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International Primary Care Association

Clinical Focus Volume 1 N1

Volume 1 Issue 1 - 2005


The finding of a thyroid nodule raises concern of malignant disease. Thyroid nodules are common but thyroid cancer is rare. The incidence of thyroid cancer in those with clinical features strongly suggestive of malignancy is high but the majority of patients do not have these features. Appropriate investigation will identify the more common benign nodules, avoiding unnecessary testing and surgical treatment in the majority. All patients with thyroid nodules require biochemical assessment to exclude hyper or hypothyroidism and overt thyroid dysfunction effectively rules our malignancy. Fine needle aspiration cytology (FNAC) is increasingly used as first line investigation of thyroid nodules. Fine needle aspiration cytology and a thyroid function test are cornerstones of investigation.


Hospital medicine has undergone considerable changes over the past decade. One of these changes has been the appearance of the term ‘acute medicine’ in the vocabulary of clinicians and managers working within the NHS. Since its first mention in a Royal College of Physicians document in 1996, the development of acute medicine has been a ‘roller-coaster’ ride, culminating in the establishment of subspecialty status in July 2003. The field now has its own journal, a specialist society and over 150 consultants across the UK. So what have been the catalysts for these rapid and dramatic changes, and what opportunities does the field of acute medicine offer for general practitioners with special interests?


I have had an interest in cardiology for some time, which developed during my time in anaesthesia and I felt that primary care had more to offer in this area. Some brief research (and a few emails) encouraged me to further develop my interest when I heard what others were doing in primary care. I was particularly interested in developing a local echocardiography service due to my personal interest in ultrasound and the pressures on our secondary care provider. A quick audit revealed a turn around time of almost four months from our local open access echo service (from dictation of referral to the typed report landing on my desk). The final catalyst was my desire to work as a GP with a special interest as the daily grind of full time partnership was adversely affecting my quality of life.


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