Table Of ContentTaylor’s Diagnostic and
Therapeutic Challenges
Taylor’s Diagnostic and
Therapeutic Challenges
A Handbook
Robert B. Taylor, M.D. Editor
Professor Emeritus
Department of Family Medicine
Oregon Health & Science University
School of Medicine
Portland, Oregon
Associate Editors
Alan K. David, M.D. Scott A. Fields, M.D.
Professor and Chairman Professor and Vice Chairman
Department of Family and Department of Family Medicine
Community Medicine Oregon Health & Science University
Medical College of Wisconsin School of Medicine
Milwaukee, Wisconsin Portland, Oregon
D. Melessa Phillips, M.D. Joseph E. Scherger, M.D., M.P.H.
Professor and Chairman Clinical Professor
Department of Family Medicine Department of Family and
University of Mississippi School Preventive Medicine
of Medicine University of California, San Diego
Jackson, Mississippi School of Medicine
San Diego, California
With 19 Illustrations
Robert B. Taylor, M.D.
Professor Emeritus
Department of Family Medicine
Oregon Health & Science University
School of Medicine
Portland, OR 97201-3098, USA
Associate Editors
Alan K. David, M.D. Scott A. Fields, M.D.
Professor and Chairman Professor and Vice Chairman
Department of Family and Department of Family Medicine
Community Medicine Oregon Health & Science University
Medical College of Wisconsin School of Medicine
Milwaukee, WI 53226-0509, USA Portland, OR 97201-3098, USA
D. Melessa Phillips, M.D. Joseph E. Scherger, M.D., M.P.H.
Professor and Chairman Clinical Professor
Department of Family Medicine Department of Family and
University of Mississippi School Preventive Medicine
of Medicine University of California, San Diego
Jackson, MS 39216-4500, USA School of Medicine
San Diego, California 92103-0801
ISBN 0-387-22337-1 Printed on acid-free paper.
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Preface
This book presents the approach to selected problems that clinicians
often find difficult to diagnose or treat. At first, the topics may seem
eclectic, but they have been chosen to reflect areas in which I—as a
clinician like you—always seem to need to know more (such as ge-
netic disorders and diabetes mellitus), am sometime puzzled as to the
etiology (such as headache, thyroid disease, anemia, fatigue, and skin
rashes), or am frustrated when problems sometimes do not respond
to my best management efforts (such as when patients overeat, drink
too much alcohol, or misuse drugs). Also in the latter group are sleep
disorders, chronic pain, and other entities discussed in the pages that
follow.
In fact, what the seemingly diverse topics presented here share in
common is that they all cause both patients and physicians more than
their share of challenges.
The chapters in this book are drawn from the sixth edition of the
large reference book, Family Medicine: Principles and Practice,
which is widely used by family physicians in the United States and
abroad. The publisher and I believe that, in addition to family physi-
cians, the chapters in this book will also be useful to other clinicians
providing primary care, such as general internists, general pediatri-
cians, nurse practitioners, and physician assistants. The price of the
“big book” can be a deterrent to some; publication of a smaller book
on focused topics allows clinicians to purchase a book on the topics
that meet their specific needs. In addition, some find pocket-sized
manuals easier to handle than larger, heavy books.
Whatever the reason you picked up this book, I hope that you find
it useful in your daily care of patients. Comments are welcome.
Robert B. Taylor, M.D.
Clinical Practice
Notice
Everyone involved with the preparation of this book has worked
very hard to assure that information presented here is accurate and
that it represents accepted clinical practices. These efforts include
confirming that drug recommendations and dosages discussed in this
text are in accordance with current practice at the time of publica-
tion. Nevertheless, therapeutic recommendations and dosage sched-
ules change with reports of ongoing research, changes in govern-
ment recommendations, reports of adverse drug reactions, and other
new information.
A few recommendations and drug uses described herein have Food
and Drug Administration (FDA) clearance for limited use in restricted
settings. It is the responsibility of the clinician to determine the FDA
status of any drug selection, drug dosage, or device recommended to
patients.
The reader should check the package insert for each drug to de-
termine any change in indications or dosage as well as for any pre-
cautions or warnings. This admonition is especially true when the
drug considered is new or infrequently used by the clinician.
The use of the information in this book in a specific clinical set-
ting or situation is the professional responsibility of the clinician. The
authors, editors, or publisher are not responsible for errors, omissions,
adverse effects, or any consequences arising from the use of infor-
mation in this book, and make no warranty, expressed or implied,
with respect to the completeness, timeliness, or accuracy of the book’s
contents.
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Clinical Practice Notice . . . . . . . . . . . . . . . . . . . . . . . . . vii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1 Cultural, Race, and Ethnicity Issues in Health Care . . . . . . 1
Enrique S. Fernandez, Jeannette E. South-Paul, and
Samuel C. Matheny
2 Family Issues in Health Care . . . . . . . . . . . . . . . . . . . . . 16
Thomas L. Campbell, Susan H. McDaniel, and
Kathy Cole-Kelly
3 Genetic Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
John W. Bachman
4 Care of the Obese Patient . . . . . . . . . . . . . . . . . . . . . . . . 54
Michael T. Railey
5 Care of the Patient with Fatigue . . . . . . . . . . . . . . . . . . . 63
John Saultz
6 Care of the Patient with a Sleep Disorder. . . . . . . . . . . . . 75
Thomas A. Johnson, Jr. and James J. Deckert
7 Care of the Alcoholic Patient . . . . . . . . . . . . . . . . . . . . . 88
Gerald M. Cross, Kenneth A. Hirsch, and John P. Allen
8 Care of the Patient Who Misuses Drugs . . . . . . . . . . . . . 117
Jerome E. Schulz
x Contents
9 Care of the Patient with Chronic Pain . . . . . . . . . . . . . . 133
Carole Nistler
10 Care of the Dying Patient . . . . . . . . . . . . . . . . . . . . . . . 145
Frank S. Celestino
11 Diseases of the Rectum and Anus . . . . . . . . . . . . . . . . . 159
Thomas J. Zuber
12 Common Dermatoses . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Daniel J. Van Durme
13 Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Charles Kent Smith, John P. Sheehan, and
Margaret M. Ulchaker
14 Thyroid Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Michael B. Harper and E.J. Mayeaux, Jr.
15 Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Daniel T. Lee and Angela W. Tang
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Contributors
John P. Allen, Ph.D., M.P.A., Chief, Treatment Research Branch, Na-
tional Institute on Alcohol Abuse and Alcoholism, Rockville, MD
John W. Bachman, M.D., Professor of Medicine, Mayo Medical
School; Consultant, Department of Family Medicine, Mayo Clinic,
Rochester, MN
Thomas L. Campbell, M.D., Professor, Department of Family Med-
icine and Department of Psychiatry, University of Rochester School
of Medicine and Dentistry, Rochester, NY
Frank S. Celestino, M.D., Associate Professor and Director of Geri-
atrics, Department of Family and Community Medicine, Wake For-
est University School of Medicine, Winston-Salem, NC
Kathy Cole-Kelly, M.S.W., M.S., Associate Professor of Family Med-
icine, Case Western Reserve University School of Medicine, Cleve-
land, OH
Gerald M. Cross, M.D., Command Surgeon, United States Army
FORSCOM, Atlanta, GA
James J. Deckert, M.D., Associate Clinical Professor of Family and
Community Medicine, University of Missouri–Columbia, School of
Medicine; Clinical Faculty, Mercy Family Medicine Residency Pro-
gram and Geriatric Services, St. John’s Mercy Medical Center, St.
Louis, MO
Enrique S. Fernandez, M.D., M.S.Ed., Family Physician, Miami, FL
Michael B. Harper, M.D., Professor of Family Medicine, Louisiana
State University Health Sciences Center, Shreveport, LA
xii Contributors
Kenneth A. Hirsch, M.D., Ph.D., Head, Inpatient Mental Health Ser-
vices, Naval Medical Center, San Diego, CA
Thomas A. Johnson, Jr., M.D., Clinical Professor of Family and Com-
munity Medicine, University of Missouri–Columbia School of Med-
icine; Clinical Faculty, Mercy Family Medicine Residency Program,
St. John’s Mercy Medical Center, St. Louis, MO
Daniel T. Lee, M.D., Assistant Clinical Professor of Family Medi-
cine, University of California-Los Angeles School of Medicine, Los
Angeles; Faculty, Santa Monica-UCLA Medical Center Family Prac-
tice Residency Program, Santa Monica, CA
Susan H. McDaniel, Ph.D., Professor, Department of Psychiatry
(Psychology) and Department of Family Medicine, University of
Rochester School of Medicine and Dentistry, Rochester, NY
Samuel C. Matheny, M.D., M.P.H., Claire Louise Caudill Professor
and Chair, Department of Family Practice, University of Kentucky
College of Medicine, Lexington, KY
E.J. Mayeaux, Jr., M.D., Associate Professor of Family Medicine,
Louisiana State University Health Sciences Center, Shreveport, LA
Carole Nistler, M.D., Private Practice, Olmsted Community Hospi-
tal, Rochester, MN
Michael T. Railey, M.D., Assistant Professor of Community and Fam-
ily Medicine, St. Louis University School of Medicine; Forest Park
Hospital Family Medicine Residency Program, St. Louis, MO
John Saultz, M.D., Professor and Chairman, Department of Family
Medicine, Oregon Health & Science University School of Medicine,
Portland, OR
Jerome E. Schulz, M.D., Clinical Professor of Family Medicine, East
Carolina University Brody School of Medicine; Pitt County Memo-
rial Hospital, Greenville, NC
John P. Sheehan, M.D., Associate Clinical Professor of Medicine,
Case Western Reserve University School of Medicine, Cleveland,
OH
Charles Kent Smith, M.D., Dorothy Jones Weatherhead Professor of
Family Medicine, Case Western Reserve University School of Med-
icine, Cleveland, OH
