Journal of general internal medicine
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The past decade has seen declining interest in primary care medicine and a dramatic increase in the cost of a medical degree. Seventy-nine percent of housestaff in an internal medicine residency program responded to a survey to determine whether medical school loan burden was related to career choice in a primary care field or specialty area. ⋯ Fourteen percent of those with debts < 40,000 and 59% with debts > $40,000 stated that financial conditions had a moderate to marked impact on their career decision making. Excessive loan burden has a significant influence on residents' career decision making and a negative influence on choosing careers in primary care internal medicine.
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To determine: 1) whether a simple clinical prediction rule could identify emergency department patients with ureteral calculi; 2) whether the kidney, ureter, and bladder (KUB) radiograph provides diagnostic information beyond that obtained from the history and physical examination; and 3) whether ureteral calculi can be diagnosed accurately in the emergency department without emergency excretory urography, commonly known as intravenous pyelography (IVP). ⋯ These findings, which should be confirmed in another emergency department, suggest that subsets of patients with suspected ureteral calculi may be managed without emergency IVP; this approach thereby reduces the time a patient spends in the emergency department, radiation exposure, expense, and morbidity.
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To determine how the physical health of homeless adults varies by the demographic characteristics of age, gender, ethnicity, lifetime length of homelessness, and work status. ⋯ Age and gender contributed most to the understanding of differences in health status among homeless adults. Since the homeless have a wide variety of physical, mental, social, and substance-abuse problems, primary care providers are in the best position to provide the broad-based care needed by such persons.