Early diagnosis and treatment of leprosy in the United States.

Leprosy is a chronic disease of the skin and peripheral nerves that afflicts more than 5 million persons worldwide and more than 7,000 persons in the United States. Although leprosy is indigenous to the southern United States, most new cases in this country occur among immigrants from foreign areas where the disease is endemic. Leprosy presents as a skin rash and/or peripheral neuropathy. The diagnosis can be confirmed when acid-fast bacilli are found in skin biopsies or smears. The multiple-drug treatment regimens recommended by the World Health Organization have considerably reduced the length of treatment to six months to two years. The optimum duration of treatment has yet to be determined. In most countries, including the United States, leprosy remains one of the most stigmatizing diseases.

Intuition and problem solving.

General practitioners use the hypothetico-deductive method of scientific reasoning to solve problems. In the first few minutes of their consultations physicians form initial hypotheses about their patients' problems. This process has childlike, imaginative qualities based on intuition. It is often outside consciousness and probably based on pattern recognition. It has been neglected from study and analysis because of these ;mystical' qualities. Yet it is the key to fast and efficient problem solving. If the process could be understood, its efficiency would be improved. This paper is an attempt to explore the nature of general practitioners' intuition.

Research in the family physician's office.

Family medicine as a specialty has now "come of age." To maintain its new status, the specialty must be able to survive the vigorous assessment that is given other specialties by the public, the profession, and the academic community. One way of achieving this is for the family physician to do research of excellent quality and quantity. Traditionally, medical research has been done by secondary and tertiary care specialists and little has been done on the primary care needs of the black patient. The research done is of limited value for the family physician's daily work, a reason why family practitioners must do their own research. A research methodology has been described which is readily applicable to the family physician's office. It is an extension of good record keeping and includes Problem-Oriented Medical Records, an Age-Sex Register, a Daily Worksheet or Encounter Form, and a Morbidity Index, incorporating the "Pri-Care" (ICHPPC) code. The system is simple to use and requires only a small increase in administrative time. Every family physician is encouraged to consider its use.