Aust Fam Physician
-
Medicines in older patients have the potential to provide great gains as well as significant harms. ⋯ Appropriate prescribing and deprescribing (drug withdrawal) for older patients requires a thorough understanding of the individual, their therapeutic goals, the benefits and risks of all of their medicines, and medical ethics. There is very limited evidence on the safety and efficacy of medicines in older adults, particularly in the frail, who often have multiple comorbidities and functional impairments. In robust older patients, therapy usually aims to delay or cure disease and to minimise functional impairment. In frail older patients, symptom control, maintaining function and addressing end-of-life issues become the main priorities. Optimising medicines is a time-consuming, multidisciplinary process that requires extensive communication, frequent monitoring and review, and has a major clinical impact.
-
Familial hypercholesterolaemia (FH) is a relatively common inherited cause of premature coronary artery disease. However, a significant number of people remain undiagnosed. Several clinical guidelines on FH have been published recently, but these need to be placed in context for Australian general practitioners. ⋯ General practitioners are well placed to institute screening for FH in the general practice setting. Screening approaches could include opportunistic screening for family history, opportunistic screening of lipids, systematic searching of general practice electronic records, and universal screening of children. The role of specialist lipid clinics is important in the GP management of patients with FH.
-
Health assessments have beneficial effects on health outcomes for people with intellectual disability living in the community. However, the effect on medical costs is unknown. ⋯ Health assessments for adults with intellectual disability living in the community are encouraged as they produce enhanced patient care but do not increase overall consultation or medication costs.
-
Australian medical students should graduate with an understanding of the principles of medical law and ethics, and their application to clinical settings. Although student perspectives have been studied previously, the teacher experience of ethical issues also needs to be understood, particularly in the general practice setting. ⋯ General practitioners in this study describe sometimes needing to apply judgement and compromise in situations involving legal or ethical issues, in order to act in the best interests of patients and to successfully negotiate the patient-doctor relationship. Students learning in this clinical context may perceive mixed messages and ethical lapses in these challenging 'grey' areas. The ethical acumen and emotional resilience of both students and clinical teachers may be enhanced by ongoing reflective discussion with colleagues.
-
Elevated serum ferritin is commonly encountered in general practice. Ninety percent of elevated serum ferritin is due to noniron overload conditions, where venesection therapy is not the treatment of choice. ⋯ After exclusion of hereditary haemochromatosis, investigation of elevated serum ferritin involves identifying alcohol consumption, metabolic syndrome, obesity, diabetes, liver disease, malignancy, infection or inflammation as causative factors. Referral to a gastroenterologist, haematologist or physician with an interest in iron overload is appropriate if serum ferritin is >1000 µg/L or if the cause of elevated serum ferritin is still unclear.