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The prescription at the end of the consultation

Respondents

Rick Davis

Carly Flumer

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Why should you always examine the patient?

In the second question in our two-minute question series Dr. Moyez Jiwa, host of the Health Design podcast asks if the clinical examination is a crucial part of the experience when visiting a doctor.

The respondents have all been featured in our podcasts. You an hear the longer conversations here:

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Covid will impact all of our health

Homebound status is associated with poorer physical and mental health, as well as disability in the elderly. We aimed to examine the prevalence and the role of homebound status on mortality in a representative sample of the French non-institutionalized population. This study included 7497 people aged 65 and over who were interviewed in 1999 and 2001 about the consequences of health problems on activities of daily living. Homebound status was defined as staying permanently inside the home, excluding an accident or a temporary illness. The influence of the homebound status on two-year mortality was assessed in a logistic regression model adjusted for the main confounders (age, sex, living as a couple, physical and mental impairments). The prevalence of homebound status was 4.7% (95% CI: 3.9–5.4) in this study. The number of homebound elderly was estimated at 421 000 in France. The prevalence of homebound status increases with age and reaches 33.9% in people aged 95–99 years (95% CI: 13.1–54.6). Compared to non-homebound subjects, homebound elderly were more likely to be female, widower, to live alone and to have had a former low level job. Homebound status was associated with a number of physical and mental impairments. It increased the risk of dying within two years with an adjusted OR 3.45 (95% CI: 2.66–4.46). Homebound status should be considered as an indicator of frailty and used in the identification of old people likely to benefit from preventive interventions.

Herr et al. Homebound status increases death risk within two years in the elderly: Results from a national longitudinal survey

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How can you add value as a family doctor?

Ninety percent of people will consult a family doctor in 2020. The graph on the left suggests why they will do so. A significant number will have minor self limiting illness, a larger proportion will have chronic/ long-term illness and most will attend for multiple reasons. The graph on right demonstrates that most people will have risk factors for long-term illness often more than one risk factor. To reduce the risk(s) they will need to change their lifestyle. The challenge in primary care is to add value by triggering/ prompting lifestyle change. That is a very specialist skill set. Mandates a new paradigm and or a new set of tools.

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Why does a haircut cost more than a visit to a doctor?

These conversations with Diana Anderson and Cheryl Janis may be relevant in this context.

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Most of what happens in medicine is talk

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Interview with Michael Bungay Stanier- author of the Coaching Habit is available here.

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Your choices in medicine make the greatest difference

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Making a diagnosis as a family doctor

The fact that it is often difficult or perhaps impossible to correlate the pathology and symptoms of coronary artery disease has led to a great deal of discussion and numerous explanations have been proposed.

Fred M Smith

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