The Journal of family practice
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The family physician will rarely see patients with bone tumors; however, when bone tumors do arise, they can be devastating as they unfortunately occur in young patients and are among the most malignant of lesions. The diagnosis of a bone tumor should be suspected if there is deep aching pain, a mass, or a pathological fracture. ⋯ In general, benign tumors are treated with biopsy, local excision, or curettage with bone grafting. Malignant tumors require much more extensive surgery including wide radical excision (probably amputation), chemotherapy, and/or radiation therapy as indicated.
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Informed consent, regardless of patient recall, is required in increasing detail. The family physician must obtain consent from every patient for every procedure except for a few clearly defined areas: "Emergency," "Waiver," "Therapeutic Privilege," "Immaterial Risks," and "Generally Known Risks." Because courts have adopted the "reasonable patient" standard of disclosure, suits can be won without expert testimony. The elements of informed consent require explaining the nature of the procedure, the consequences that will probably occur, the material risks that may occur, alternatives available, and problems in recuperation. Consent, like any contract, is a meeting of the minds and the physician has an obligation to himself to document that agreement.
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Pulmonary function tests provide important clinical information in patients with pulmonary disease. Spirometry gives accurate, rapid information regarding the presence or absence of obstructive or restrictive lung disease and the response to bronchodilators. Particular attention to technique is necessary for valid results. Further information on pulmonary function is provided by the measurement of static lung volumes by dilution techniques or body plethysmography; in some instances lung compliance measurements are indicated.
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Some patient encounters may produce a variety of unpleasant reactions such as guilt, anger, frustration, or dissatisfaction in the physician. These troubling feelings may arise from various sources and can affect the outcome of medical care. ⋯ Just under 30 percent of these encounters were troubling to the physician, but psychosocial problems and lower social class patients produced a significantly greater frequency of troubling. More experienced physicians had significantly fewer troubling encounters.
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Comparative Study
Measuring continuity of care in a family practice residency program.
While the significance of continuity of care in medical practice has not yet been completely assessed, this concept has been espoused by the new specialty of family practice along with some other specialties. It is an integral component in family practice residency programs. The purpose of this paper is to identify several methods of measuring continuity of care in a residency setting and to demonstrate their application. Measurements called COC (Continuity of Care) and UPC (Usual Provider Continuity) will be described as they apply to overall patient visits, visits for chronic conditions, and visits by family members.