Dr Jim Muir & Dr Dan Kennedy recently had the chance to visit Belfast to give a talk on the Queensland approach to skin cancer management.
In Northern Ireland they have a very different approach to Queensland. Skin cancer is far from rare in Northern Ireland. There are a lot of fair skinned people, and many have significant solar damage. some from outdoor work, others from decades of holidaying in the Mediterranean. Sun bed use is also common. In recent years older members of the 'Irish diaspora' have been returning home from sunnier climates.
Dr Jim Muir said:
"Our impression was that most GPs do not feel confident in dermatology and skin cancer. Training is not as readily available as here (Queensland). Surgical skills and/or facilities are lacking often. The system works against management within the community. Patients are managed by referral to hospital-based dermatology and plastics units. This seems to translate to prolonged wait times and multiple appointments.
"Interestingly we met two GPs who had worked in Australia. They compared the conditions they managed easily within our system but in Northern Ireland they had to refer on. In Australia they were managing everything from 'routine' skin checks to cryotherapy to field treatments to biopsies, curettes and excisions. Only a minority of patients needed referral. They were both adamant that skin cancer management was much more efficient and cost effective under our system. We are far from perfect, but it was illuminating to see the contrast.
"We are hoping to set up a study comparing skin cancer management in Australian general practice to Northern Ireland. This may provide insight into what their system can "learn" from ours.
"They were interested in Tele-Derm National. Although distance is not much of an issue in Northern Ireland wait times to consultation are very long. We were shown a few examples of patients where these prolonged waits resulted in poor outcomes. Utilising telemedicine for diagnostic and management advice is not readily available there.
On a more social level the Northern Ireland skin cancer 'community' showed us a great time. A country replete with history, natural beauty and great 'craic'."
Dr Jim Muir