Australia has the highest prevalence of skin cancer in the world. Australian GPs manage skin cancer at a rate of 1.2/100 encounters, and excision of skin lesions is one of the most common procedures in general practice. There is an expectation that GP registrars should be able to comprehensively assess and manage skin cancers, including undertaking a range of related minor procedures.
Thyroid disease includes thyroid dysfunction (hypo- and hyperthyroidism), and structural disease (goitre, nodules and cancer), and is commonly encountered in Australian general practice. Investigation and management of thyroid disease is usually straightforward, but inappropriate testing and screening is well recognised and can lead to patient harm.
Transient ischaemic attacks (TIAs) are uncommon presentations in general practice and can be difficult to diagnose. However, it is essential that registrars are competent in the assessment of symptoms consistent with a TIA, as early intervention is critical to reduce the risk of stroke. Stroke affects 50,000 Australian’s each year, 30% of whom are under 60 years of age. Evidence suggests adherence to guidelines for management of TIA is poor.
Upper respiratory tract infection (URTI) is the most common problem managed by GP registrars. Antibiotic resistance is a major public health threat and current evidence-based guidelines do not recommend the use of antibiotics for simple URTIs and sore throat. However, Australian GPs issued over 2 million antibiotic prescriptions for URTI in 2011 (with antibiotics being prescribed in 32% of URTI presentations). Supervisors can play a key role in reducing unnecessary antibiotic prescription by appropriate supervision and role modelling.
Urinary tract infection (UTI) is a common presentation in Australian general practice, comprising about 1% of all problems managed. The presentation of UTIs is highly variable, ranging from mild dysuria to severe sepsis, and masquerades are not uncommon. The approach to investigation and management depends on the patient’s age, gender, co-morbidities and presentation. GP registrars are likely to have seen many presentations of UTI in their ED experience, but are often less confident on the approach to investigation, and management of recurrent or complicated infection.