During my career, I have been on both sides of the clinical fence. From 1980 until 1992, I was a practicing nephrologist; from 1992 on, I have been a primary care physician (PCP). It should come as no surprise to the readers of CONSULTANT that I have found primary care practice to be much more demanding.
When patients come in for a Pap smear, we have them write their name and address on an envelope, which we file in a box organized by month. Then as results come in, we retrieve the appropriate envelopes from the box and mail them out. Any envelopes left in the folder at the end of the month serve as reminders that those patients haven't been contacted yet.
These photographs were taken 1Z\x hours after a 45-year-old woman accidentally dropped a hot curling iron onto her right eye while she was styling her bangs. The images show white coagulation of the superficial corneal epithelium, erythema of the lateral infraorbital area, and a transverse pale area of the superior eyelid. Severe pain occurred immediately after the injury. The vision in her right eye was partially obscured by the white coagulation.
Before you prescribe an anticholinergic for patients with urinary frequency or urge incontinence, advise them to cut out all caffeine. Complete avoidance--rather than just decreased intake--often results in an immediate improvement in symptoms. Also instruct patients to keep their daily fluid intake under 64 oz. Should medication still be needed, these steps can help ensure a good outcome.
Diagnosing the cause of abdominal pain in a child can be difficult. When I suspect appendicitis, I ask the patient to jump down from the exam table. If this causes no pain, the diagnosis is most likely not appendicitis. Pain indicates rebound tenderness, and further workup is likely needed.
When using pulse oximetry to evaluate patients with Buerger disease, Raynaud phenomenon, a history of heavy smoking, or other conditions that cause vasoconstriction of the fingers, place the probe on the earlobe. In such patients, this gives a more accurate measurement of arterial hemoglobin saturation than does a digital placement.-- Lynda Sutliff, RN, FNP San Angelo, Tex
ABSTRACT: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis.
When I dry-shave patients in preparation for surgery or suturing, I find that a mailing label best removes the shaved hair. These labels are large and have tackier adhesive than most medical tapes. Just peel off the backing and wrap the label around several fingers, adhesive side outward. The shaved hair sticks to it readily, and cleanup is quick.
When you examine a young child's ears, position the patient on the parent's lap with his or her abdomen against that of the parent, one leg on either side of the parent's trunk, and the child's head against the parent's chest. Have the parent reach one arm around the child's shoulders, and with the other hand hold the child's head against his or her own chest. After you examine the exposed ear, ask the parent to turn the child's head so you can examine the other ear.
A 90-year-old woman with a history of dry age-related macular degeneration in both eyes noticed blurred vision in her left eye after she rubbed her right eye. She had undergone cataract surgery in both eyes 10 years earlier and was pseudophakic.
A 73-year-old woman presented for evaluation because of a sudden severe but painless loss of vision in her left eye 2 days earlier.
The failure of many clinicians to apply evidence-based guidelines in daily practice is not news. What we need to focus on is how to identify and overcome the barriers to implementation of these guidelines.
When using pulse oximetry to evaluate patients with Buerger disease, Raynaud phenomenon, a history of heavy smoking, or other conditions that cause vasoconstriction of the fingers, place the probe on the earlobe. In such patients, this gives a more accurate measurement of arterial hemoglobin saturation than does a digital placement.
Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of persons with normal thyroid function have a TSH level of less than 2.5 mIU/L.
Shortly after awakening, an 82-year-old man with a history of cataracts in both eyes noticed a sudden painless diminution of vision in the left eye. He had no new headaches or jaw claudication. His medications included hydrochlorothiazide and atorvastatin.
An 89-year-old woman, who has long lived on the special care (dementia) unit of a nursing home because of advanced Alzheimer disease, is seen to assess possible injuries after a fall. Many prior falls have been ascribed to her lack of safety awareness in negotiating the environment, rather than to neuromuscular, sensory, or cerebellar deficits.
Diagnosing the cause of abdominal pain in a child can be difficult. When I suspect appendicitis, I ask the patient to jump down from the exam table. If this causes no pain, the diagnosis is most likely not appendicitis. Pain indicates rebound tenderness, and further workup is likely needed.
The weight of some of my patients exceeds the upper limit of our office scales. Rather than invest in a more expensive scale for this small group of patients, we placed 2 scales side by side.
When patients come in for a Pap smear, we have them write their name and address on an envelope, which we file in a box organized by month. Then as results come in, we retrieve the appropriate envelopes from the box and mail them out. Any envelopes left in the folder at the end of the month serve as reminders that those patients haven't been contacted yet.
