Australian Family Physician November 2008 - Malaise
Vol 37, (11) 897 - 976
The theme for the November issue of AFP
is Malaise. This month's articles include Somatisation, ‘I just don’t
feel right’, Pathology testing in the tired patient – a rational
approach, Aches, pains and osteoarthritis, ‘I’ve been bleeding from the
bowel’, Lessons from the TAPS study and Steroid injection in lateral
epicondylar pain.
In the real world
Kath O’Connor
A man, 45 years of age and weighing 70 kg, walks out of a
textbook and into your practice. He complains of central chest
pain radiating down his left arm and nausea.
Somatisation
Janice Charles, Salma Fahridin, Helena Britt
Somatisation is when physical symptoms develop through stress or
emotional problems. Each year in the BEACH program (Bettering the
Evaluation and Care of Health), somatisation disorder is managed about 30
times in 100 000 encounters.
‘I just don’t feel right’
Carolyn Ee
Much undifferentiated illness is seen in general practice.
Patients with vague feelings of general unwellness may have
multiple unrelated problems, serious underlying pathology,
definite but indefinable pathology, no definable pathology, and/or
illness of psychological origin.
Pathology testing in the tired patient - A rational approach
Michael Harrison
Pathology tests are often ordered by general practitioners to
investigate patients with nonspecific complaints such as malaise
and tiredness.
Aches, pains and osteoarthritis
Louise Stone
Aches and pains are commonly seen in general practice and
osteoarthritis may be an underlying cause. Chronic pain can
be very distressing for patients and management may be
challenging for the general practitioner. Osteoarthritis is a
common cause of chronic pain and disability.
‘I’ve been bleeding from the bowel’
Andrew Knight
Much undifferentiated illness is seen in general practice. Patients
with a vague feeling of general unwellness may have multiple
unrelated problems, serious underlying pathology, definite but
indefinable pathology, and/or illness of psychological origin.
Lessons from the TAPS study - Recall and reminder systems
Meredith A B Makeham, Deborah C Saltman AM, Michael R Kidd
Let your computer help you help your patients. The recall
and reminder system within your computerised medical
records can be used to improve the quality of care you
provide and avoid serious patient safety errors.
Steroid injection in lateral epicondylar pain
Bo Xu, Hershel Goldman
What is the evidence for using steroid injection to treat lateral
epicondylar pain in the general practice setting? In reviewing four
randomised controlled trials, this article concludes that steroid
injection is indicated if rapid pain relief is desired in the short term.
Type 2 diabetes – which BGLs matter? - The fasting, pre- and post-prandial glycaemia debate
Patrick J Phillips, Stephen M Twigg
There is vigorous debate about the relative importance of targeting
fasting blood glucose levels (BGLs) and postprandial BGLs.
The painful mouth
Geoffrey Quail
The painful mouth presents a diagnostic challenge to the general
practitioner. Despite curriculum revision of most medical courses,
oro-pharyngeal diseases are still inadequately covered.
Clinical Challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue.
AFP in Practice
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues. Requirements to earn 40 Category 1 CPD points for a SGL activity are: minimum of four and a maximum of 10 people, minimum of 8 hours of discussion in a year, and at least two GPs.
A 'target' skin lesion
Keng Yin Loh
A boy, 12 years of age, was being treated for pneumonia.
The cold haemagglutination test was positive for
Mycoplasma pneumoniae.
Failure to diagnose: bowel obstruction
Sara Bird
The patient, 36 years of age, attended the general
practitioner, Dr Park, on 20 March 2005. The patient
reported that she had been well until that morning
when she experienced 'crampy' abdominal pain.
Medical students go back to school - The Triple A journey
Smita Shah, Jessica K Roydhouse, Susan M Sawyer
Studies in medical humanities show that attention to the human
aspects of medicine deepens the relationship between clinicians and
patients and adds social value to medical encounters.
The role of spirituality in medicine
Craig Hassed
Spirituality is an important determinant of physical,
emotional and social health and may, in some circumstances,
be a central aspect of the management of some conditions.
Book reviews
Books reviewed this month are Journeys with the Black Dog: Inspirational stories of bringing depression to heel by Tessa Wigney, Kerrie Eyers, Gordon Parker, editors and Toxicology Handbook by Lindsay Murray, Frank Daly, Mark Little, Mike Cadogan
Multidisciplinary care plans and diabetes - Benefits for patients with poor glycaemic control
Nicholas Zwar, Iqbal Hasan, Oshana Hermiz, Sanjyot Vagholkar, Elizabeth Comino, Mark Harris
The authors have previously found that multidisciplinary care plans
are associated with improved processes and outcomes of care for
diabetic patients.
Enhancing the choice of general practice as a career
Jill Thistlethwaite, Michael R Kidd, Stephen Leeder, Tim Shaw, Kate Corcoran
The shortage of general practitioners in Australia is likely to continue
unless more doctors choose general practice as a career.
Antihypertensive prescribing - A survey of general practice supervisors and registrars
Peter Eastman
Hypertension is a common problem in general practice. Prescribing
guidelines vary, but generally favour thiazide diuretics as first line
treatment for uncomplicated essential hypertension.
GPs' experiences with loneliness
Hiske van Ravesteijn, Peter Lucassen, Marjan van der Akker
Loneliness has a negative influence on health. General practitioners are confronted with lonely patients in their daily practice, but there is little information about how GPs deal with loneliness.