GP Training – Breast Examination

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Every Thursday I attend GP education and training sessions at Chichester Medical Education Centre which is part of St Richard’s Hospital. I have done so for the past four or five years. Indeed the CMEC website has the above image of me adorning its section on GPs and Practice Teams – a fact as astonishing as it is amusing!

Not only do I attend the GP Lunch Club but also the GP Three Day Update sessions if I feel I need to brush up on the particular subject areas on offer. These three-day events are run twice every year and I, paying for myself, can pick and choose from the expertise on offer.

I have had to examine a few lady’s breasts recently, and, although in each case I have been certain of my findings, I am aware that my breast examination training dates back 20 years, so I booked myself into today’s Breast Update session. It was directed by the excellent breast surgeon Wendy Sotheran, who impressed me a great deal with her state of the art kit and information. I now know a good deal more than I did yesterday about the OSNA machine and the importance of the sentinel node, and the blue dye.

However, what I went for was the breast examination training, and I am glad to say that this has not changed much in the past 20 years. My original tutor made it clear that the touch should be light and stroking in nature, not pushy and shovey, and this was reiterated by Wendy Sotheran today. However, I also learned how to do some things that I will probably never actually do, and the other GPs on the course were not keen to do these either: They were taking a punch biopsy and aspirating a benign breast cyst. Although I have no intention of using these invasive procedures with my patients I am pleased that I was taught how to carry them out, so I better understand what my patients have to go through when referred to a specialist.

Hypericum_oilI was able to speak to the other GPs about my experience with the use of infused St John’s Wort oil in cases of benign breast lumps. I have never read of St John’s Wort oil being used for this purpose in any herbal medicine reference book, but many years ago I decided to use this externally with a patient who had fretted and worried about her breast cysts (and had all sorts of investigations prior to seeing me) and it had resolved the matter within days. Since then I have used the same beautiful red infused oil on a number of other women, getting them to gently massage the oil in to the effected area twice daily, and on each occasion the cysts have resolved. It is a great relief for the patient, especially as it is not invasive, not toxic and won’t interact with anything else.

I came away reassured of my own knowledge but glad to have learnt more about the technology that is now used in breast cancer assessment. And also to have made personal contact with the consultants at St Richard’s who clearly endeavour to make this sort of experience less awful for their patients.

Blue dye – just a last note about the blue dye that is used to highlight the sentinel node: it is supposed to fade in three weeks, but in one of my patients who had this procedure it has not fully faded after 18 months. Mrs Sotheran was apologetic about the fact that on some occasions and in some people it does not seem to disappear as it ought but leaves a bruise-like look for many months. (Although my St John’s Wort oil is red, due to the red oil glands in the leaf of the plant infusing into the oil in which they are steeped, it does not leave the breast an unnatural colour.)

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