The Nature of General Family Practice: 583 clinical vignettes in family medicine An alternative approach to syllabus development PDF
Preview The Nature of General Family Practice: 583 clinical vignettes in family medicine An alternative approach to syllabus development
The Nature of Ceneral Family Practice The Nature of Ceneral Family practice 583 clinical vignettes in family medicine An alternative approach to syllabus development Edited by w. E. Fabb & J. R. Marshall GEORGE A. BOGDEN & SON, INC., PUBLISHERS 45 HUDSON STREET, RIDGEWOOD, NEW JERSEY 07450 Published in USA and Canada by George A. Bogden & Son, Inc. 45 Hudson Street Ridgewood, New Jersey 07450 Published in UK by MTP Press Limited Falcon House Lancaster, England Copyright © 1983 MTP Press Limited Softcover reprint of the hardcover 1st edition 1983 First published 1983 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. ISBN-13: 978-94-009-6597-3 e-ISBN-13: 978-94-009-6595-9 DOl: 10.1007/978-94-009-6595-9 Contents Case Nos. Page No. Preface vii Acknowledgements ix Contributors xi Introduction xvii 1 Why has the Patient Really Come? 1-34 1 2 Problems of Living 35-73 19 3 Family Problems 74-94 39 4 Patient Education and Preventive Care 95-113 51 5 Routine Examination 114-122 61 6 Emergencies 123-146 67 7 Attempted Suicide 147-153 79 8 Dying and Death 154-172 83 9 Contraception and Family Planning 173-187 95 10 Sexual Problems 188-198 103 11 Problems of Pregnancy 199-229 109 12 Headaches 230-246 125 13 Fits, Faints and Funny Turns 247-276 133 14 Eye Problems 277-288 149 15 Upper Respiratory Problems (Including ENT Problems) 289-324 155 16 Breathing Problems 325-357 173 17 Chest Pain 358-383 191 18 Abdominal Problems 384-424 205 v CONTENTS 19 Genitourinary Problems 425-461 227 20 Skin Problems 462-476 247 21 Lumps 477-483 255 22 Musculoskeletal Problems 484-516 261 23 Injuries 517-540 279 24 Tiredness 541-559 291 25 Weight Loss 560-567 301 26 Iatrogenic Illness 568-583 307 Questions and Sub-questions 1-583 317 Index 643 vi preface The idea of producing this book of case histories from general family prac tice was only a twinkle in the editors' eyes until October 1980, when in a room in the Marriott Hotel in New Orleans, the editors met with John Fry, Joseph Levenstein and Bill Jackson to discuss new book projects. The idea was put to the group, which endorsed it enthusiastically. Encouraged by this and by John Fry's advice, the conception of The Nature of General Family Practice took place. It was agreed that to illustrate the universal nature of general family prac tice it would be useful to collect case histories from all around the world, that for preference they should be brief, and that they should be ac companied by major questions and sub-questions, but no answers. The name 'Vignettes' was applied to these cases and their questions. Subsequently, well over a hundred family physicians were asked by letter to provide ten vignettes. Sixty doctors from ten countries accepted the invitation and forwarded their contributions during the second half of 1981. Almost all of those who, for a variety of reasons were unable to contribute, said they liked the idea and looked forward to using the final product. Altogether, over 600 vignettes were received, and 583 selected for final inclusion. In order to preserve the flavour of the cases, the editors have made asfew changes as were necessary to comply with the format of presentation. The cases represent each contributor's own words, own expressions and own ways of telling a story. They give a feeling for the doctor and the way he or she thinks and feels. The gestation of this book has been a long one, but the baby looks to be in good shape. Whether it will be an only child, will depend on how people like the look of this one. W. E. Fabb, J. R. Marshall, Melbourne, 1983 vii Acknowledgements The editors wish to place on record their deep appreciation of the efforts of all of those who contributed to this book. Their contributions are acknowledged throughout the book and they are listed in the contributors' pages. Without their support, this book could not have been created. They have given it a truly international flavour. The addresses of the contributors have been provided in the contributors' pages should any reader wish to cor respond with them about any of their cases. We also wish to acknowledge the painstaking way in which Mrs. Judith White and Mrs. Julie Rodman have prepared the manuscript, and the sup port given by Nadia Gottardo during its final preparation. To our families, who wondered why the gestation of this book was taking so long and whether it would ever be delivered, we can only say - thank you for your patience. W. E. Fabb, J. R. Marshall, Melbourne, 1983 ix Contributors Loren H. Amundson MD Diplomate ABFP Gurna Margaret Dick MB BCh BAO FellowAAFP FRACGP Professor of Family Medicine, University of General Practitioner South Dakota School of Medicine, 32 Augusta Road, Lenah Valley, Hobart, Associate Director, Sioux Falls Family Tasmania 7008, Australia Practice Residency Program 3001 South Holly Avenue, Sioux Falls, SD 57105, USA Edward Domovitch MD CCFP Assistant Professor, Department of Gary Beazley MD CCFP FCFP Family and Community Medicine, Professor and Head, Department of Family University of Toronto Medicine, University of Manitoba Wellesley Hospital, Family Practice Unit, Room E6003, 409 Tache Avenue, 146 Wellesley Street East, Toronto, Winnipeg, Manitoba, Canada R2H 2A6 Ontario, Canada M4Y 1J2 Patricia E. Boiko BA Chemistry MD Charles Driscoll MD Third year Resident, Family Medicine Family Physician Department of Family Practice, Department of Family Practice, Medical University of South Carolina, The University of Iowa Hospitals and Clinics, 17 i Ashley Avenue, Charleston, SC 29425, The University of Iowa, Iowa City, IA 52242, USA USA Tommy Bouchier Hayes FRCGP DRCOG Lieutenant Colonel, British Army Earl V. Dunn MD CM The Hospital, RMA Sandhurst, Camberley, Professor, Department of Family Surrey GU15 4PH, UK and Community Medicine, University of Toronto Dennis Gerard Chambers MB ChB (Edin) 2075 Bayview Avenue, Toronto, Canada LRCP LRCS LRFP & S FRACGP M4N 3M5 General Practitioner 45 Farrell Flat Road, Clare, South Australia Wesley E. Fabb MB BS FRACGP 5453, Australia FCGPS (Hon) FFGP (SA) (Hon) MCFPC(Hon) Brian H. Connor MB BS FRACGP DCH National Director, Family Medicine DObst RCOG DRACOG Programme, Royal Australian College of General Practitioner General Practitioners 145 Faulkner Street, Armidale, 70 Jolimont Street, Jolimont, Victoria 3002, New South Wales 2350, Australia Australia Zelda Cramer MB ChB General Practitioner Fred B. Fallis BA MD CCFP FCFP Department of Family Medicine, Director of Continuing Education, Faculty Sackler School of Medicine, of Medicine, University of Toronto Tel Aviv University, Israel Fitzgerald Building, Toronto, Canada xi THE NATURE OF GENERAL FAMILY PRACTICE Boris Michael (Boz) Fehler MB BCh (Wits.) Peter Grantham BA MD CCFP FCFP DCH (RCPS) London MFGP (SA) Royal Canadian Legion Professor and FRCGP(UK) Head, Department of Family Practice, President, South African Academy of University of British Columbia Family Practice/Primary Care Mather Building, Vancouver, P.O. Box 52523, Saxonwold, Canada V6T lW5 2132 Johannesburg, South Africa John C. Hasler MB BS DA DCH FRCGP Paul Freeling MB BS FRCGP General Practitioner and Regional Head of Sub-Department of Organiser for General Practice Training, General Practice, St. George's Hospital Oxford Region, UK Medical School Sonning Common Health Centre, Cranmer Terrace, Tooting, Wood Lane, Sonning Common, London SW17 ORE, UK Reading RG4 9SW, England, UK John Fry OBE MD FRCS FRCGP Michael William Heffernan MB BS General Practitioner FRACGP OObst RCOG MEd 138 Croydon Road, Beckenham, Kent Director of Research, Family Medicine BR3 4DG, England, UK Programme, Royal Australian College of General Practitioners Eric Gambrill MB BS FRCGP 70 Jolimont Street, Jolimont, Victoria 3002, DObstRCOG Australia General Practitioner, Associate Adviser in General Practice, British Postgraduate Medical Federation Albert Himmelhoch MB BS FRACGP "Leacroft", Ifield Road, Crawley, Sussex, FRCGP England, UK Director of Medical Services, Hornsby & Ku-ring-gai Hospital David A. Game, AO MB BS (Adelaide) Palmerston Road, Hornsby, New South Wales 2077, Australia FRACGP General Practitioner 50 Lambert Road, Royston Park, William D. Jackson MB BS FRACGP South Australia 5070, Australia Past President, Royal Australian College of General Practitioners Peter Leon Gibson, MB ChB (NZ) Kings Lane, St. Leonards, Tasmania 7250, FRNZCGP Australia Censor-in-Chief, Royal New Zealand College of General Practitioners, Douglas H. Johnson MD CCFP FCFP Regional Co-ordinator, New Zealand Professor and Head, Department of Family Medicine Training Programme Family and Community Medicine, 3 Riverlea Avenue, Pakuranga, Auckland, Sunnybrook, University of Toronto New Zealand Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto M4N 3M5, Canada Peter Francis Gill MB 8S (Melb) MD FRACGP General Practitioner James D. E. Knox MD FRCGP FRCP Ed 67 Hopkins Street, Moonah, Tasmania Professor of General Practice, 7009, Australia Department of General Practice, University of Dundee William Francis Glastonbury MB BS Westgate Health Centre, Charleston Drive, FRACGP Dundee DD2 4AD, Scotland, UK General Practitioner 103 Tusmore Avenue, Tusmore, Campbell Thompson Lamont MD CCFP South Australia 5065, Australia DiplABFP Professor, Department of Family Medicine, John Grabinar MB BCh MRCGP University of Ottawa General Practitioner Family Medicine Centre, 175 Bruyere 80 Torridon Road, London SE6 lRB, UK Street, Ottawa, Ontario, Canada xii CONTRIBUTORS Joseph Henry Levenstein MB ChB R. T. Mossop MB ChB FCGP(Zimb) MFGP(SA) Senior Lecturer (General Practice), Head, Department of General Practice, Department of Community Medicine, University of Cape Town Godfrey Huggins School of Medicine, 163 Koeberg Road, Brooklyn, University of Zimbabwe Cape Town 7405, South Africa Box A178, Avondale, Zimbabwe Stanley Levenstein BSc MB ChB MFGP (SA) Alistair John Moulds MB ChB MRCGP General Practitioner DObstRCOG 163 Koeberg Road, Brooklyn, General Practitioner, Trainer Cape Town 7405, South Africa Laindon Health Centre, Basildon, Essex, England, UK Dennis Levet MB ChB (Cape Town) FRACGP General Practitioner David S. Muecke MB BS FRACGP 762 Sandy Bay Road, Sandy Bay, Hobart, General Practitioner Tasmania 7005, Australia "Woodlawn", 6 View Road, Walkerville, South Australia 5081, Australia Mary Deirdre Mahoney MB BS (Qld) FRACGP John Edward Murtagh BSc BEd MB BS State Director, Family Medicine FRACGP DObst RCOG Programme, Royal Australian College of Senior Lecturer in Community Practice, General Practitioners Monash University 14 Cribb Street, Milton, Brisbane, Community Practice Teaching Unit, Queensland 4064, Australia 867 Centre Road, East Bentleigh, Victoria 3165, Australia Frank Mansfield MA MB B(Chir) MRCP DObst RCOG FRACGP General Practitioner E. John H. North MB BS FRACGP Lot 39, Edward Road, Lesmurdie, State Director, Family Medicine Western Australia 6076, Australia Programme, Royal Australian College of General Practitioners T. Dion Manthorpe MB BS FRACGP "Trawalla", 22 Lascelles Avenue, Toorak, MRACGP Victoria 3142, Australia General Practitioner PO Box 692, Port Lincoln, South Australia Kenneth C. Nyman MB BS FRACGP 5606, Australia MRCS (Eng) LRCP (Lond) DObst RCOG General Practitioner/part-time John Robinson Marshall MB BCh Senior Lecturer FRACGP 7 A The Rise, Drabble Road, City Beach, Director of Educational Research and Western Australia 6015, Australia Resource Development, Family Medicine Programme, Royal Australian College of Warren Lambert Ogborne MB BS General Practitioners MRCP (Edin) FRACGP 15 Gover Street, North Adelaide, Medical Educator, Family Medicine South Australia 5006, Australia Programme, Royal Australian College of General Practitioners Roland M. Meyer MB BCh (Wits.) "Bagworthy", 31A Carrington Road, MFGP(SA) Wahroonga, New South Wales 2076, General Practitioner Australia 1206 Lister Buildings, 195 Jeppe Street, Johannesburg 2001, South Africa Daryl S. Pedler MB BS DObst RCOG Carl A. Moore BA MD CCFP FCFP FRACGP Professor and Chairman, State Director, Family Medicine Department of Family Medicine, Programme, Royal Australian College of McMaster Faculty of Health Sciences General Practitioners 1200 Main Street West, Hamilton, 15 Gover Street, North Adelaide, Ontario L8N 3Z5, Canada South Australia 5006, Australia xiii
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