Aust Fam Physician
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Flashes and floaters are common ophthalmic issues for which patients may initially present to their general practitioner. It may be a sign of benign, age-related changes of the vitreous or more serious retinal detachment. ⋯ Although most patients presenting with flashes and floaters have benign age-related changes, they must be referred to an ophthalmologist to rule out sight-threatening conditions. Key examination features include the nature of the flashes and floaters, whether one or both eyes are affected and changes in visual acuity or visual field.
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Case Reports
Blame, shame and hopelessness: medically unexplained symptoms and the 'heartsink' experience.
'Heartsink' patients present a moral dilemma. We recognise their suffering, but at the same time struggle with the feelings they trigger in us. Patients also experience negative feelings. Without a diagnosis they lack a narrative or vocabulary to make sense of their own suffering. ⋯ Doctors and patients often experience frustration and helplessness in consultations around medically unexplained symptoms. Without a diagnosis, patients lack social legitimacy as 'sick' people with 'real' illnesses. They often describe feeling blamed for their own distress. Because of this, they can experience deep feelings of worthlessness and shame. Patients with a history of abuse can be particularly vulnerable. Management includes validating their suffering, helping them construct appropriate explanations for their distress and providing empathic interpersonal care, while minimising the risk of iatrogenic harm.
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There are over 332 000 Australians living with dementia. On average, families notice symptoms 3 years before a firm diagnosis is made. These symptoms are chronic and typically progressive and terminal. ⋯ GPs play a crucial part in managing the needs of people with dementia and caregivers by providing ongoing support and by facilitating access to evidence-based care. Scheduled, regular reviews of people with dementia and their caregivers should become standard practice, and psychosocial interventions that can assist both parties should be offered.
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Ten years of experience with hundreds of general practices in the Australian Primary Care Collaboratives program has provided many lessons for improving practice appointment systems. ⋯ Demand is finite and predictable. We can shape our demand by influencing when, why and for whom people make appointments. We can change our daily appointment numbers and our team capacity to match our reshaped demand. Contingency plans for expected and unexpected drops in capacity can prevent appointment backlogs. Embedding and monitoring our demand and capacity management can help ensure smooth flow of patients through the practice with good care and improved staff and patient satisfaction.
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Concussion is common in many sports and recreational activities. It is thought to reflect a functional rather than structural injury to the brain. The clinical features are typically short-lived and usually resolve spontaneously. Complications, however, can occur and may include prolonged symptoms and/or cognitive deficits in the short term, as well as depression and cumulative deterioration in brain function in the longer term. ⋯ The critical issues in the clinical management of concussion in sport include making a diagnosis, differentiating between concussion and other pathologies (particularly structural head injury), recognising the presence of any modifying factors (which may increase the risk of complications) and determining when the patient can safely return to competition. The key components of safe return-to-play decisions include rest, neuropsychological testing and a graded program of exertion before return to sport.