Dr David Ward, a GP in Ipswich, shares his advice for GPs who,
like him, may not come across hepatitis C regularly
Although our practice covers areas of deprivation, I haven’t come across many patients with hepatitis C (HCV). However, that isn’t to say that there aren’t those who may have it, as a recent experience taught me. As GPs, we are committed to improving patient care across the board and a part of this is remaining vigilant for the signs that may indicate those among our patients who would benefit from further investigation and treatment; this includes spotting those patients that might be at risk of HCV and ought to have a test.
GPs have to know a little about everything, and to stay up-to-date on the vast array of illnesses that may affect our patients is a tall order. So, let’s be honest, learning about HCV may not be one of your priorities. Like me, you may habitually be on the lookout for the big killers: cancer, heart disease and chronic lung disease, so it is sometimes easy to forget less common diseases. Why is HCV important? Well, it can cause cirrhosis and may lead to primary liver cancer and the need for liver transplantation.
I admit myself that it wasn’t on my radar before one of my patients was diagnosed, but since then I’ve realised the importance of staying aware of the information resources out there. With HCV estimated to affect around 185,000 people in the UK1, there may be many more undetected cases, and we as GPs are in a strong place to identify these. Websites such as this one, created to give you access to succinct, accurate information and advice when you need it, really are useful.
HCV is admittedly a difficult disease to spot, but there is helpful advice out there, including on this website. From my experience. I’d offer the following advice:
- Take notice of a patient’s past history – there can be tell-tale signs buried in a patient’s notes, such as use of intravenous drugs in the distant past, that indicate that they should be recommended for screening.
- Remember that you could be surprised by who is at risk – keep an open mind and don’t have any preconceptions about those who may have used drugs in the past.
- Be aware of the risk groups in your area – for instance, in Ipswich, we have seen an influx of refugees and have seen a rise in hepatitis B patients as a result. The same could be true for other diseases including hepatitis C. Remain aware of the changing population landscape in your area as individuals from South Asia are known to be a high-risk group. Patients who are at risk of having contracted HCV should be offered testing.
- Stay up to date – be aware that there is effective, NICE-recommended treatment for HCV and that even if your patient may have contracted HCV many years ago, you should refer them to a specialist for assessment.
As with many healthcare issues for your patients, you are a trusted source of advice, able to point people in the direction of local support services. So if one of your patients is diagnosed with HCV, you may not be personally involved in their treatment, but as their GP you still have a very important role to play.
1Hepatitis C in the UK; The Health Protection Agency Annual Report 2009, p4.