Treatment for hepatitis C has traditionally been managed by specialists in hospital based liver clinics. There was a good reason for this in the days when treatment was based on interferon. It was difficult, unpleasant, and fraught with unexpected events. Gastroenterologists and liver specialists were also pretty keen to retain hold of hepatitis care for reasons of professional prestige as well as financial reasons. And family doctors were often ill informed at best. Some were actively discriminatory.
But things are changing, in Australia at least. People without cirrhosis can now have their hep C treatment managed through a General Practitioner, in consultation with a liver specialist. In Australia and other Commonwealth countries, General Practitioners usually manage basic illness at an early stage of development and conditions requiring urgent intervention. Hep C is neither of these so this will be a big change for the medical community and for all of us as patients. But I believe it is an important one.
Management of hep C in a community setting like a family doctor is an important step in normalising hepatitis C. Treatment will no longer be shrouded in the secrecy and mystique of the hospital, which will go some way to de-catastrophising hepatitis C. Just like HIV, hopefully it will soon be seen as just another treatable condition. It is also easier and better for people to access treatment locally.
General practitioners who manage treatment for people with hep C are not required to undergo any specialist training, but they must consult with a liver specialist by telephone fax or skype. Not all General Practitioners will want to take on this responsibility, and that is their choice. There is no point in pressuring them into it. But there are plenty who will take an interest in this emerging field and we need to encourage them.
This revolution for hep C treatment will not be without teething problems. Even 20 years ago, General Practitioners without relevant experience would freak out if they had to prescribe antibiotics for someone with HIV. Often the reassuring voice of a knowledgeable patient helped them over this hurdle.
If you are seeking hepatitis C treatment through a General Practitioner, be gentle. It is likely that you will know more than the doctor at first, so take the time to explain your medical history. Get them to understand your fears and expectations. We need to bring General Practitioners along with us on this journey and the interaction you have will help the doctor treat others that follow you through treatment.
Access to Direct Acting Antiviral hep C treatment starts on 1st March in Australia. If you don’t have cirrhosis, a General Practitioner can initiate and manage your treatment, after consulting with a liver specialist.
The opinions expressed above are mine alone and do not necessarily reflect those of my employer