Manual of Family Practice PDF
Preview Manual of Family Practice
Manual of Family Practice Second Edition 2002 Lippincott Williams & Wilkins Philadelphia 530 Walnut Street, Philadelphia, PA 19106 USA, LWW.com 0-7817-2652-2 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Copyright for Chapter 14.3 (“Genetic Disorders and Pregnancy”) is held by the Mayo Foundation, Rochester, Minnesota. Printed in the USA Library of Congress Cataloging-in-Publication Data Manual of family practice / editor, Robert B. Taylor.—2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 0-7817-2652-2 1. Family medicine—Handbooks, manuals, etc. I. Taylor, Robert B. [DNLM: 1. Family Practice—methods—Handbooks. WB 39 M2939 2002] RC55 .M266 2002 616—dc21 2001029829 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editor, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. The authors, editor, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. Editor Department of Family Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Family Medicine, Montefiore Medical Center, Bronx, New York Robert B. Taylor M.D. Professor Kathryn M. Andolsek M.D., M.P.H. Department of Family Medicine, Oregon Health Sciences Clinical Professor University School of Medicine and Active Staff, Department Department of Community & Family Medicine, Duke of Family Medicine, Oregon Health Sciences University University Health System, Durham, North Carolina Hospital, Portland, Oregon With 206 Contributors Evan A. Ashkin M.D. Secondary Editors Clinical Assistant Professor Department of Family Medicine, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, North Richard Winters Carolina Acquisitions Editor John W. Bachman M.D. Michelle M. LaPlante Consultant Developmental Editor Department of Family Medicine, Mayo Clinic and Mayo Foundation; Professor, Department of Family Medicine, Mayo Robert Pancotti Medical School, Rochester, Minnesota Production Editor R. Eugene Bailey M.D. Colin Warnock Assistant Professor Manufacturing Manager Department of Family Medicine, State University of New York-Upstate Medical University, Syracuse, New York Christine Jenny Cover Designer Nancy J. Baker M.D. University Family Physicians/Smiley's Clinic Circle Graphics Minneapolis, Minnesota Compositor Robert A. Baldor M.D. R.R. Donnelley Printer, Crawfordsville Associate Professor and Vice-Chairman Department of Family Medicine & Community Health, The CONTRIBUTING AUTHORS University of Massachusetts Medical School, Worcester, Massachusetts Alan M. Adelman M.D., M.S. Otis L. Baughman III M.D. Associate Chair & Professor Professor Department of Family & Community Medicine, Pennsylvania Department of Family Medicine, Medical University of South State University College of Medicine; Faculty, Department of Carolina College of Medicine, Charleston; Director, Family & Community Medicine; M.S. Hershey Medical Center, Spartanburg Regional Healthcare System, Family Medicine Hershey, Pennsylvania Residency Program, Spartanburg, South Carolina Thomas Agresta M.D. Dennis J. Baumgardner M.D. Assistant Professor Professor Department of Family Medicine, University of Connecticut Department of Family Medicine, University of Wisconsin School of Medicine, Farmington, Connecticut Medical School; Faculty, St. Luke's Medical Center, Milwaukee, Wisconsin John P. Allen Ph.D. Associate Director of Treatment Studies Christopher B. Behrens M.D. U.S. National Institute on Alcohol Abuse and Alcoholism, Assistant Clinical Instructor Rockville, Maryland Department of Medicine, Harborview Medical Center; Medical Educator, Northwest AIDS Education and Training William A. Alto M.D., M.P.H. Center, University of Washington Center for Education and Associate Professor Research, Seattle, Washington Department of Family & Community Medicine, Maine- Dartmouth Medical School, Fairfield; Faculty, Department of Marvin Moe Bell M.D., M.P.H. Family Practice, Maine General Hospital, Waterville, Maine Clinical Associate Professor Department of Family & Community Medicine, University of Navin M. Amin M.D. Arizona College of Medicine, Tucson; Associate Director, Professor Family Practice Residency, Scottsdale Healthcare-Osborn, Department of Family Medicine, University of California, Scottsdale, Arizona Irvine College of Medicine, Orange; Chairman and Program Director, Department of Family Medicine/Pediatrics, Kern Michelle Anne Bholat M.D., M.P.H. Medical Center, Bakersfield, California Assistant Professor and Chief of Clinical Services Department of Family Medicine, University of California-Los Matthew R. Anderson M.D. Angeles Medical Center, Los Angeles, California Assistant Professor Linda R. Bigi D.O. Bruce M. Bushwick M.D. Clinical Instructor Associate Program Director Department of Family Practice, Northwestern University Family Practice Residency Program, York Hospital, York, Medical School, Chicago; Attending Physician, Department of Pennsylvania Family Practice, Glenbrook Family Care Center, Glenview, Illinois Thomas A. Bzoskie M.D. Associate Clinical Professor Nina R. Birnbaum M.D. Department of Family Medicine, University of California-Los Assistant Clinical Professor Angeles School of Medicine, Los Angeles; Faculty, Santa Department of Family & Community Medicine, University of Monica-UCLA Family Practice Residency Program, Santa California-San Francisco School of Medicine; Active Staff, Monica, California Department of Family & Community Medicine, San Francisco General Hospital, San Francisco, California David B. Callahan M.D. Assistant Clinical Professor Carol E. Blenning M.D. Department of Family Medicine, Virginia Commonwealth Assistant Professor University/Medical College of Virginia, Richmond, Virginia Department of Family Medicine, Oregon Health Sciences University School of Medicine; Medical Director, Richmond Frank S. Celestino M.D. Family Health Center, Portland, Oregon Associate Professor Department of Family & Community Medicine, Wake Forest Richard D. Blondell M.D. University School of Medicine; Attending Physician, North Professor Carolina Baptist Hospital, Winston-Salem, North Carolina Department of Family & Community Medicine, University of Louisville School of Medicine, Louisville, Kentucky Jodi A. Chaffin R.Ph. Herbal Resource Pharmacist Karen M. Bolton M.D. Health Partners Center for Health Promotion, Minneapolis, Assistant Clinical Professor Minnesota Department of Family Medicine, University of Washington School of Medicine, Seattle; Medical Director, Anacortes S. Shekar Chakravarthi M.B., B.S. Family Medicine, Anacortes, Washington Medical Director Senior Services, Hunterdon Medical Center, Flemington, New Cora Collette Breuner M.D., M.P.H. Jersey Assistant Professor Department of Pediatrics, University of Washington School of Rabin F. C. Chandran M.D. Medicine; Faculty, Division of Adolescent Medicine, Children's Hospital Medical Center, Seattle, Washington Assistant Clinical Professor Department of Family Medicine, Brown University School of Medicine; Assistant Residency Director, Department of Richard Joseph Breuner M.D. Family Medicine, Memorial Hospital of Rhode Island, Clinical Assistant Professor Pawtucket, Rhode Island Department of Family Medicine, University of Washington School of Medicine; Faculty, Swedish Family Practice Jason Chao M.D., M.S. Residency, Swedish Health Services, Seattle, Washington Associate Professor Department of Family Medicine, Case Western Reserve Dan Brewer M.D. University School of Medicine; Predoctoral Division Director, Associate Professor Department of Family Medicine, University Hospitals of Department of Family Medicine, University of Tennessee Cleveland, Cleveland, Ohio School of Medicine; Active Staff, Department of Family Medicine, University of Tennessee Medical Center, Knoxville, Kathi D. Clement M.D. Tennessee Associate Professor Department of Family Medicine, University of Wyoming; James Broomfield M.D. Faculty, Department of Family Medicine, United Medical Assistant Professor Center, Cheyenne, Wyoming Department of Family Medicine, University of Wyoming Family Practice Residency-Cheyenne; Active Staff, Elise M. Coletta M.D. Department of Family Practice, United Medical Center, Cheyenne, Wyoming Assistant Professor Department of Family Medicine, Brown University School of Medicine, Providence; Chief of Gerontology, Department of Michael H. Bross M.D. Family Medicine, Memorial Hospital of Rhode Island, Medical Director Pawtucket, Rhode Island Institute for Research and Education in Family Medicine, St. Louis, Missouri Carol Cordy M.D. Clinical Associate Professor Robert L. Buckley M.D. Department of Family Medicine, University of Washington Clinical Professor School of Medicine; Faculty, Family Practice Residency Department of Family Practice, Loyola Stritch School of Program, Swedish Hospital and Medical Center, Seattle, Medicine, Maywood; Chairman and Executive Director, Washington Department of Medical Education, Resurrection Medical Center, Chicago, Illinois Gerald M. Cross M.D. John P. Fogarty M.D. Commander Professor and Chairman Darnall Army Community Hospital, Fort Hood, Texas Department of Family Practice, University of Vermont College of Medicine; Clinical Leader, Department of Family Practice Health Care Service, Fletcher Allen Health Care, Peggy R. Cyr M.D. Burlington, Vermont Clinical Assistant Professor Department of Family Medicine, Maine Medical Center, Thomas Paul Forks D.O., Ph.D. Portland, Maine Assistant Professor Department of Family Medicine, University of Mississippi Mel P. Daly M.D. School of Medicine; Family Physician, Department of Family Faculty Medicine, Baptist Hospital, Jackson, Mississippi Greater Baltimore Medical Center, Baltimore, Maryland Keith A. Frey M.D., M.B.A. Marilyn S. Darr Pharm.D., M.D. Chairman Clinical Assistant Professor Department of Family Medicine, Mayo Clinic, Scottsdale, Department of Family Medicine, University of Washington Arizona School of Medicine, Seattle; Associate Program Director, Family Medicine of Southwest Washington Residency Program, Carolyn L. Frymoyer M.D. Southwest Washington Medical Center, Vancouver, Washington Assistant Professor Department of Family Medicine, State University New York- Upstate Medical University; Attending Physician, Department Susanne R. Dillon M.D. of Family Medicine, St. Joseph's Hospital Health Center, Active Member Syracuse, New York Department of Family Practice, St. Luke's Hospital and St. Alphosus Hospital, Boise, Idaho Michael Genova M.D. Assistant Clinical Professor Lisa Grill Dodson M.D. Department of Family Medicine, University of California-Los Assistant Professor Angeles School of Medicine, Los Angeles; Faculty, Santa Department of Family Medicine, Oregon Health Sciences Monica-UCLA Family Practice Residency Program, Santa University School of Medicine, Portland, Oregon Monica, California Patrick T. Dowling M.D., M.P.H. Dwenda K. Gjerdingen M.D. Professor and Chairman Professor Department of Family Medicine, University of California-Los Department of Family Practice & Community Health, Angeles School of Medicine, Los Angeles, California University of Minnesota School of Medicine; Active Staff Member, Department of Family Practice, St. Joseph's Hospital, St. Paul, Minnesota Pamela Dull M.D. Assistant Clinical Professor Bruce W. Goldberg M.D. Department of Family Medicine, Ohio State University College of Medicine; Attending Physician, Department of Associate Professor Family Medicine, Ohio State University Hospitals, Columbus, Departments of Family Medicine and Public Health & Ohio Preventive Medicine, Oregon Health Sciences University School of Medicine, Portland, Oregon Thomas P. Ehrlich M.D. Ronald H. Goldschmidt M.D. Assistant Clinical Professor Department of Family Practice, Virginia Commonwealth Professor University School of Medicine, Richmond; Residency Faculty, Department of Family & Community Medicine, University of Department of Family Practice, Fairfax Family Practice, California-San Francisco School of Medicine; Director, Family Fairfax, Virginia Practice Inpatient Service, San Francisco General Hospital, San Francisco, California Nancy C. Elder M.D., M.S.P.H. Eduardo C. Gonzalez M.D. Associate Professor Department of Family Medicine, University of Cincinnati Associate Professor School of Medicine, Cincinnati, Ohio Department of Family Medicine, University of South Florida College of Medicine, Tampa, Florida Paul Evans D.O. David B. Graham M.D. Associate Dean for Curricular Affairs; Associate Professor Department of Family Medicine, Oklahoma State University Clinical Assistant Professor College of Osteopathic Medicine, Tulsa, Oklahoma Department of Family Medicine, Oregon Health Sciences University School of Medicine, Portland; Private Practice, Strawberry Wilderness Family Clinic, John Day, Oregon Lyle J. Fagnan M.D. Associate Professor Pepi Granat M.D. Department of Family Practice, Oregon Health Sciences University School of Medicine; Medical Director, Oregon Clinical Professor Health Sciences University-Gabriel Park Family Health Center, Department of Family Medicine & Community Health, Portland, Oregon University of Miami School of Medicine; Attending Physician, Department of Family Medicine, Baptist Health Systems of Meg Hayes M.D. South Florida, Miami, Florida Assistant Professor Department of Family Medicine, Oregon Health Sciences Joseph W. Gravel Jr. M.D. University School of Medicine, Portland, Oregon Residency Program Director Tufts University Family Practice Residency, Malden, John M. Heath M.D. Massachusetts Associate Professor Department of Family Medicine, Robert Wood Johnson Lee A. Green M.D., M.P.H. Medical School, New Brunswick, New Jersey Associate Professor Department of Family Medicine, University of Michigan Fred E. Heidrich M.D., M.P.H. Medical School, Ann Arbor, Michigan Clinical Associate Professor Department of Family Medicine, University of Washington James L. Greenwald M.D. School of Medicine; Residency Director, Group Health Associate Professor Cooperative, Seattle, Washington Department of Family Medicine, State University of New York-Upstate Medical University; Attending Physician, Michael James Henehan D.O. Department of Family Practice, Crouse Hospital, Syracuse, New York Associate Clinical Professor Department of Family and Community Medicine, Stanford University School of Medicine, Stanford; Faculty Member, James K. Gude M.D. Family Practice Residency Program, San José Medical Center, Clinical Professor San José, California Departments of Medicine and of Family & Community Medicine, University of California-San Francisco School of Charles E. Henley D.O., M.P.H. Medicine, San Francisco, California Professor and Chairman Department of Family Medicine, Oklahoma State University Robert M. Guthrie M.D. College of Osteopathic Medicine; Attending Physician, Professor Department of Family Practice, Tulsa Regional Medical Department of Emergency Medicine, Internal Medicine, & Center, Tulsa, Oklahoma Pharmacology, The Ohio State University College of Medicine, Columbus, Ohio Michael M. Herbst M.D. Associate Professor Frank A. Hale Ph.D. Department of Family Medicine, University of California-Los Professor Angeles School of Medicine, Los Angeles; Chairman, Department of Family & Community Medicine, University of Department of Family Practice, Santa Monica-UCLA Medical Arizona College of Medicine, Tucson, Arizona Center, Santa Monica, California John G. Halvorsen M.D., M.S. Denise D. Hermann M.D., F.A.C.C. Thomas and Ellen Foster Chairman and Professor Associate Clinical Professor Department of Family & Community Medicine, University of Department of Medicine, University of California-San Diego Illinois-Chicago College of Medicine at Peoria; Active Staff, School of Medicine; Assistant Director, Heart Failure/Cardiac Department of Family Practice, Methodist Medical Center, Transplantation Program, University of California-San Diego Peoria, Illinois Medical Center, San Diego, California Todd L. Hamel M.D. Kenneth A. Hirsch M.D., Ph.D. Instructor Medical Manager Department of Family Medicine, Oregon Health Sciences Department of Mental Health, Naval Medical Center, San University School of Medicine, Portland, Oregon Diego, California Jimmy H. Hara M.D. Joseph Hobbs M.D. Associate Clinical Professor Chairman Department of Family Medicine, University of California-Los Department of Family Medicine, Medical College of Georgia Angeles School of Medicine; Residency Director, Department School of Medicine, Augusta, Georgia of Family Practice, Kaiser-Los Angeles, Los Angeles, California Douglas F. Hoffman M.D. Active Staff Diane M. Harper M.D., M.P.H., M.S. Department of Sports Medicine & Orthopedics, St. Associate Professor Mary's/Duluth Clinic, Duluth, Minnesota Departments of Community & Family Medicine and Obstetrics & Gynecology, Dartmouth Medical School, Lebanon, New Pamela S. Horst M.D. Hampshire Associate Professor Department of Family Medicine, State University of New Jeffrey D. Harrison M.D. York-Upstate Medical University; Faculty, St. Joseph's Assistant Professor Hospital Family Practice Residency Program, Syracuse, New Department of Family Medicine, University of Nebraska York Medical Center, Omaha, Nebraska William J. Hueston M.D. Professor and Chairman Private Practice Department of Family Medicine, Medical University of South Mobile Infirmary Medical Center, Mobile, Alabama Carolina, Charleston, South Carolina Evan W. Kligman M.D. James W. Jarvis M.D. Clinical Professor Assistant Professor Department of Family & Community Medicine, University of Department of Family Medicine, Medical University of South Arizona; Co-Director, Arizona Center on Aging, University of Carolina, Charleston; Faculty Family Physician, Benton M. Arizona Health Science Center, Tucson, Arizona Montgomery Center for Family Medicine, Self Memorial Hospital, Greenwood, South Carolina Michael S. Klinkman M.D., M.S. Associate Professor Cynda Ann Johnson M.D. Department of Family Medicine, University of Michigan Professor and Chair Medical School, Ann Arbor, Michigan Department of Family Medicine, University of Iowa College of Medicine; Clinical Chief, Family Practice Service, University Aubrey L. Knight M.D. of Iowa Hospitals & Clinics, Iowa City, Iowa Associate Professor Department of Family Medicine, University of Virginia School Jeffrey G. Jones M.D., M.P.H. of Medicine, Charlottesville; Director, Family Practice Medical Director Education, Carilion Health System, Roanoke, Virginia Employee Health, St. Francis Hospital, Indianapolis, Indiana Donald R. Koester M.D. Daphne Karel M.D. Associate Professor Associate Professor Department of Family Practice, Southwestern Medical School, Department of Family Medicine, Medical University of South Dallas; Active Staff, Department of Family Practice, Hillcrest Carolina, Charleston; Active Staff, Self Memorial Family Baptist Medical Center, Waco, Texas Practice Residency Program, Greenwood, South Carolina Peter B. Kozisek M.D. David A. Katerndahl M.D., M.A. Associate Program Director Professor Family Practice Residency of Idaho, Boise, Idaho Department of Family & Community Medicine, University of Texas Health Science Center; Active Staff, University Karen W. Krigger M.D. Hospital, San Antonio, Texas Assistant Professor Department of Family & Community Medicine, University of Michael T. Kernan M.D. Louisville School of Medicine, Louisville, Kentucky Associate Professor Department of Family Medicine, State University of New Valerie B. Laing M.D. York-Upstate Medical University; Associate Residency Director, Family Practice Residency Program, St. Joseph's Active Staff Hospital Health Center, Syracuse, New York Department of Dermatology, Boice-Willis Clinic, Rocky Mount, North Carolina Kenneth F. Kessel M.D. Walter L. Larimore M.D. Professor Department of Family Medicine, Rush University School of Vice President of Medical Outreach Medicine/Rush-Presbyterian St. Lukes Medical Center, Focus on the Family, Colorado Springs, Colorado Chicago; Associate Director, Department of Family Practice, La Grange Memorial Hospital, La Grange, Illinois Lars C. Larsen M.D. Professor Sanford R. Kimmel M.D. Department of Family Medicine, The Brody School of Associate Professor & Associate Residency Director Medicine at East Carolina University; Active Staff, Department of Family Medicine, Medical College of Ohio, Department of Family Medicine, University Health System, Toledo, Ohio Pitt Memorial Hospital, Greenville, North Carolina Mitchell S. King M.D. Kim Edward LeBlanc M.D., Ph.D. Assistant Professor Director Department of Family Medicine, Northwestern University Residency Program, Department of Family Practice, Medical School, Chicago; Residency Program Director, University Medical Center (LSU), Lafayette, Louisiana Department of Family Medicine, Glenbrook Hospital, Glenview, Illinois Daniel T. Lee M.D. Assistant Clinical Professor Jeffrey T. Kirchner D.O. Department of Family Medicine, University of California-Los Clinical Associate Professor Angeles School of Medicine, Los Angeles; Active Staff, Department of Family & Community Medicine, Temple Department of Family Practice, Santa Monica-UCLA Medical University School of Medicine, Philadelphia; Associate Center, Santa Monica, California Director, Department of Family & Community Medicine, Lancaster General Hospital, Lancaster, Pennsylvania Clarence W. Legerton III M.D. Associate Professor George L. Kirkpatrick M.D. Department of Medicine, Division of Rheumatology & Residency Program, Chestnut Hill Hospital, Philadelphia, Immunology, Medical University of South Carolina, Pennsylvania Charleston, South Carolina Jerry T. McKnight M.D. William T. Leslie M.D. Chairman Assistant Professor Department of Family Medicine, University of Alabama Department of Internal Medicine, Rush University School of College of Community Health Sciences; Physician, Medicine, Chicago, Illinois Department of Family Medicine, DCH Regional Medical Center, Tuscaloosa, Alabama James E. Lessenger M.D. Albert A. Meyer Jr. M.D. Private Practice Porterville, California Consulting Associate Professor Department of Community & Family Medicine, Duke University Medical Center, Cary; Attending Physician and Wade A. Lillegard M.D. Medical Staff, Department of Medicine, Central Carolina Assistant Clinical Professor Hospital; Sandtills Family Practice, Sanford, North Carolina Department of Family Medicine, University of Minnesota- Duluth School of Medicine; Co-Director, Department of Kim W. Meyer R.N., M.H.S., PA-C Orthopedics, St. Mary's/Duluth Clinic, Duluth, Minnesota Physician Assistant Private Family Practice, Durham, North Carolina Joseph G.M. Lurio M.D. Assistant Professor Donald B. Middleton M.D. Department of Family Medicine, Albert Einstein College of Medicine, Bronx; Medical Director, Family Practice Sites, Professor Continuum Family Health, New York, New York Department of Family Medicine, University of Pittsburgh School of Medicine; Director, Family Practice Residency, University of Pittsburgh Medical Center, Pittsburgh, Susan E. MacDonald M.D., C.C.F.P. Pennsylvania Assistant Professor Department of Family Medicine, Queen's University, Kingston, William F. Miser M.D., M.A. Ontario, Canada Associate Professor & Residency Director Department of Family Medicine, The Ohio State University Russell G. Maier M.D. College of Medicine & The Ohio State University Medical Clinical Associate Professor Center, Columbus, Ohio Department of Family Medicine, University of Washington, Seattle; Central Washington Family Medicine, Yakima, Norman J. Montalto D.O. Washington Associate Professor Department of Family Medicine, West Virginia University Timothy R. Malloy M.D. School of Medicine; Active Staff, Department of Family Director Medicine, Charleston Area Medical Center, Charleston, West Department of Geriatrics; Associate Professor, Department Virginia of Family Medicine, University of Nebraska College of Medicine, Omaha, Nebraska Eric D. Morgan M.D., M.P.H. Residency Director Katherine L. Margo M.D. Department of Family & Community Medicine, Eisenhower Assistant Professor Army Medical Center, Fort Gordon, Georgia Department of Family Practice & Community Medicine, University of Pennsylvania School of Medicine, Philadelphia; John P. Muench M.D. Active Faculty, Harrisburg Hospital Family Practice Residency, Harrisburg, Pennsylvania Assistant Professor Department of Family Medicine, Oregon Health Sciences University School of Medicine, Portland, Oregon Thomas D. Masten M.D. Clinical Associate Professor Jessica H. Muller Ph.D. Department of Family Practice, Orthopedics, Physical Medicine, & Rehabilitation, State University of New York- Associate Professor Upstate Medical University, Syracuse, New York Department of Family & Community Medicine, University of California-San Francisco School of Medicine, San Francisco, California Richard C. Mauer M.D., A.B.E.S. Attending Physician John B. Murphy M.D. Covenant Medical Center, Waterloo, Iowa Professor Department of Family Medicine, Brown University School of K. Patricia McGann M.D., M.S.P.H. Medicine, Providence; Residency Director, Department of Associate Professor of Clinical Medicine Family Medicine, Memorial Hospital of Rhode Island, Stanford University School of Medicine, Stanford, California Pawtucket, Rhode Island Marc W. McKenna M.D. James E. Nahlik M.D. Associate Professor Associate Clinical Professor Department of Community & Family Practice, University of Pennsylvania School of Medicine; Director, Family Practice Department of Community & Family Medicine, St. Louis Douglas S. Parks M.D. University School of Medicine; Chief, Department of Family Practice, Missouri Baptist Medical Center, St. Louis, Missouri Associate Professor Department of Family Practice, University of Wyoming Family Practice Residency—Cheyenne; Department of Family Sara L. Neal M.D., M.A. Practice, United Medical Center, Cheyenne, Wyoming Assistant Professor Department of Family Medicine, Wake Forest University Paul M. Paulman M.D. School of Medicine, Winston-Salem, North Carolina Professor Department of Family Medicine, University of Nebraska Jon O. Neher M.D. College of Medicine, Omaha, Nebraska Clinical Associate Professor Department of Family Medicine, University of Washington Kevin A. Pearce M.D., M.P.H. School of Medicine, Seattle; Active Staff, Valley Family Care, Renton, Washington Associate Professor Department of Family Practice, University of Kentucky College of Medicine, Lexington, Kentucky Gary R. Newkirk M.D. Clinical Professor Linda M. Petter D.O. Department of Family Medicine, University of Washington School of Medicine, Seattle; Director, Family Practice Head Residency, Spokane, Washington Department of Family Practice, St. Francis Hospital, Franciscan Health System, Federal Way, Washington Carole Nistler M.D. John L. Pfenninger M.D., F.A.A.F.P. Active Staff Department of Family Practice, Olmsted Medical Center, Clinical Professor Rochester, Minnesota Department of Family Medicine, Michigan State University College of Human Medicine, Lansing; President & Medical Director, The National Procedures Institute, Midland, William A. Norcross M.D. Michigan Professor Department of Family & Preventive Medicine, University of Garfield C. Pickell M.D. California-San Diego School of Medicine, La Jolla; Active Staff, University of California-San Diego Medical Center, San Associate Clinical Professor Diego, California Department of Family Medicine, University of California- Davis School of Medicine, Sacramento, California Jim Nuovo M.D. Eric Douglas Poplin M.D., M.P.H. Associate Professor Department of Family & Community Medicine, University of Medical Director California-Davis School of Medicine, Sacramento, California St. Francis Occupational Health, Indianapolis, Indiana Michael L. O'Dell M.D. Michael D. Prislin M.D. Associate Professor Professor Division Director of Family Medicine, University of Alabama Department of Clinical Family Medicine, University of School of Medicine, Huntsville Campus; Active Staff, California-Irvine College of Medicine, Irvine, California Huntsville Hospital, Huntsville, Alabama Michael A. J. Purdon M.D. Cynthia G. Olsen M.D. Clinical Instructor Professor Department of Family Medicine, University of Washington Department of Family Medicine, Wright State University School of Medicine; Active Staff, Department of Family School of Medicine, Dayton, Ohio Medicine, Swedish Medical Center, Seattle, Washington Eugene Orientale Jr. M.D. Janey M. Purvis M.D. Associate Professor Clinical Assistant Professor Department of Family Medicine, University of Connecticut Department of Family Medicine, Oregon Health Sciences School of Medicine, Farmington; Attending Staff, Department University School of Medicine, Portland; Physician, Cascades of Family Medicine, St. Francis Hospital, Hartford, East Family Practice Center, Klamath Falls, Oregon Connecticut Martin A. Quan M.D. Susan M. Ott M.D. Professor Associate Professor Department of Family Medicine, University of California-Los Department of Medicine, University of Washington School of Angeles School of Medicine; Residency Director, Department Medicine, Seattle, Washington of Family Medicine, University of California-Los Angeles Medical Center, Los Angeles, California Pamela D. Parker M.D. Robert T. Quinn II M.D. Resident & Instructor Department of Obstetrics & Gynecology, University of Fellow Missouri School of Medicine & Truman Medical Center, Kansas Department of Plastic Surgery, Providence Hospital, City, Missouri Southfield, Michigan Joshua J. Raymond M.D., M.P.H. Assistant Clinical Professor Department of Family & Community Medicine, University of Attending Physician California-San Francisco School of Medicine, San Francisco; Department of Family Medicine, St. Peter's University Service Chief, Department of Family Medicine, Natividad Hospital, New Brunswick, New Jersey Medical Center, Salinas, California Barbara D. Reed M.D., M.S.P.H. Roland Sakiyama M.D. Associate Professor Professor Department of Family Medicine, University of Michigan Department of Family Medicine, University of California-Los School of Medicine, Ann Arbor, Michigan Angeles School of Medicine, Los Angeles, California Carmen Rebecca Rexrode M.D. John W. Saultz M.D. Active Staff Professor and Chairman Love Memorial Clinic, Moorefield, West Virginia Department of Family Medicine, Oregon Health Sciences University School of Medicine, Portland, Oregon Ronald D. Reynolds M.D. Volunteer Associate Professor Ted C. Schaffer M.D. Department of Family Medicine, University of Cincinnati Clinical Assistant Professor College of Medicine, Cincinnati; Center Director, New Department of Family Medicine, University of Pittsburgh Richmond Family Practice, New Richmond, Ohio School of Medicine; Director, UPMC/St. Margaret Hospital Family Practice Residency Program, Pittsburgh, Pennsylvania James P. Richardson M.D., M.P.H. Clinical Associate Professor Joseph K. Schoeber M.D. Departments of Family Medicine and Epidemiology & Associate Professor Preventive Medicine, University of Maryland School of Department of Family Medicine, University of Wyoming Medicine; Chief, Geriatric Medicine, St. Agnes Healthcare, College of Health Sciences, Laramie; Program Director, Baltimore, Maryland Family Practice Residency Program, Casper, Wyoming Richard G. Roberts M.D., J.D. Martin C. Schulman M.D. Professor Associate Clinical Professor Department of Family Medicine, University of Wisconsin Department of Family & Preventive Medicine, University of Medical School, Madison, Wisconsin California-San Diego School of Medicine; Clinical Service Chief, Division of Family Medicine, University of California- John W. Robinson M.D. San Diego Medical Group, La Jolla, California Residency Director St. Mark's Family Medicine Residency; President, Utah Health Jerome E. Schulz M.D. Care Institute, Midvale, Utah Clinical Professor Department of Family Medicine, East Carolina University Jonathan E. Rodnick M.D. Brody School of Medicine, Pitt County Memorial Hospital, Greenville, North Carolina Professor & Chair Department of Family & Community Medicine, University of California-San Francisco School of Medicine, San Francisco, Robert H. Scott M.D. California Clinical Assistant Professor Department of Family Medicine, University of Washington JoAnn Rosenfeld M.D. School of Medicine; Chief, Department of Family Medicine, Swedish Medical Center, Seattle, Washington Assistant Professor Johns Hopkins School of Medicine, Baltimore, Maryland David P. Sealy M.D. Joseph E. Ross M.D. Associate Professor Department of Family Medicine, Medical University of South Assistant Clinical Professor Carolina, Charleston; Self Memorial Hospital Family Practice Department of Family Medicine, University of Illinois- Residency, Greenwood, South Carolina Rockford; Active Staff, Department of Family Medicine, Swedish American Hospital, Rockford, Illinois John P. Sheehan M.D., F.A.C.E., F.A.C.N. Robert G. Ross M.D. Associate Clinical Professor Department of Medicine, Case Western Reserve University Associate Professor School of Medicine, Cleveland; Medical Director, North Coast Department of Family Medicine, Oregon Health Sciences Institute of Diabetes and Endocrinology, Inc., Westlake, Ohio University School of Medicine, Portland; Program Director, Cascades East Family Practice Residency Program, Klamath Falls, Oregon Robert D. Sheeler M.D. Assistant Professor and Clinical Practice Chair Nannette A. Sageser Pharm.D. Department of Family Medicine, Mayo Medical School, Rochester, Minnesota Clinical Pharmacist Family Medicine of Southwest Washington, Southwest Washington Medical Center, Vancouver, Washington William M. Simpson Jr. M.D. Professor Stephen D. Saglio M.D.
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