Primary care
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Clearly, there are numerous troubling variations in the medical diagnosis of child sexual abuse. These variations include delays in disclosure; rapid healing; maturational changes; variations in normal congenital findings; the technique of the examiner; patient position, relaxation, and cooperation; and additional medical conditions that mimic abuse. ⋯ Emphasis on the child's history in documenting the abuse is increasing. As physicians, we must develop interviewing techniques that will assist in child protection, and we must listen and believe the comments made by our patients.
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Because physicians are often the first professionals to have contact with a sexually abused child, they must be alert to the symptoms and prepared to respond knowledgeably. Early and effective intervention affects the overall prognosis for the child and family positively. As physicians become aware of child sexual abuse, protocols can be used routinely as part of a child's medical care. Regular checks on potentially abusive situations can prevent the tragic and traumatic occurrence of child sexual abuse.
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Domestic violence is an enormous health care issue that primary care physicians are powerfully suited to address. Rarely, however, do primary care physicians recognize that many of the patients who regularly and routinely present to them are victims of abuse. This article is designed to empower America's front-line doctors to recognize and appropriately treat the many victims of domestic violence who currently suffer from this silent epidemic. The reader will come to understand that it is via relatively simple-to-learn techniques that physicians can significantly impact the health and well-being of their communities.
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Primary care physicians should be aware of the popular street drugs being abused in their practice areas. A basic understanding of the drugs and their use will make the physician more credible in the eyes of the patient. ⋯ Specific presenting complaints, physical findings, and laboratory tests will help establish the diagnosis of substance abuse. After the diagnosis is established, a drug treatment program can bring about a seemingly miraculous recovery from the disease of chemical dependency, to the lasting benefit of the patient and the patient's family.
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No screening test has been proven to reduce prostate cancer mortality. DRE has been the traditional method of screening, and it is often used to detect other diseases in addition to prostate cancer. ⋯ In addition, it is not known whether the use of these tests will reduce prostate cancer mortality, or instead cause harm to those patients screened. Given the potential for harm, and the extraordinary expense, routine screening of asymptomatic men with newer modalities should be considered experimental.