The Journal of family practice
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Although physicians in most family practice residency programs hospitalize their patients at community hospitals, those in 21 programs in the United States hospitalize patients exclusively at university hospitals. Through a questionnaire mailed to directors of each of these programs, it was learned that family practice residency faculty have medical intensive care (ICU) privileges at 38 percent of these university hospitals. No family physicians had ever been denied ICU privileges at any of these hospitals. ⋯ At 62 percent of these university hospitals, family physicians do not have ICU privileges. However, no family physician had every made a formal application for them. Intensive care patients at these hospitals were generally cared for by specialists and house staff in internal medicine or critical care.
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Five percent of the population aged over 65 years, or more than 1 million people, are homebound. Musculoskeletal dysfunction is the final common pathway of all forms of arthritis and many neuromuscular disorders and is the prime cause for being homebound. ⋯ Many can be helped by modification of the home environment or physical and occupational therapy. This paper outlines the diagnosis and management of common functional disabilities found in homebound patients.
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No authoritative source has reported the percentage of each medical school's graduates who enter family practice residency programs. This study is the first of a series of reports from the American Academy of Family Physicians to report such data. ⋯ The West North Central Region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in December 1981; the New England and Middle Atlantic regions had the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in December 1981 as were graduates from privately funded medical schools.
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One hundred thirty-one Illinois family physicians, 53 general practitioners, and 65 general internists responded to a survey on medical ethics. From these data emerged a profile of the family physicians and an identification of the ethical problems they encounter most frequently in their practice: (1) issues about contraception, (2) pain control, (3) telling the patient the truth, (4) sexual issues, (5) informed consent, (6) confidentiality, (7) controlling patients' behavior with medication, (8) sterilization, (9) professional etiquette, (10) patients' rights, and (11) peer review.
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There are many factors that have mitigated against optimal or even adequate medical care of the dying patient despite recent technological advances in medicine. Major changes are now taking place in terms of public expectations, medical practice, and legislation related to dying and death in this society. The dying patient has five basic requirements that must be met: independence, dignity, acceptance by others of an individual approach to dying, relief of symptoms, and physical care. ⋯ Regardless of setting, the family physician plays a central role in the care of the dying patient and his or her family during preterminal, terminal, and follow-up stages. This paper presents an approach to comprehensive care whereby the symptoms of incurable terminal illness can be effectively relieved on an individualized basis. Anticipatory guidance and care are important for the effects of terminal illness and death of a family member on the surviving family members, particularly with regard to recognition and treatment of depression.