The Nature of General Family Practice: 583 clinical vignettes in family medicine An alternative approach to syllabus development

662 Pages·1983·18.35 MB·English

by  W. E. Fabb

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