Straddling medical specialties: should we have more comprehensive advanced training?

Abstract

Over careers spanning 35 years each, we have witnessed great advances in medicine especially in genetics, imaging, immunotherapies and targeted cancer therapies. Our respective specialties of endocrinology and medical oncology have come to overlap significantly necessitating better communication and skills across both specialties. We will highlight common scenarios that straddle endocrinology and medical oncology. The same broad issues apply to other closely related specialties, albeit with different clinical challenges. At present, we see expensive and inefficient cross‐referrals to other subspecialists or sometimes no referral at all, leading to significant clinical omissions. Opportunities for dual advanced training, or for more comprehensive single advanced training could more efficiently lead to enhanced patient care and communication.

Real‐world Australian data reflect very high sustained virologic response at 12 weeks with direct acting antiviral therapy for hepatitis C and suggests highly achievable even in those without an end‐of‐treatment response

“…People who inject drugs (PWID) have achieved clearance of HCV either spontaneously or through treatment are recommended to undergo HCV RNA testing every 12 months or following an episode of high-risk injecting. 7 Given the imperative for regular follow up and the high rate of SVR12 with DAA therapy shown, the necessity for routine HCV RNA testing at 12 weeks post-therapy in PWID can be contended as delay in investigation holds little bearing on future management. Despite this, confirming SVR12 can prove opportunistic depending on an individual's level of engagement with healthcare.…”