A recent AusDoc survey of 418 GPs and GP registrars focusing on pathology tests has uncovered a raft of unmet needs for GP education, and opened up a range of opportunities for pathology organisations and pharma companies to offer meaningful med ed.

Respondents were crying out for further education, with several key areas of particular concern.

1. Genetic testing

More than 84% of respondents said they were interested in a genetic testing update that includes topics such as what to order when, and how to interpret results from tests ordered by other specialists. Only 0.94% of those survey said they were not at all interested in learning more about this topic.

The Royal College of Pathologists of Australasia (RCPA) advises: “Requestors should be aware that testing for inherited genetic variants often raises significant medical, ethical, psychological, and legal issues.”

So how should GPs approach navigate such difficult waters?

The RCPA, in conjunction with Australian Doctor, has created a series of educational pieces in the Common Sense Pathology series, including genetic testing advice, but GPs say they’re still experiencing a knowledge gap.

Respondents to the AusDoc survey noted:

“Genetic testing pre-pregnancy and early screening. We still need education in this rapidly changing space.”

“There are many new tests, and it can be difficult to explain what they mean to patients in a meaningful way.”

The RCPA’s website contains a section on Genetic Tests and Laboratories, which includes searchable lists of genes, available pathology tests, and various disorders and their associated genes.

2. Vague presentations

More than 84% of respondents said they were interested in learning more about ordering and interpreting test results for non-specific presentations.

Symptoms such as “fatigue”, “tiredness”, “non-specific”, and “vague” symptoms were reported as the most troublesome for GPs. What tests should they order? And what do the test results indicate?

The RCPA and Australian Doctor Common Sense Pathology series includes some guidance on investigating fatigue, but GPs are still hungry for more guidance. Survey respondents noted: “Undifferentiated and psychosomatic symptoms are often situations where it is difficult to determine which tests to order.”

They called for pathology labs to help: “Sometimes pathology could recommend further tests based on results seen.”

“Urgent need to differentiate tests into categories of significance in their own right and irrelevance to other tests and symptomatology.”

Some called for specific algorithms for deciding on which tests to order, rather than just suggestions on reports of “could add” or “should add”.

3. Interpretation of results for complex conditions

GPs struggle with autoimmune conditions and rheumatological disorders most, with many unsure of the clinical implications of pathology test results. One respondent summed up the current state of mind of many GPs: “I try very hard not to order tests that I don’t know how to interpret. Also [there’s] no point ordering a test if it is not going to influence management.”

“I just don’t know enough about the specific tests e.g. ANA, ENA, C protein etc.”

“Probably all the tests related to rheumatologist disorders. Trying to remember which specific tests rule in or rule out specific syndromes.”

A guide to hormone testing was also called for, as many respondents struggle to interpret results in a way that is meaningful to patients. “Interpretation of female hormone levels, investigation of testosterone and androgen levels: when is this indicated?”

“Endocrine and hormone tests are the worst, as there was minimal medical training for these conditions in med school.”

4. Long-term monitoring

A GP’s guide to pathology testing for monitoring long-term conditions sparked the interest of 75% of respondents. “With chronic conditions, the trends are so much more valuable in management.”

“Monitoring, especially older people and those with medical conditions on a regular basis does pick up pathology, such as low iron and bowel cancer, low thyroid function and lethargy, hyperthyroidism, diabetes, etc.”

5. Tests ordered by other practitioners

Many AusDoc survey respondents expressed frustration at having to order and interpret tests suggested to patients by naturopaths. Respondents called for a guide to commonly ordered tests done by integrative medical practitioners and naturopaths.

“Patients often bring me these results to look at and I often have no idea if any are significant!”

Conclusion

The results of the AusDoc survey highlight several key areas of unmet need and open opportunities for meaningful medical education, including algorithm development, step-by-step guides, and pathology-led case studies.

Sources:

1. AusDoc Survey: GP understanding and behaviours in ordering and interpreting pathology tests (October 2023), n=418 (95% GPs, 5% GP Registrars).

2. The Royal College of Pathologists of Australasia. Common Sense Pathology. Available online: https://www.rcpa.edu.au/Library/Publications/Common-Sense-Pathology

Accessed 14/2/24.