Treatment

Prescribed treatment, such as drugs or physiotherapy, is not always necessary. For some conditions, the most important part of a GP’s role may be to offer reassurance that a symptom is not a cause for concern.

Many minor health problems cure themselves. In long-term illness, a family doctor can provide crucial support and understanding, often based on a relationship built over years. However, in many cases drug treatment will be recommended, either on a short-term basis to relieve an acute problem (such as antibiotics for a bacterial infection), or for a longer period for a chronic condition (such as drugs for high blood pressure). Other treatments may be recommended to complement prescribed medicines; for example, physiotherapy may be prescribed in combination with non-steroidal anti-inflammatory drugs (NSAIDs) to treat a muscle problem.

Sometimes surgery may be necessary to treat a condition and in most cases this involves referral to hospital, unless the surgery is very minor (such as wart removal). Sometimes, despite many investigations, a definitive cause cannot be found to explain a patient’s symptoms. In these circumstances, the GP may recommend measures that aim to relieve symptoms and to address factors that may be contributing to the problem, such as stress.

Tests and investigations

Where further tests or investigations are required, your doctor may arrange them directly or refer you to a hospital specialist, who will organise the appropriate procedures. Tests and investigations can range from simple blood tests to highly sophisticated imaging tests, such as MRI and radionuclide scanning. The tests you will have depend on the nature of the condition that is suspected. Some of the more common tests and investigations are described below.

Blood tests

These are among the most frequently and easily performed medical tests. The composition of the blood can tell a great deal about the state of someone’s health. Blood cell tests look at the number and composition of red and white blood cells and platelets in the blood. They help doctors in diagnosing diseases of the blood, such as anaemia. Blood cell tests can also show evidence of infection because it causes the white blood cell count to rise. Tests on blood chemistry measure the levels of certain chemicals and minerals in the blood and are particularly used to check the functioning of the kidneys and the liver. Finally, blood lipid tests measure the levels of certain fatty substances (known as lipids) in the blood. High levels of some lipids cause fatty deposits to develop on the lining of the artery walls, a condition known as atherosclerosis.

Urine tests

The substances that are usually checked in a urine analysis include glucose, proteins, some electrolytes and creatinine (a product of protein metabolism). The presence of certain hormones in the urine indicates pregnancy. Testing a urine sample may also reveal blood cells, bacteria or other substances that indicate an underlying problem.

Tissue tests

Tissue tests, often called biopsies, involve taking a small sample of tissue from the body for examination under a microscope. Biopsies may be done for a number of reasons, including confirmation of a diagnosis or in order to investigate a suspicious lump or area of tissue. In the case of cervical smears, a few cells from the cervix are removed to be examined for pre-cancerous changes.

Patch tests

A dermatologist or allergist can carry out patch tests on the skin to look for evidence of allergic reactions. In these tests, small, diluted amounts of potential allergens are placed on strips or discs, which are then taped to the skin for 48 hours. When the strips or discs are removed, the skin underneath is examined. Skin that is reddened or inflamed indicates an allergic reaction to the substance. Tested areas that show nore action at first are examined again after a further 48 hours for any delayed reaction.

X-rays

These use high-intensity radiation to form an image on film placed on the other side of the body. Hard structures in the body, such as bones, block the radiation and show up on the film as white areas. X-rays are useful for imaging hard structures but are not very useful for imaging most soft tissues, including liver tissues, since soft tissue does not effectively block the radiation. However, a type of X-ray known as a contrast X-ray may be used to image certain soft tissue structures, such as those in the digestive tract.

Ultrasound scanning

This type of scanning uses sound waves to produce images. The image is formed by the “echo” of the sound waves as they bounce off different parts of the body. The echoes differ in their wavelength according to the density of the area examined. Ultrasound has become an important diagnostic tool, for example to investigate breast lumps in young women and to look for a cause of abdominal pain, such as gallstones. Ultrasound scanning also plays an important part in antenatal testing. A specialised form of ultrasound scanning, known as echocardiography, may be used to assess heart structure and function.

Computerised tomography (CT) scanning

In this technique, X-rays in conjunction with a computer produce images that build up a cross-sectional view of the body. CT scanning makes it possible to gather detailed information about organs and tissues. CT scans are most often taken of the head and the abdomen.

Magnetic resonance imaging (MRI)

Like CT scanning, MRI provides highly detailed crosssectional images of internal organs and structures. These images are created by a computer using information received from a scanner. Unlike X-rays or CT scanning, MRI does not involve radiation; instead, it uses a magnetic field and radiowaves. MRI may distinguish abnormal soft tissue more clearly than CT scanning, and may be used at a greater range of planes through the body than is possible with CT scanning. MRI is especially useful for imaging the brain and for detecting tumours. It is also valuable for looking at the intervertebral discs and may be used to

investigate low back pain.

Radionuclide scanning

In radionuclide scanning a radioactive substance called a radionuclide is introduced into the body (usually by injection) and is taken up by the organ or tissue to be imaged. A counter outside the body detects the radiation that is emitted and this information is in turn transmitted to a computer, which transforms it into images. Radionuclide scans may be used to detect abnormal levels of activity in organs such as the thyroid gland and the kidneys and is useful for detecting tumours and other disorders in these organs. Another type of scanning, known as thallium scanning, may be used to investigate heart function.

Endoscopy

This procedure allows doctors to look inside the body. A tube-like instrument is inserted into the body. Endoscopes are very fine fibre-optic instruments that allow doctors to view organs and other structures on a monitor. Depending on the area to be viewed, access may be through a natural opening, such as the mouth or anus. Alternatively, it may be through a small incision, which may be made into a joint or the abdominal cavity. Many endoscopic procedures are performed under a general or local anaesthesic.

Hospital medicine

Hospital doctors are specialists who have additional training in their chosen area. For example, an oncologist specialises in cancer and an urologist in disorders of the urinary tract. In some cases, hospital doctors “superspecialise”, concentrating on one particular aspect of a speciality. For example, an endocrinologist (a specialist in diseases affecting the hormone system) may have a particular interest in diabetes mellitus.

Visiting a hospital specialist can seem daunting, but it is worth remembering that his or her aims are the same as your GP’s: to make a diagnosis, which may involve ordering some tests, and to recommend treatment that will cure or relieve your condition while causing the fewest possible side-effects. Be as open as possible; feel free to ask any questions you have and discuss any concerns. In some cases, specialists will prescribe drugs or recommend a treatment and then hand the patient’s care back to the GP; in other cases, they will wish to see the patient on a regular basis to monitor progress and to make changes to the treatment plan as necessary.

Making a diagnosis

Key to making appropriate recommendations for treatment is making a diagnosis whenever possible. The GP will look for patterns of symptoms that may suggest particular disorders.

For example, certain types of chest pain may be characteristic of coronary artery disease. He or she will take your medical history, which involves not only asking about your symptoms but also about other issues.

This may include a discussion of any previous illnesses, lifestyle habits (such as alcohol intake, exercise and whether you smoke) and the health of relatives. If stress may be contributing to or causing your symptoms, the GP will ask about work,conflicts, worries, relaxation and sleep patterns. He or she may then carry out a physical examination.

All of this information will guide the GP to make a diagnosis and to select appropriate treatment, or to recommend further tests or referral to a hospital specialist if necessary.

Complementary therapies in general practice

Doctors increasingly recognise the value of complementary therapies and a GP may aim to incorporate them into his treatment plan. The relative roles of these treatments may depend on several factors, including the condition to be treated, the patient’s wishes and the treatment options available to the doctor.

For certain conditions, such as cancer, schizophrenia or coronary artery disease (CAD), the GP will generally recommend that conventional drugs and procedures take a predominant role, but for other disorders complementary therapies may be a preferred first option. Complementary therapies can often work hand-inhand with conventional treatments to relieve symptoms, reduce underlying stress and improve general well-being.

The role of the GP

The GP plays a key role in the delivery of medical treatment, being the usual first port-of-call for people who are ill. GPs have a broad knowledge base and expertise in diagnosing a wide range of illnesses. In many cases they can recommend the appropriate treatment, whether it is lifestyle measures (such as reducing stress), drugs or other treatments.

Sometimes, a GP will recommend referral to a specialist or to another member of the medical team, such as a counsellor or speech therapist.

Doctors and Diagnosis

Different medical specialities tend to focus on particular systems. Thus, apart from the family doctor (general practitioner – GP), there are doctors who specialise in treating problems with the ears, nose and throat; doctors who specialise in obstetrics and gynaecology; doctors who specialise in treating problems with the heart; and so on.

Some specialities deal only with specific conditions, such as cancer, while others, such as radiology and haematology, concentrate mainly on diagnosis. In some instances, the combined expertise of several specialist doctors may be needed to treat a condition or an injury successfully. Specialists are normally based in hospitals. In addition to specialists, many other medical professionals deliver healthcare. These include nurses, health visitors, physiotherapists, occupational therapists and counsellors.