Referrers

We are grateful that you entrust us with the care of your patients, and we are proud of the care we provide. Please see below some information regarding our processes and pathways to assist your referral to our service.

We accept referrals by MedicalObjects (preferred) or fax. All referrals are triaged by clinical urgency. For routine, non-life-threatening conditions, extended wait times may unfortunately apply due to extreme demand. Most of our practitioners have extensive public system commitments, where we are proud of our ability to provide urgent and emergent care, and all of our specialists are happy to receive phone calls from other medical practitioners regarding patient concerns.

Patients always have their choice of specialist, although following triage patients will be advised if other practitioners could also be suitable for their condition, if an earlier appointment is available - an estimate of wait times is provided, but the choice of doctor is always in the patients' hands, as is protected by Medicare legislation.

Geriatricians have a unique medicare item number to facilitate an extended appointment to cover the entire biopsychosocial framework of an older person - for that reason, we are grateful that for your patients over the age of 65 years, inclusion of the term "comprehensive geriatric assessment" in your referral allows a higher rebate for a longer appointment to ensure detailed assessment can be performed.

If this is forgotten, our friendly staff will contact referrers to request the addition of this phrase if felt appropriate, to ensure the patients are booked in to the most beneficial consultation for them.

Dr Tsang is one of only two Neuro-otologists in Queensland. For this reason, he is unable to meet the great demand for his niche expertise. Thus, he has partnered with Kayla Kieseker from AVC and Grant Collins from QVCC to provide a comprehensive vestibular service for patients suffering from vertigo or dizziness.

These referrals are identified upon receipt, and if not already undertaken the patients are advised to consider a review with both Grant and Kayla prior to Dr Tsang's appointment. The team then case-conference with Dr Tsang, so by the time his assessment occurs, he has all of the information required to make a comprehensive management plan for the patient without additional steps.

It is noted that many patients will have seen other vestibular physiotherapists in the past and may not see the need to repeat this. However, the multidisciplinary framework is key to optimising the diagnostic path of these tricky patients, and Dr Tsang hopes this new pathway will streamline his support of this tricky demographic and allow him to help more of those in need of his expertise.

Nerve conduction studies primarily look at large-fibre (ie. proprioception and vibration sensory modalities, and power/reflexes) post-ganglionic (ie. the dorsal root ganglion) nerve pathways - this means it is a very sensitive test for axonal insult below the level of the dorsal root ganglion or anterior horn cell, but can be insensitive to pre-ganglionic pathology (especially sensory radiculopathy). In the setting of neuropathic symptoms in a limb, the highest value of NCS is really in assessing for a peripheral nerve lesion rather than confirming a radicular source of sensory symptoms (which, often, it cannot do without motor involvement).

The highest yield of nerve conduction studies is therefore where: the pathology is likely at the nerve level; there is a fixed sensory or motor deficit (ie. the examination is abnormal); and the symptoms are compatible with a peripheral nerve distribution. Processes outside of this classification - such as unexplained pain with normal examination, pure sensory radiculopathy, and central disorders (eg. brain or spine pathologies) are not assessed by NCS and are better evaluated clinically and/or radiologically.

EMG evaluates motor nerve and muscle function and can, therefore, be used as an adjunct to NCS to confirm a pattern of motor nerve or muscle involvement - it is most helpful in motor radiculopathy (eg. L5 foot drop versus common peroneal nerve); anterior horn cell disease, myopathy or neuromuscular junction transmission disorders.

Due to the above limitations, a normal neurophysiological test does not entirely exclude pathology. Our Neurophysiologists always endeavour to produce logical, readable reports that suggest the most useful next steps if the diagnosis is not clear; if the situation is clearly more complex, a formal consultation can be arranged to provide further input.