The interdisciplinary value of vascular and endovascular management may sometimes be under recognised, but Dr Stefan Ponosh would like to see this changed.
The vascular and endovascular surgeon will be giving a talk on referral practices to specialists like himself at the upcoming clinical education event, Medical Forum Live.
“It’s not like cardiology, it’s not particularly publicised, I don’t think GP’s get a lot of updates on it,” Dr Ponosh said of his specialty areas.
He said he received many referrals in situations where the patient did not need to see a specialist.
“Part of that is an AI driven problem with radiology, they’re reporting a lot more nonsense and the GPs are referring that on, where in reality they don’t need to,” Dr Ponosh said.
He said in the past six months he had seen many patients referred with arterial disease in calf arteries that had been found on an ultrasound.
“I see a lot of people referred with a blockage in one of those, which I actually don’t need to see. We only actually treat tibial disease when people’s feet are at risk, so when there are severely compromised blood vessels, blood supply, or ulcers, and that needs to be blockage of two or three calf arteries or more severe disease,” Dr Ponosh said.
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He said in many of these cases, if a patient has no symptoms, arterial disease in the calf could be managed conservatively.
“A lot of these patients who turn up with non-urgent arterial disease in their calves are not on the appropriate medications, they’re not taking statins, or aspirin, not having their diabetes sorted out,” Dr Ponosh said.
“Optimising these patients’ medical risk factors is what will change these patients’ outcomes rather than seeing me, because they’re more likely to have a heart attack or strokes than have problems with their leg arteries.”
Conversely, Dr Ponosh said patients with ulcers were often not referred to him early enough.
“Fifty percent of them, I see three, four, even five months later when they should have been referred on day zero,” he said.
Dr Ponosh said there were lots of low risk, low stress options to treat ulcers, particularly in older patients. But he warned delayed treatment affected outcomes.
“If it’s an ulcer on their toe, they could end up losing their toe. A reasonably benign looking ankle ulcer from venous disease or varicose veins, which is easy to fix with keyhole options these days, can lead to bone infection or osteomyelitis,” he said.
“In a contemporary setting, unless they’re a very simple traumatic wound that are healing on their own cognisance, most ulcers in patients who have poor pulses of venous disease or diabetes should be referred for specialist attention.”
Dr Ponosh will be speaking at Medical Forum Live, a clinical education event taking place on May 9 where attendees can earn up to 22 hours of CPD.
His talk will be one of the presentations taking place. The day will cover clinical education on common, acute and chronic presentations to general practice. Connect with colleagues from across WA and complete almost 50% of your yearly CPD requirements.
REGISTER TO ATTEND – SPACES ARE LIMITED
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