Annals of family medicine
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It finally happened to me: I was sued for malpractice by the family of a patient who had died suddenly. My inner turmoil in the aftermath of this traumatic event affected me deeply. While I was an experienced family doctor dedicated to patient-centered medicine, the event challenged my customary approach to my patients. I share three vignettes from my practice that describe my inner dialogue both "preprosecution" and "postprosecution" and explain how I acted in each case.
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Annals of family medicine · Sep 2014
Randomized Controlled Trial Multicenter Study Comparative StudyTreatment of forefoot problems in older people: a randomized clinical trial comparing podiatric treatment with standardized shoe advice.
Consultations for forefoot pain are frequent in primary care, but scientific support of treatment options is scarce. The purpose of this study is to investigate the effect of podiatric treatment vs standardized advice on proper shoe characteristics and fit of shoes by means of an information leaflet for people aged 50 years and older with forefoot pain in primary care. ⋯ This study found that shoe advice provided to patients consulting their general practitioner for forefoot pain and symptom relief resulted in outcomes similar to treatment outcomes in patients consulting a podiatrist. Based on these results, primary care physicians should be cautious when referring a patient to a podiatrist; instead, they should start by providing advice on proper characteristics and fit of shoes.
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Annals of family medicine · Sep 2014
ReviewBarriers to implementation of case management for patients with dementia: a systematic mixed studies review.
Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. ⋯ Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services.
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Annals of family medicine · Sep 2014
Comparative StudyInequities in ambulatory care and the relationship between socioeconomic status and respiratory hospitalizations: a population-based study of a canadian city.
Individuals of lower socioeconomic status have higher rates of hospitalization due to ambulatory care-sensitive conditions, particularly chronic obstructive pulmonary disease and asthma. We examined whether differences in patient demographics, ambulatory care use, or physician characteristics could explain this disparity in avoidable hospitalizations. ⋯ In the setting of universal health care, the income-based disparity in hospitalizations for respiratory ambulatory care-sensitive conditions cannot be explained by factors directly related to the use of ambulatory services that can be measured using administrative data. Our findings suggest that we look beyond the health care system at the broader social determinants of health to reduce the number of avoidable hospitalizations among the poor.