Patients' expectations of the family physician in health promotion.

This study evaluated patients' perceptions of the family practice physician's role in providing health promotion services. We distributed a questionnaire to a convenience sample of 450 patients (mean age = 40.4 years, SD = 15.8); 382 responded, yielding an 85% response rate. At least 70% of the respondents believed physicians should counsel all patients concerning yearly Pap smears, breast self-exams, and smoking cessation. A sizeable minority believed physicians should teach sex education to teens (41%), discuss social support systems with patients (41%), and discuss home-safety issues with patients (42%). The topics patients least wanted physicians to discuss were financial problems (32%) and seat-belt usage (31%). These patients thought physicians should refer them to other professionals for dental care (33%), marital problems (21%), and financial problems (20%). At least half of the respondents thought physicians should help in the following areas only if requested to do so by the patient: sexual problems (58%), sleeping difficulties (54%), and marital problems (53%). Chi-square analyses were conducted to examine differences in beliefs based on age, sex, educational level, and preventive health orientation of the respondent. We found significant differences based upon these demographic variables; however, interaction effects among the demographic variables also exist.

Family practice physicians' perceptions and practices regarding health promotion for the elderly.

This study assessed 321 family practice physicians' perceptions and practices regarding health promotion in the elderly; specifically, whether health promotion is perceived to be beneficial for this segment of the population. A random sample of 250 male and 250 female members of the American Academy of Family Physicians was surveyed. The internal reliability of the questionnaire was assessed, yielding a Cronbach alpha of .84. Respondents were 46% male and 54% female, and 67% of them had completed a residency program. Three-fourths (77%) of the respondents were between 25 and 50 years of age. The majority believed that health promotion counseling is of value to patients of all ages (88%) and that medical schools should devote more attention to preventive medicine (69%). These physicians identified lack of third-party payment, lack of sufficient staff, lack of competence in prescribing prevention programs for the elderly, and finding counseling the elderly about preventive health issues not professionally gratifying as barriers to health promotion of the elderly. All health promotion practices but one listed on the questionnaire were perceived as important by at least half the physicians. Until compensation for health promotion is available and physicians perceive themselves as competent concerning health promotion in the elderly, it is likely their clinical practices and recommendations will lag behind their favorable attitudes toward the topic.

The structure and regulation of family practice residency laboratories.

BACKGROUND: Increasing regulation of physician office laboratories (POLs), increased complexity of outpatient care, and technological advances have increased the need to train family practice residents in POL management. There is little information on how residency laboratories are organized, how they are regulated, and how often quality controls and proficiency testing are done. METHODS: A questionnaire was sent to 385 ACGME-approved family practice residencies to determine the scope of testing, quality-assurance activities, and administrative structure of the residency laboratory. RESULTS: Two hundred and ninety-seven programs responded, for a response rate of 77%; 91.6% were performing routine office tests and 40.7% were performing automated testing. Of programs that performed automated tests, 71.2% were performing daily normal and abnormal quality-control specimens. Proficiency testing was only performed by 57.8% of programs. The program's parent hospital viewed the residency laboratory as a POL in 55.6% of cases and as a satellite of the hospital laboratory in 32.6%. CONCLUSIONS: Residency laboratories are more frequently organized as POLs than satellite laboratories of the parent hospitals. The POL model offers an excellent opportunity to teach residents about office laboratory management. Residency laboratories should be implementing proficiency testing for both patient safety and resident teaching. Many residency laboratories will need to increase the frequency of quality controls as the new CLIA '88 regulations are implemented. Accreditation by a private organization may be an attractive option for family practice office laboratories.

Provisions of the Americans with Disabilities Act and the development of essential job functions for family practice residents.

BACKGROUND: Family practice residency program directors and faculty are frequently faced with residents who sustain a temporary illness or become disabled during residency. In addition, disabled applicants are seeking positions in medical schools and residencies. Program directors and faculty have an obligation to understand the laws that apply to disability and illness to develop fair and workable policies within their programs. This article explores the provisions of the Americans With Disabilities Act that apply to family practice residency programs and residents with illness and disability. One of the key requirements for dealing with resident illness or disability is the development of essential job functions. We present a strategy to enable individual residency programs to develop a list of essential job requirements for family practice residents. An example of essential job requirements is given.

Injury prevention in children.

Injuries are the leading cause of death in children. Approximately 23,000 children are killed each year in the United States, and many more suffer from nonlethal injuries. This article discusses general principles of effective intervention strategies, the most serious injury categories, and practical injury prevention advice for primary care physicians.

Universal precautions in the family physician's office.

BACKGROUND: The risk of occupational exposure to the human immunodeficiency virus (HIV) may be one of the important issues facing family physicians in the 1990s. The use of universal precautions has been shown to reduce the incidence of exposures to bloodborne pathogens. Studies indicate, however, that these guidelines are not being followed consistently by physicians or their staffs. METHODS: A survey of 3568 randomly sampled members of the American Academy of Family Physicians was performed using a questionnaire that was designed by the authors. Three mailings were conducted. RESULTS: The total response rate was 39%. Approximately 80% of the respondents reported that they used gloves appropriately and disposed of sharp instruments in a puncture-resistant container. Only 39% "always" or "almost always" used eye protection when indicated, and only 35% "almost never" or "never" recapped used needles. There was a significant number of physicians who reported that they or their office staff had had an occupational exposure to bloodborne pathogens within the last year. CONCLUSIONS: Family physicians and their staffs do not uniformly follow universal precaution guidelines and, as a result, many have been exposed to blood products. If the physician or the office staff would not recap used needles and would place used sharp instruments in a puncture-resistant container, the greatest risks of occupational exposure would be reduced.

Comparison of three antismoking interventions among pregnant women in an urban setting: a randomized trial.

This study examined smoking cessation and cigarette reduction of indigent inner city pregnant women (n = 193) who completed one of three interventions: a special video program based on their perceptions of the effects of smoking during pregnancy, the American Lung Association's "Freedom From Smoking For You and Your Baby" program, or the usual physician's advice. Six percent of the women quit smoking, and 43% reduced the number of cigarettes they smoked. There were no significant differences among the three groups for either the number who quit smoking or who reduced the number of cigarettes smoked.

Wegener's granulomatosis.

Wegener's granulomatosis is a rare disease of unknown etiology. Until recently it was considered uniformly fatal. Family physicians should be aware of the variable presentations of this disease and keep the diagnosis in mind when faced with a puzzling, chronic, progressive multisystem process. New laboratory markers can lead to earlier diagnosis, and aggressive treatment can improve the prognosis.

Evaluation and follow-up of abnormal Pap smears.

An estimated 13,500 cases of invasive cervical cancer and 6,000 related deaths occur each year in the United States. These numbers can be significantly reduced if all women are regularly screened with Papanicolaou (Pap) smears and undergo colposcopy when abnormalities are detected. Screening with Pap smears should begin at age 18 or at the age of first sexual intercourse and should be repeated every one to three years, depending on individual risk factors, until age 65. Screening may be discontinued in women over age 65 who have had normal findings on two consecutive Pap smears. Risk factors for cervical cancer include sexual intercourse before age 20, more than two sexual partners in a lifetime, cigarette smoking and genital human papillomavirus (HPV) infection. Use of a spatula and Cytobrush for cervical sampling will improve the chances of collecting an adequate sample containing endocervical cells. Family physicians must know the significance of various cervical abnormalities reported by the laboratory. In women with cervical or genital HPV infection and persistent inflammatory cervical changes unresponsive to appropriate therapy, colposcopy is necessary to screen for underlying dysplasia.

Training generalist physicians: structural elements of the curriculum.

To train more generalist physicians, structural changes must be made along the continuum of medical education. Future generalists require in-depth exposure to primary care practice, with substantive experience in the longitudinal management of patient panels and the opportunity to work with successful generalist role models. Clinical training and course work must incorporate a wide range of skills and disciplines, including areas now under-emphasized, such as epidemiology, health services, and psychosocial medicine. Recommendations for structural changes to increase the generalist focus of medical education include: 1) the development within institutions of central authorities, involving departments of internal medicine, family medicine, and pediatrics, in joint efforts to foster all aspects of generalist training, including recruitment, curriculum development, community linkages, innovative approaches to training, and recognition and support for successful generalist teachers; 2) commitment of a minimum of 50% of clinical training to ambulatory care settings at both medical school and residency levels; 3) required longitudinal care experiences for all medical students and a 20% or greater time commitment to longitudinal care for internal medicine, pediatrics, and family medicine residents; and 4) increased numbers of generalist faculty and enhanced teaching skills among faculty in the outpatient environment, to guarantee increased exposure of medical students and residents to generalist role models.