Annals of family medicine
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Annals of family medicine · Sep 2013
Toward a simple diagnostic index for acute uncomplicated urinary tract infections.
Whereas a diagnosis of acute uncomplicated urinary tract infection (UTI) in clinical practice comprises a battery of several diagnostic tests, these tests are often studied separately (in isolation from other test results). We wanted to determine the value of history and urine tests for diagnosis of uncomplicated UTIs, taking into account their mutual dependencies and information from preceding tests. ⋯ Most women with painful and/or frequent micturition can be correctly classified as having either a low or a high risk of UTI by asking 3 questions: Does the patient think she has a UTI? Is there at least considerable pain on micturition? Is there vaginal irritation? Other women require additional urine dipstick investigation. Sediment and dipslide have little added value. External validation of these recommendations is required before they are implemented in practice.
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Annals of family medicine · Sep 2013
Being uninsured is bad for your health: can medical homes play a role in treating the uninsurance ailment?
In the United States, stable health insurance coverage is associated with improved health outcomes. A lack of insurance is associated with premature death from preventable causes. ⋯ The magnitude and complexity of the US "uninsurance" problem, as well as recent federal initiatives to expand coverage options, inspire important questions: Can medical homes play a more active role in helping patients find and keep insurance coverage? How can basic tenets from the chronic care model be operationalized to build systems to treat the uninsurance ailment? Creating effective processes and tools within the medical home to keep a patient insured may be as important to improving population health as helping a patient maintain a normal blood pressure. Similar system-level interventions could be used to support both endeavors.
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Annals of family medicine · Sep 2013
Measuring up: musings of a family doctor on the employee time clock.
Recently, at the health maintenance organization (HMO) where I work, they introduced an employee time clock. As in many other workplaces, doctors across the country are now obligated to punch the clock at the beginning and end of their workday. ⋯ I provide details on how the introduction of the clock influences small everyday clinical decisions that potentially affect the quality and depth of treatment while sharing the internal dialogue that accompanies me as I reaffirm my professional integrity again and again with each hastened visit. I also bring the internal dialogue of 2 of my patients, to illustrate the emotional world on the other side of these 10-minute interventions.