Primary healthcare news, information & resources


What we've been reading - July


Keeping up with medicine is made easier when we share clinical stories with our colleagues. On this page we share brief learnings and articles that have interested our GP liaison team during the month of July. If you come across an article, video or resource you think clinical and management teams should know about, send it to newsletters@pinnacle.health.nz.

Selective mutism - thoughts from Dr Jo Scott-Jones

As medical director I get approached a lot and asked "just a quick question" several times a day. Here's a response I made to a question I was asked about selective mutism, how a GP would respond and if Pinnacle has resources for practices around this issue.

"In general a GP is going to approach any problem that's presented to them with a very patient-centred and specifically tailored approach to the family and circumstances in front of them. So if presented, accompanied by a parent with a well and happy child with a story of not talking in some circumstances, such as at school, but evidently chatty to the GP, they will take a different approach to a child who appears withdrawn and sad, who is presented by a relative or friend of the family and heaven forbid who also has signs of physical or emotional neglect. 

Most GPs would be able to undertake an age specific developmental assessment of physical and social skills, and signs of physical illness, developmental delay, or disabilities associated with selective mutism and would take a different referral pathway to that of an otherwise normal child. 

I think most of us would refer a family with no complicating factors on to further support either via the paediatric team, or perhaps directly to a speech and language therapist. Complicating factors would take us to appropriate other referral. 

It's probably important to mention here, that "referral on" from primary care does not mean what it means in secondary care teams - this family would continue to be supported, reviewed and involved closely with their GP team throughout the process of support that would be required. 

We don't have any specific Pinnacle information on selective mutism to hand out to practices. I don't feel too bad about this as it isn't really our role to provide general medical education to our members. 

Having said this I am sure our clinical and quality staff get asked all the time for advice about a variety of topics, and like most good GPs if they can't provide a direct answer they will find someone who can, or do a bit of research and pass this on. I certainly do this a lot of the time. 

My "go to" resource for clinical questions is DynamedPlus - to which we have negotiated access for ALL health providers in ALL of the Midland DHBs. (One password has been provided for all of the network - access the login details on this secure Pinnacle webpage). 

Doing this and selecting 'selective mutism' reveals information about social anxiety disorder noting that "Selective mutism is considered a separate disorder from social anxiety disorder, but children with selective mutism are generally acknowledged to meet diagnostic criteria for social anxiety disorder."

I wouldn't find this very helpful, so next I'd turn to HealthPathways - which actually has nothing under "mutism" or "mute" - so then I'd look at the NICE guidelines from the UK - which also take me to complicated information about social anxiety disorder and autism. 

The next thing I would do would be to look at trusty Dr Google and search for something NZ specific - here I find http://selectivemutism.org.nz/ which seems to be a patient-led information site, with links to what appear to be reasonable resources. I hope this helps." 

I'd be keen for feedback from anyone with better GP resources for patients with selective mutism.

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