About the GP and Technology Used
Dr Cowan has been a GP for 22 years and currently works at the Nap Surgery, in Kings Langley in the Herts Valleys CCG area. Since October 2021, clinicians across Herts West Essex (HWE) ICS have had access to Advice & Guidance via Consultant Connect. On average, calls are connected in just 47 seconds, providing clinicians in HWE with rapid advice from specialist clinical teams.
We asked Dr Cowan to share examples of how the service has helped improve patient care recently.
Initial Patient Presentations
“I saw a patient who had recently been diagnosed with an extensive DVT. She exercised frequently right up until the diagnosis and during my follow-up appointment with her, she mentioned that she was on her way to an exercise class that day. As the patient had only just started on a direct oral anticoagulant (DOAC), I used Consultant Connect to speak to a Haematologist for advice on whether there was a minimum amount of time a person should be on a DOAC before resuming exercise to reduce the risk of thromboembolism. The consultant was really helpful and advised that, although there was very little evidence on this, the consensus opinion was that it was safe to exercise as soon as the DOAC was started as its primary mechanism of action was to stop clot extension. We concluded that the patient could continue to exercise, assuming it was not causing her any symptoms or pain.”
On another occasion, Dr Cowan used the service for specialist advice about a patient showing abnormal liver function as part of his blood test monitoring for methotrexate.
“I saw a patient whose blood tests came back showing very high levels of transaminases as part of his liver function blood test monitoring on methotrexate. The level of transaminases was just above the level at which specialist advice was recommended in order to decide if methotrexate should be temporarily stopped. Previously, I would have had to call the hospital. However, I was able to get through to a Rheumatologist via Consultant Connect who confirmed that is was best to omit the dose for that week and repeat the liver function blood test the following week. This was especially helpful as the patient was very reluctant to stop his methotrexate so being able to provide timely specialist advice and reassurance was particularly important for him. She also discussed the best ongoing management with respect to the repeat transaminase levels which was so useful.”
In another example, Dr Cowan spoke to an Endocrinologist regarding a bulimic patient who had also recently taken a course of anabolic steroids as part of her bodybuilding work.
“The patient had started to purge again, so I did some basic blood tests, to ensure, amongst other things, that this hadn’t resulted in any electrolyte abnormalities. As part of those tests, I got some very abnormal and unexpected thyroid function results back, which suggested some pituitary dysfunction and considering her history of taking anabolic steroids, I was concerned about her hypothalamic-pituitary-adrenal axis. I called an Endocrinologist via Consultant Connect to discuss the most appropriate investigations and how quickly we needed to request these. He was fantastic and gave a very clear action plan and advice. It was so quick, and I was able to reassure the patient, set up next day investigations and ensure that she was safely managed and followed up.”
How using the service helped the patients and GP
On all occasions, the timeliness of advice received from the specialists reassured the patients and meant that they got the right care faster.
Dr Cowan adds what she likes the most about Advice & Guidance via Consultant Connect:
“It’s so helpful and saves such a lot of time. I do honestly think it’s a lifeline. I think I’ve covered pretty much every specialty now – I’ve spoken with a Rheumatologist, an Endocrinologist, a Gastroenterologist, a Cardiologist and a Haematologist.”