Aust Fam Physician
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Communication about end of life care may involve difficult conversations for patients, family members and health professionals. However, a lack of understanding of a person's wishes about their future care may result in a loss of dignity for the person, and additional distress for their family members and health professionals and burden to the healthcare system. ⋯ Involving patients and their family members in advance care planning may be challenging and time consuming for GPs. However, there are a number of resources to support this activity in relation to training, communication support and Medicare item funding.
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Bone mineral density is presently the only reliable diagnostic test for osteoporosis. ⋯ Bone mineral density is subsidised for all patients aged more than 70 years, yet GPs are more likely to request bone mineral density tests only among those who already have a fracture. General practitioner education on the role of bone mineral density testing among all patients aged 70 years or more is important as it influences initiation of appropriate osteoporosis treatment.
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This article identifies the roles that gay men with depression ascribe to their chosen general practitioner and considers how they might influence the dynamics of clinical interactions between gay men and their doctors. ⋯ Gay men who have ongoing contact with their GP may expect them to intuitively understand which roles are expected and appropriate to perform in each consultation and over time. General practitioners should consider these changing roles, and take them into account (as appropriate) to achieve open and trusting relationships in the care of their gay male patients.
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Rheumatoid arthritis is a chronic disease that can cause irreversible joint damage and significant disability. With a prevalence of 1%, it has a considerable cost to the community. Diagnosis is based on a combination of clinical and laboratory features. Patients typically present with a symmetrical polyarthritis of the small joints of the hands and feet accompanied by early morning stiffness and, occasionally, constitutional symptoms. ⋯ It is increasingly recognised that there is a 'window of opportunity' within which disease modifying antirheumatic drug therapy should be commenced to arrest progressive disease and joint destruction. Methotrexate is usually the first line agent in the management of rheumatoid arthritis but simple analgesia and nonsteroidal anti-inflammatory drugs are also important for symptom control.
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Addiction to opioids, or opioid dependence, encompasses the biopsychosocial dysfunction seen in illicit heroin injectors, as well as aberrant behaviours in patients prescribed opioids for chronic nonmalignant pain. ⋯ The same principles and skills general practitioners employ in chronic illness management underpin the care of patients with opioid dependence. Opioid pharmacotherapy, with the substitution medications methadone and buprenorphine, is an effective management of opioid dependence. Training and regulatory requirements for prescribing opioid pharmacotherapies vary between jurisdictions, but this treatment should be within the scope of most Australian GPs.