Ultrasound-guided FNAC has a significantly lower yield of inadequate aspirates than palpable FNAC. The ability of FNAC to predict neoplasia in 89% patients and to exclude neoplasia in 95.9% patients makes an important contribution to the multidisciplinary assessment of patients.

The amount of time spent by patients with surgeons is already so short as to cause concern about both the appropriateness and value of consultations. It is unreasonable to increase workload further. There is a clear need for outpatient clinics to be managed, with regular examination of what is taking place and how long it takes. Only then will it be possible to tailor schedules to the actual requirements of the service.

No abstract

Despite its growing importance, the hospital outpatient clinic is often ill-equipped to respond to the new challenges it faces. Overall, there is a need for the system to be managed, rather than simply to respond to whatever comes its way, and to ensure that the growing literature on individual and organisational change is understood and applied.

There is now considerable evidence on what can and should be done to improve the existing system of outpatient care.