Map of medicine Care Pathway

NT map of medicineOne of the ongoing challenges for the Lymphoedema Support Network is supporting General Practitioners (GPs) in their efforts to diagnose those living with chronic oedema/lymphoedema and correctly manage their care. This can be every bit as frustrating for them as it is for those of you who have had negative experiences in primary care.
GPs are expected to have knowledge and experience of literally thousands of conditions, from the common cold, right through to life-threatening heart conditions, cancer and everything in between; they have increasingly little time available to them and are under constant pressure to reduce costs.
The LSN has made a huge impact on the knowledge base of thousands of GPs through our BMJ Learning module, but the challenge for them is often knowing how best to manage the condition, from the point of the patient presenting at their surgery with unexplained swelling, the diagnostic process, referral to a specialist service, and ongoing support in the self-management stage.

A common method for supporting GPs through this process in other conditions is using a ‘care pathway’. A care pathway is a flowchart that asks key questions and, depending on the answers, offers the GP guidance on what to do next or what conclusion they have reached. Some of these care pathways are quite easy but others, such as chronic oedema/lymphoedema are actually quite complex, there are many different causes of swelling, many medications that can make it worse and many medical conditions that can include swelling as a symptom. Once everything else has been excluded, and chronic oedema/lymphoedema is suspected – what does the GP do then, refer to a clinic?, try and manage it themselves, is there even a clinic available to them? As you can see it may not be as easy as we would imagine.

The LSN generally has a response to such challenges of finding and implementing a solution and this situation was no different. After much investigation, we decided to work with Map of Medicine to produce a care pathway for Chronic Oedema/Lymphoedema. The care pathway, which would be available to many GPs directly to the computer on their surgery desk, would be funded by the LSN and written by Professor Peter Mortimer and Dr Vaughan Keeley with input from other experts and patients. We imagined the process would be relatively simple and we anticipated that the pathway would be launched within a few months! As it turned out, it has taken very much longer than we imagined to ensure that the pathway is accurate and reflects the needs of the GP. However, the wait is over and we are delighted to announce that the pathway went live at the end of May. We believe that this is a huge step forward in our mission to ensure that patients receive the care and support that they need.

Enclosed in this issue of LymphLine you will find a postcard which advertises the pathway that we hope you will be able to pass on to your GP for us – it also tells them to contact us for a hard copy version if they are not able to access the Map of Medicine from their surgery. Imagine a scene when rather than presenting to your GP with unexplained swelling and being told to ‘put your feet up’ or ‘take Nurofen and rest your arm’ your GP turns to his computer, types in one of the key words we have identified, such as ‘swelling’, ‘recurrent cellulitis’, ‘oedema’, etc. and they are presented with a clear, evidence based path to follow, complete with advice that they can give to you about what you can do to help yourself whilst you wait for investigations or referral – what a difference it would have made to so many of you and hopefully what a difference it will make to others in the future.

They say that patience is a virtue, and in this case, we are sure that the waiting will have been worth it.