The physician-patient relationship is part of the patient's larger social system and is influenced by the patient's family. A patient's family member can be a valuable source of health information and can collaborate in making an accurate diagnosis and planning a treatment strategy during the office visit. However, it is important for the physician to keep an appropriate balance when addressing...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 871 1988, the National Cholesterol Education Program, Adult Treatment Panel I (NCEP–ATP I) developed its first set of guidelines, establishing clear goals for patients with lipid abnormalities. In 1993, the NCEP–ATP II revised its initial recommendations and developed a second set of guidelines; in addition to emphasizing CHD risk status, this report p...

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1007 the hair is broken or shed at the roots, and whether shedding or thinning has increased. The patient’s diet, medications, present and past medical conditions, and family history of alopecia are other important factors. The physical examination has three parts. First, the scalp is examined for evidence of erythema, scaling, or inflammation. Follicu...

More than one-third of family physicians reported participating in a quality improvement (QI) activity in the past year. Continuous QI is vital to improving personal and population health outcomes and reducing costs. Support for QI activities, their evaluation, and the dissemination of successful efforts are sorely needed.

AIM To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. METHOD We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped patients completed a questionnaire about their expectations before and after the consultation. Pa...

No doubt there are as many reasons for becoming a family physician as there are family physicians. Some would say that they inherited the gene from their fathers or mothers, who were family physicians before them; it was their destiny. Some remember physicians who inspired them to pursue this path by setting a wonderful example: their own family physicians or the physicians who practised in the...

Tetanus and Diphtheria The tetanus and diphtheria toxoids vaccine (Td) is effective in preventing tetanus and diphtheria, two potentially life-threatening conditions. Diphtheria is an infection of the nasal, pharyngeal, laryngeal, or other mucous membranes that can cause neuritis, myocarditis, thrombocytopenia, and ascending paralysis. Tetanus infection can cause production of a neurotoxin, lea...

regions (Figure 1): the hindfoot or rearfoot (talus and calcaneus); the midfoot (navicular bone, cuboid bone, and three cuneiform bones); and the forefoot (metatarsals and phalanges). Differences between a newborn foot and an adult foot are summarized in Table 1. Simultaneous observation of both feet can reveal many deformities. The skin should be examined for unusual creases or folds that can ...

The seven categories of alternative medicine, as established by the National Institutes of Health Office of Alternative Medicine, are mind-body interventions, bioelectromagnetic therapies, alternative systems of medical practice, manual healing methods, pharmacologic and biologic treatments, herbal medicine, and diet and nutrition. Mind-body approaches have been shown to be effective in a varie...