Constipation Misperception: Could It Be Familial Adenomatosis Polyposis?

Colorectal cancer is the second leading cause of cancer deaths in the United States. Familial adenomatosis polyposis (FAP) is a rare cause of colorectal cancer. The United States Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years. While age is the most important risk factor, we need to consider the family history of colorectal cancer. FAP is a rare cause of colorectal cancer, leading to high morbidity and mortality if undetected and undiagnosed. It is easy to overlook the family history in a busy primary care clinic with limited patient encounter times. Clinicians mustn't forget this important piece of information as it can give leads for further patient evaluation. We present a case report of a 21-year-old male who presented to our clinic to establish primary care and with vague abdominal complaints. Still, the concerning family history of early onset colon cancer in his half-sister raised red flags and directed us to further evaluate. Further evaluation revealed our patient, in fact, had FAP.

Using Generalized Anxiety Disorder-2 (GAD-2) and GAD-7 in a Primary Care Setting.

Anxiety disorders are highly prevalent in the primary care setting and are responsible for significant morbidity as well as a loss of productivity. Evaluation by mental health specialists and behavioral specialists can sometimes be confounded with problems of availability, accessibility, and the patient's hesitancy to talk to new providers due to lack of prior relationship and trust. Primary care providers already have the advantage of being available for their patients, and have built years of trust behind them to strengthen this relationship. The biggest problems which confront primary care are the time constraints as well as the presence of multiple medical demands. This leads to a constant need for tools that facilitate early recognition and diagnosis of mental health disorders while also providing judicious utilization of clinic time. This article attempts to review the use of two of these popular tools: Generalized Anxiety Disorder scale-2 (GAD-2) and GAD-7 in the primary care setting.

Writing and reading in the electronic health record: an entirely new world.

BACKGROUND: Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence. PURPOSES: This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. METHODS: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. RESULTS: Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= - 0.33, p<0.001) and narrative (r= - 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). CONCLUSIONS: Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.

Electronic health communication: an educational application for this principle of the Patient-centered Medical Home.

The Patient-centered Medical Home (PCMH) relies on comprehensive, consistent, and accessible communication for the patient with all members of their health care team. "E-medicine" and health information technology (HIT) create many new possibilities in addition to standard face-to-face encounters. There is interest by both physicians and patients for enhanced access through electronic communication. However, there is little published literature regarding specific educational programs for medical professionals using electronic communication with patients. Faculty in a required 6-week family medicine clerkship developed, implemented, and evaluated an electronic health communication curriculum. This curriculum consists of a didactic session on electronic health communication including anticipated errors of communication and common clinical pitfalls. Each clerkship student receives a weekly e-mail from a standardized patient centered on a clinical question. Additionally, each e-mail contains a different communication challenge or predicted error. Students receive feedback each week on the e-mails and are evaluated with an objective structured clinical exam (OSCE) during the final week. The results of the weekly e-mails and the final OSCE show that students improve overall but continue to make predicted errors in communication despite didactic instruction and actual practice. These results reinforce the need for medical student education on electronic health communication with patients.