Primary care
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The primary care physician must be able to recognize potentially life threatening or permanently disabling oncologic complications that may be prevented or reversed by foresight or prompt action. The physician must be able to assist the patient in treatment decisions and recognize those situations in which palliation is possible. Accurate diagnosis and treatment of oncologic emergencies and paraneoplastic syndromes may both improve the quality of life and increase the length of survival in the patient with cancer.
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This article provides general guidelines and principles for physicians caring for adolescent patients from various cultural backgrounds. Suggestions are offered for managing the special problems presented by new immigrants. Case vignettes are liberally used to illustrate health care issues.
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The Baby Doe legislation generated, over a 3-year period, a "large-scale national seminar" on the rights and interests of handicapped newborns and their parents. In this article, the background for the Baby Doe legislation is provided, the details of what the law says are presented, and the implications of the legislation for medical practice are discussed, including the creation of infant bioethics committees. ⋯ It will cause some resentment among parents whose interests conflict with their children's survival, among doctors who dislike shared decision making, and among others who resist the intrusion of the state into "private affairs." Yet subjecting life-and-death medical decisions to more professional scrutiny will probably yield better treatment rather than worse treatment in a majority of cases. In addition, it may have further spin-offs that benefit both the professions and society in times to come.
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The care of the trauma patient is a complex undertaking involving multiple health care professionals and represents one of the greatest challenges to any physician. There is perhaps no greater opportunity to have a positive impact on patient care than in the care of these patients. ⋯ With proper motivation and experience, the physician's care of trauma patients will continually improve. This will lead to a rewarding experience for the patient and the physician alike.