Heat-related illness. Plan ahead to protect your patients.

Environmental heat illnesses range from irksome to devastating. People at particular risk are the elderly, the chronically mentally ill, the community-dwelling developmentally delayed, people without social contacts, athletes, and those without access to air-conditioning. Because heat-related deaths are preventable, community-wide response to heat emergencies, together with individual and community education programs, could greatly decrease morbidity and mortality.

Managing rheumatologic disease in nursing home patients.

Precise diagnosis and treatment are essential when dealing with rheumatologic complaints in elderly nursing home patients. National surveys suggest that for every nursing home resident, there are two equally frail elders living in the community. The same principles of diagnosis and management apply to this latter group of patients, including use of multidisciplinary input from nurses and physical and occupational therapists, who are becoming increasingly available in the rapidly expanding and accessible home healthcare system. However, the therapeutic value of the physician's thoughtful and empathic history taking and careful hands-on examination should not be underestimated.

The doctor-patient relationship: time management and diagnostic methods of the family physician. An undergraduate perspective.

Physicians are often called upon to mentor students considering a career in medicine. There are seldom clear guidelines as to what either the student or the physician should do during these experiences. The following article is offered as a model of what the student and physician authors considered a productive experience that was both academically sound and directed toward helping the student thoughtfully look at a medical career. The study itself, accomplished during a one month "interim" experience during the student's junior year of college, addresses the question, "How do family practice doctors function during typical office visits?"

Care with an indwelling urinary catheter. Tips for avoiding problems in independent and institutionalized patients.

Ideally, no patient would have an indwelling urethral catheter. However, certain circumstances require long-term catheterization. In these patients, bacterial colonization is to be expected. Morbidity and mortality related to long-term catheterization can be minimized by attention to the details of catheter care, prompt treatment of often minimally symptomatic catheter-related infections, and attentiveness to changes in patient condition or alternative treatments that may permit catheter removal.

Adult hearing loss.

Identification and evaluation of adult hearing loss is an important task for primary care physicians. Recent studies reporting the reliability and validity of simple testing instruments reinforce this conclusion. Although most cases will be secondary to noise exposure or age-related and benefit from amplification, a diligent search for more unusual causes, some of which have specific curative therapy, is always needed. The initial prescription and fitting of hearing aids is the realm of the audiologist. The primary care physician can enhance the treatment program by providing global evaluation, educating the patient as to likely therapy and realistic expectations of results, and providing long-term follow-up and functional assessment of hearing aid use. The burden of hearing loss is particularly heavy in the nursing home population. In this arena, the physician can ease the burden by being attentive to the possibility of hearing loss causing unexpected behavior, searching for, and when possible, treating reversible causes, and using assistive devices and behavioral techniques to enhance communication when the hearing impairment cannot be corrected.