From 1 November 2014, glycated haemoglobin (HbA1c) testing is now funded on the Medicare Benefits Schedule for the diagnosis of diabetes mellitus – MBS item 66841 (up to once every 12 months).
The Australian Diabetes Society and other international organisations have recommended since 2011 that an HbA1c ≥48 mmol/mol (≥6.5%) can be used to establish a diagnosis of diabetes.1 Until now this has been impracticable in Australia as it was only Medicare-funded for patients with established diabetes, however this new listing on the MBS provides clinicians with a more practical and efficient way to make the diagnosis.
1. d’Emden M, et al. The role of HbA1c in the diagnosis of diabetes mellitus in Australia. Med J Aust 2012;197:220–1. (full text)
One of the key features of clinical learning at Sydney Medical School are the SCORPIO sessions (SCORPIO apparently stands for “structured, clinical, objective, referenced, problem-orientated, integrated and organised”). With the exception of a few pseudo-SCORPIOs during haematology block, I’ve generally found SCORPIOs to be great learning experiences and I’m quite fortunate that my clinical school reputedly organises more SCORPIOs than the other USyd clinical schools.
Each SCORPIO session generally starts with a short introductory session to outline the session, after which students divide into small groups and rotate around several teaching stations. Each station features either a patient with a certain clinical presentation to solve/discuss – e.g. a young lady with immune thrombocytopenic purpura (ITP) – or known clinical signs to elicit – e.g. a gentleman with a pronounced aortic valve ejection systolic murmur and carotid bruits.
For endocrinology block, the clinical school has organised a SCORPIO each week in lieu of clinical diagnostic skills tutorials. By coincidence our postponed neurology SCORPIO was also held this week, which meant that we had two SCORPIOs today.
- Charcot-Marie-Tooth disease
- L5 sensorimotor radiculopathy
- Brachial plexopathy secondary to radiotherapy
Endocrinology SCORPIO 1 (thyroid disorders)
- Graves’ disease
- Toxic multinodular goitre
- Hashimoto’s thyroiditis
After enduring the frustration of most of this week, today’s double SCORPIO clinical day provided a welcome breath of fresh air.