March 2014

A 58-year-old woman presented to clinic with concerns about this skin lesion on her upper chest. She reports it has been present for 1 year and is slowly enlarging. The lesion is otherwise asymptomatic and her past history is only significant for rheumatoid arthritis (RA), for which she takes methotrexate and etanercept.

In a recent pilot study, primary care providers (PCPs) who regularly consulted with pain management specialists through telehealth technology wrote fewer prescriptions for the high-dose, short-acting opioid analgesics that are widely associated with greater rates of addiction and overdose.

Nearly two-thirds of family physicians would not purchase their current electronic health record (EHR) system again due to poor functionality and high costs, according to new data that discovered alarming disconnect between care providers' health information technology needs and the present state of EHR technology.

Since family physicians are more likely to adhere to a patient-centered biopsychosocial model than specialist physicians who treat chronic pain, primary care seems to be the logical "home" for its treatment.

Since pain typically presents before bone lesions are displayed on radiographs, a true diagnosis may be overlooked and the early stages can be easily missed.

The true prevalence of resistant hypertension is unknown, but it is estimated to occur in up to 20% of patients with chronic hypertension.

Whether direct-to-consumer advertising is a good or bad thing remains a matter for debate, but what is not up for discussion is the need for due diligence on the part of physicians in managing patients who are motivated by those ads to seek medical attention.

When encouraging and supporting patients to quit smoking, varenicline is unlikely to increase the risk of neuropsychiatric adverse events such as suicide, depression, and aggression, even in patients with pre-existing psychiatric illness.

Older age, chronic corticosteroid use, severe trauma, abrasion, or some combination of red flags predict an increased risk of spinal fracture, but a prior history of malignancy is the only useful predictor of spinal malignancy.

Family physicians should place as great an emphasis on walking as they do on monitoring medication and laboratory data, and strongly recommend increased ambulatory activity to their patients.

One patient-centered medical home pilot was associated with improvement in only one of 11 quality areas and was not associated with reductions in hospital utilization or costs of care over 3 years.

Family physicians should screen all patients for domestic violence, counsel those at risk on safe havens and the dangers of living in a home with a handgun, and encourage safe gun ownership practices.