Dr Neville Geary on Dear Reader blog
Need to think twice before bagging tests -
from William Ferguson
A recent group of patients would agree with Dr Ferguson. Amongst
them a 13 year old Maori girl with fatigue , irritability and
generally feeling out of sorts. Vitamin D level 21.
Adult male 55 years with depressed mood and a rather angry view of
anything to do with nutrition. Was B12 , vitamin D and iron
In the area of psychiatry I would prefer to tick a box than see a
patient become even more despondant when medications do not seem to
I would refer all to two very good web sites. Firstly OMIM -
Online Mendelian Inheritance in Man. A web site run by Johns
Hopkins University , It documents cases with genetic findings
matched to clinical findings.
Search any supplement you can think of and enjoy.
Also the website of the American Neuromuscular Society .
Particularly the metabolic ataxia section. Deficiency of certain
nutrients is more important to some.
While it is not appropriate to test without thinking our ethical
guidelines also dictate that we do not withold appropriate
In the area of genetic conditions treatable with vitamins
/supplements. I will buy a good bottle of wine for the GP ,
registrar or psychiatrist who refers the first confirmed case
of an electron transport disorder to Aucklands metabollic service.
Two if you find a late onset case .
Stu Thomson's comment on the Crikey Blog:
What's in a name - primary care, community
care, who cares?
I think the term "general" has long been seen as meaning "not
specialised". We need to move away from this notion. Primary care
is probably a better term, but community care is so devolved as to
include rest homes, First Aid and St. John, various types of nurse
practitioner, physiotherapists, chiropractors, and on and on. Even
hospital emergency departments are major providers of acute
Many of these also fit within the concept of primary care and we
need to define ourselves and our practices not as the trough that
accepts the discards that no-one else wants to treat (take those
who don't reach access criteria for procedures such as herniae -
know any GPs able to operate in their practice rooms?) but as the
leaders of health improvement and providers of treatment of the
majority of ailments and illnesses and injuries.
But what should we be called? Don't know if I have an answer for
that yet. Maybe we should be Community Health Specialists, or
Health Physicians. After all, we are tasked with improving health,
hospitals are generally tasked with performing procedures and
managing life-threatening emergencies, but NOT with improving
Bryan Moore's comment on our That's
Review puts merits of breast cancer screening under the
microscope - The Independent (UK)
Fascinating stuff - and the responses equally so.
Simply put, the proponents of screening will overstate its
benefits on the "positive" results (i.e. something found), the
opponents will overstate the negative effects on the negative
results (i.e. nothing found). Both of these approaches are "disease
A "patient-centred" approach would emphasize that the realization
that you don't have something (or are unlikely to have something)
has more benefit than finding out that you do!
As the vast majority of those screened are found not to have
something, just think of all the reassurance this provides!
Possibly the best example of this is Prostate cancer.
Despite all the hoo-hah, there is little evidence supporting
screening for the positive results.
In fact there is little evidence supporting treating the positive
But the value of knowing that you don't have it cannot be
underestimated. So I support screening. (And 70% of breast cancers
are still found on self-examination).