg. There was also a review of evidence on the effectiveness, efficiency, and utility of endoscopy services. She asks them to include the costs and benefits of their proposal. The following financial year, in the new open-access endoscopy clinic, Dr Grey is writing her letters about the first two referrals:

Letter 1

Re: Mr Sidney Brown

Dear Dr White,

Thank you for referring this overweight 35 year-old accountant with a 3 year history of gastro-oesophageal reflux and heartburn, treated with antacids, and more recently with ranitidine (150 mg orally bd for several 6-week periods). At endoscopy, he was found to have moderate oesophagitis. Oesophageal function studies (manometry and 24-hour pH) confirmed gastro-oesophageal reflux disease (GORD). I have referred him to a dietician and prescribed omeprazole (20 mg orally bd). If he continues to have further problems, please do not hesitate to refer him back to me.

Yours sincerely,

Dr Grey

 

Letter 2

Re: Mrs Jane Green

Dear Mr Black,

Thank you for agreeing to see this 40 year-old woman with recurrent upper abdominal pain, which is severe at times, radiating through to the right side of her back, and is associated with nausea and vomiting. Relevant history includes a heavy alcohol intake during her twenties, and her mother having had a cholecystectomy. Mrs Green’s serum amylase was normal. Ultrasound scan revealed three gallstones in the gall bladder. I think she has had recurrent episodes of cholecystitis and having discussed the therapeutic options with Mrs Green, she is keen to discuss surgery with you.

Yours sincerely,

Dr Grey