Primary care
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Sedation, with or without analgesia, is commonly used for colonoscopy procedures in the United States. Prudent drug product selection, careful titration of drug dosage to ensure use of the lowest effective dose (Table 1), and vigilant monitoring of medicated patients will optimize the value of conscious sedation in colonoscopy. When a close patient-physician relationship exists in the primary care setting, use of medications only "if needed" during the procedure may be a reasonable alternative that can minimize the exposure of patients to sedation-related side effects. Patient-controlled medication delivery may be one method used to address patient variability in the need for sedation.
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Having presented an overview of the available methods of contraception, the authors present one approach to prescribing contraceptives based on their experience. First, adolescent patients in our practice are discouraged from engaging in sexual intercourse. Abstinence is the only fail-safe method of contraception and provides benefits both emotionally and physically (i.e., prevention from sexually transmitted diseases and unwanted pregnancies). ⋯ One recent study demonstrated certain patient characteristics that were associated with good compliance with oral contraceptives, including white race, higher education level, suburban residence, and older age of both the patient and her mate. Keeping these characteristics in mind may be helpful when prescribing oral contraceptives. Of course, it is the patient's prerogative to choose the type of contraception she feels will be best suited for her.(ABSTRACT TRUNCATED AT 400 WORDS)
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Physicians are often requested to provide medical evaluations and opinions about disability. This article presents differing definitions of disability and impairment. It focuses on the specific disability systems known as workers' compensation systems, the roles physicians play in these systems, and the parties involved in workers' compensation systems.
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A number of analgesic and anesthetic options are available for patients during the intrapartum period. Appropriate attention in the prenatal period to patient education regarding these options is imperative. If pharmacologic anesthesia is required, risks and benefits both to the mother and neonate must be considered. ⋯ This discussion should begin during the prenatal period to ensure that the woman has an opportunity to make an informed choice. When the woman presents in labor, the anesthetic plan may again need to be revised. Continued patient-doctor communication throughout labor is essential with the woman's preferences, tempered by sound medical judgment, guiding optimal pain control.
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Child abuse is a common pediatric problem that can be recognized and treated appropriately by all primary care physicians who care for children. One of the necessary skills in this process involves being prepared to interface with the legal system. The physician is mandated to report suspected child abuse according to his or her state laws. ⋯ Finally, the physician may be called to testify. An understanding of how to prepare for court and how to conduct oneself in court is the final necessary skill for the primary care physician who sees children. This article provides the primary care physician with a practical understanding of the legal considerations in child abuse.