Medical standards and medical examinations医学标准和体检.ppt

Medical standards and medical examinations Tim Carter 2010 revisions Most changes are working well ADs empowered to take more discretionary decisions Some problem areas: Vision Hearing Obesity Asthma Vision Standards clear Problems in interpretation Quality of assessment – charts/plates, lighting, conditions of use, accountability MCA lanterns – limitations of CAM, servicing of Holmes Wright B, access to testing, future use of screen-based methods Hearing Use of test methods: timing, choice, application. Whisper, audiometry, RNID Sound cards in NHS computers Practicality of use Interpretation of results Hearing case study Results from one AD who tested all seafarers seen RNID tested: 82 First ENG 1: 9, all normal Subsequent ENG 1 Tested: 73 Normal: 62 Possibly below normal: 10 (3 normal on re-test) Below normal: 1 Referred to GP and for retest at next ENG 1: 8 Obesity Hawks and doves Use of framework as in standards Decisions based on capability – assessed where needed. BMI as a guide to need for assessment Practicalities of assessment ‘Doing deals’ Failure to meet agreed targets Asthma Text in MSN 1822 and in ADG Presentation at 2009 Seminar Few difficulties if no recent episodes and no continuing treatment or if poor control Considerable number of people on continuing treatment that is effectively suppressing any symptoms Risk of exacerbation at sea Provoking factor: respiratory infection MCA APPROVED DOCTORS AUDIT PROGRAMME  AUDIT VISIT SUMMARY AUDIT VISIT RESULTS Common shortcomings identified… Admin Confusion between old and new manual Using new pad of ENG 1 certificates before old one has finished Not adhering to standard restrictions ENG1 certificates not stored in locked cupboards Clinical information recorded on ENG 1s ADs giving practice / general email address as main point of contact for MCA must ensure that staff are aware of this and see all emails MCA send Clinical Soundproofing arrangements for consultation rooms Inability to access RNID test fr