The role of primary care physicians in early diagnosis and treatment of chronic gastrointestinal diseases

Multiple sclerosis (MS) is a common disabling neurologic disease with an overall prevalence in Canada of 240 in 100,000. Multiple sclerosis clinics are located at tertiary-care centers that may be difficult for a patient to access during an acute relapse. Many relapses are evaluated by primary-care physicians in private clinics or emergency departments, but these physicians' familiarity with MS is not known. Therefore, a survey was undertaken to determine the knowledge and experience of primary-care physicians regarding the diagnosis and treatment of MS relapses. A total of 1282 licensed primary-care physicians in the catchment area of the London (Ontario, Canada) Multiple Sclerosis Clinic were identified and mailed a two-page anonymous survey. A total of 237 (18.5%) responses were obtained, but only 216 (16.8%) of these respondents were still in active practice. Of these 216 physicians, only 9% reported having no MS patients in their practice, while 70% had one to five patients, 16.7% had six to ten, and 1.9% had more than ten (3.7% did not respond to this question). Corticosteroids were recognized as an MS treatment by 49.5% of the respondents, but only 43.1% identified them as a treatment for acute relapses. In addition, 31% did not know how to diagnose a relapse, and only 37% identified new signs or symptoms of neurologic dysfunction as indicating a potential relapse. Despite the high prevalence of MS in Canada, primary-care physicians require more education and support from specialists in MS care regarding the diagnosis and treatment of MS relapses.

Download Full-text

Sudden Airway Obstruction Due to Pedunculated Laryngeal Polyps

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948309200406 ◽

1983 ◽

Vol 92 (4) ◽

pp. 340-343 ◽

Cited By ~ 6

Author(s):

Jeffrey N. Hausfeld ◽

Eiji Yanagisawa ◽

Myles L. Pensak

Keyword(s):

Primary Care ◽

Differential Diagnosis ◽

Early Diagnosis ◽

Airway Obstruction ◽

Primary Care Physicians ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Diagnosis And Treatment ◽

Respiratory Obstruction

Acute upper airway obstruction from laryngeal polyps is uncommon. However, a large pedunculated laryngeal polyp, when unrecognized, may produce sudden airway obstruction. The importance of an early diagnosis and treatment is stressed. Primary care physicians, endoscopists, anesthesiologists, and otolaryngologists should be aware of this condition and add it to their differential diagnosis of sudden respiratory obstruction.

Download Full-text

Understanding the Role of Primary Care Physicians in Managing ADHD

PsycEXTRA Dataset ◽

10.1037/e684542007-001 ◽

2007 ◽

Author(s):

Thomas J. Power ◽

Nathan J. Blum ◽

Jennifer A. Mautone ◽

Patricia H. Manz ◽

Leslee Frye

Keyword(s):

Primary Care ◽

Primary Care Physicians

Download Full-text

Online PTSD Diagnosis and Treatment Training for Primary Care Physicians

10.21236/ada579903 ◽

2013 ◽

Cited By ~ 1

Author(s):

Karen H. Seal

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Diagnosis And Treatment ◽

Ptsd Diagnosis

Download Full-text

Masked Depression: Its Interrelations with Somatization, Hypochondriasis and Conversion

The International Journal of Psychiatry in Medicine ◽

10.2190/cr7j-wu5n-hc5x-2jq5 ◽

1988 ◽

Vol 17 (4) ◽

pp. 367-379 ◽

Cited By ~ 17

Author(s):

Robert Z. Fisch

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Somatic Symptoms ◽

Somatic Complaints ◽

Diagnosis And Treatment ◽

Clinical Phenomenon ◽

Clinical Problems

Masked depression appears to be a common clinical phenomenon. Most depressions present with some somatic complaints in addition to affective and cognitive ones. About one half of all depressions seen by primary care physicians initially present predominantly or exclusively with somatic symptoms. Many of these depressions are not recognized or are misdiagnosed and mistreated. The possible reasons for this are discussed here. The phenomenon of somatization in depressions and other conditions is reviewed and the interface with other related clinical problems like hypochondriasis and conversion is delineated. It is hypothesized that the proportion of depressions that are masked is positively correlated to the patients' tendency to somatize and negatively correlated to the doctors' ability to recognize depressions that hide behind somatic complaints. Suggestions for the diagnosis and treatment of masked depressions are given.

Download Full-text

Diagnostic and treatment barriers to persistent somatic symptoms in primary care – representative survey with physicians

BMC Family Practice ◽

10.1186/s12875-021-01397-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Marco Lehmann ◽

Nadine Janis Pohontsch ◽

Thomas Zimmermann ◽

Martin Scherer ◽

Bernd Löwe

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Rating Scales ◽

Treatment Guidelines ◽

Somatic Symptoms ◽

Diagnosis And Treatment ◽

Treatment Barriers ◽

Adequate Treatment ◽

Physical Disease ◽

Federal States

Abstract Background Many patients consult their primary care physician with persistent somatic symptoms such as pain or sickness. Quite often these consultations and further diagnostic measures yield no medical explanation for the symptoms – patients and physicians are left in uncertainty. In fact, diagnostic and treatment barriers in primary care hinder timely health-care provision for patients suffering from persistent somatic symptoms (PSS). The significance of individual barriers is still unknown. We compare and quantify these barriers from the perspective of primary care physicians and identify subpopulations of primary care physicians who experience particular barriers as most severe. Methods We mailed a questionnaire to primary care physicians (PCP) in Germany and asked them which barriers they consider most important. We invited a random sample of 12,004 primary care physicians in eight federal states in Germany. Physicians provided anonymous mailed or online responses. We also mailed a postcard to announce the survey and a mail reminder. Main measures were Likert rating scales of items relating to barriers in the diagnosis and treatment of PSS in primary care. Information on demography and medical practice were also collected. Results We analyzed 1719 data sets from 1829 respondents. PCPs showed strongest agreement with statements regarding (1.) their lack of knowledge about treatment guidelines, (2.) their perceptions that patients with PSS would expect symptom relief, (3.) their concern to overlook physical disease in these patients, and (4.) their usage of psychotropic drugs with these patients. More experienced PCPs were better able to cope with the possibility of overlooking physical disease than those less experienced. Conclusions The PCPs in our survey answered that the obligation to rule out severe physical disease and the demand to relieve patients from symptoms belong to the most severe barriers for adequate treatment and diagnosis. Moreover, many physicians admitted to not knowing the appropriate treatment guidelines for these patients. Based on our results, raising awareness of guidelines and improving knowledge about the management of persistent somatic symptoms appear to be promising approaches for overcoming the barriers to diagnosis and treatment of persistent somatic symptoms in primary care. Trial registration German Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS) https://www.drks.de/drks_web/setLocale_EN.do The date the study was registered: October 2nd 2017 The date the first participant was enrolled: February 9th 2018 DRKS-ID: DRKS00012942

Download Full-text

Otitis externa: the role of the veterinary nurse

The Veterinary Nurse ◽

10.12968/vetn.2021.12.7.306 ◽

2021 ◽

Vol 12 (7) ◽

pp. 306-310

Author(s):

Sue Paterson

Keyword(s):

Primary Care ◽

Otitis Externa ◽

Diagnosis And Treatment ◽

External Ear ◽

Ear Canal ◽

Veterinary Practice ◽

External Ear Canal ◽

Veterinary Surgeon

Otitis externa is a common problem in primary care veterinary practice. While the diagnosis and treatment of disease is the responsibility of the attending veterinary surgeon, the veterinary nurse, as an integral part of the veterinary surgeon-led team, plays an important role in the investigation and management of disease. Veterinary nurses are more than capable of assessing the external ear canal both macroscopically and cytologically to help the veterinary surgeon to make a diagnosis. Client facing nurse communications can help with the administration of therapy, provide owner support during treatment to increase compliance and help with follow-up assessments.

Download Full-text

Corporal Punishment

PEDIATRICS ◽

10.1542/peds.96.4.792a ◽

1995 ◽

Vol 96 (4) ◽

pp. 792-793

Author(s):

Den A. Trumbull ◽

DuBose Ravenel ◽

David Larson

Keyword(s):

United States ◽

Primary Care ◽

Social Policy ◽

Violence Prevention ◽

Corporal Punishment ◽

Primary Care Physicians ◽

Scientific Evidence ◽

The United States

The supplement to Pediatrics entitled "The Role of the Pediatrician in Violence Prevention" is timely, given the increasingly serious violence problem in the United States.1 Many of the supplement's recommendations are well-conceived and developed. However, the recommendation to "work toward the ultimate goal of ending corporal punishment in homes" (page 580)2 is unwarranted and counterproductive. Before one advises against a practice approved by 88% of American parents3 and supported by 67% of primary care physicians,4 there should be sufficient scientific evidence to support the proposed change in social policy.

Download Full-text