Abstract

Rheumatologists and clinicians in primary care communicate on a daily basis. Good communication and relations between primary and secondary care are essential for optimum patient care. When communication fails, patient care suffers: lack of clarity of roles leads to patients being lost in the middle with neither side taking responsibility for aspects of care. One difficulty in clarifying roles is the lack of clarity and agreement between what conditions and aspects of management constitute primary vs secondary care territory.

When considering the gap between primary and secondary care, the most commonly touted solution is more musculoskeletal and rheumatological education for family medicine doctors (General Practitioners – GPs). This is undoubtedly an important area of need and I will describe some important innovations in GP musculoskeletal education from the UK. However, in this talk I will suggest that the rheumatology – primary care education paradigm needs to shift, with rheumatology considering what it can learn from primary care. Most rheumatologists progress through their training with little or no exposure to primary care. GPs are expert in managing uncertainty, weeding out important symptoms in messy prodromes of disease, dealing with multi-morbidity and polypharmacy, and transferring evidence based population level medicine and making it relevant to the individual. All of these skills are important for rheumatologists.

I'll conclude with some possible implications for rheumatologists in training and examples of working in partnership that have facilitated shared learning for both parties.