Well child care records for use in Australian general practice

According to WONCA, 'the discipline of general practice/family medicine needs to be firmly established as the central discipline of medicine around which medical and allied health disciplines are arranged to form a co-operative team for the benefit of the individual, the family and the community.' Well child care is an important part of general practice. By using the records presented in this paper at the time of both routine and opportunistic age specific visits, comprehensive well child care can be provided through the efficient teamwork of family doctors and practice nurses. Comments or suggestions for improving the records can be sent to Dr R Janes.

Emergency care: an overview

Emergency care is a most important component in general practice. Practitioners are often judged by their ability to deliver appropriate life saving care sometimes in difficult circumstances. An ever present challenge is the maintenance of knowledge and skills necessary to deal effectively with emergencies. Table 3 lists the many emergencies that general practitioners have to consider to be prepared for and that includes regular updating in the basic skills of resuscitation.

Survey of general practitioner instructions to oral contraceptive users

The study indicates that this group of metropolitan general practitioners is generally well informed about the increased risk that missed pills, malabsorption or antibiotics causes. Nevertheless, there is considerable confusion about the effect on contraception efficacy and few respondents use the Family Planning Movement's '7 day rule'. The authors would like to recommend that the pharmaceutical companies and family planners put more effort into advertising this simple set of instructions for women who miss pills, have diarrhoea or vomiting or use antibiotics. There is also merit in inviting patients who have concerns to contact their doctor, practice nurse or pharmacist for advice. There are occasions when the '7 day rule' may not be necessary, such as transient vomiting or diarrhoea, or both, of less than 12 hours when the patient can be advised to take an extra active tablet from a spare pack and continue with the rest of the pack as usual. Consultations involving prescriptions for oral contraception represent an excellent opportunity for health promotion and preventive medicine.

Low back pain: pitfalls in management

As for so many presenting problems, the management of low back pain is besieged by several pitfalls. Most of these pitfalls can be blamed on 'not knowing and not looking'. It is important, therefore, to be familiar with the various causes of low back pain and recognise their clinical patterns. In particular it is vital to be aware of the pain patterns of serious spinal disease, such as neoplasia and infection, and to recognise the difference in pain patterns of inflammatory and mechanical disorders and tailor treatment accordingly. In many patients mechanical and inflammatory patterns can co-exist to produce a combined profile (Figure 1). Early accurate diagnosis should be the main objective in the management of low back pain.

Acute abdominal pain: a diagnostic approach

The author presents a diagnostic approach to the problem of acute abdominal pain in adults. The typical pain patterns for the various causes are outlined with the aid of illustrations. A systematic method is necessary to make reasonably accurate provisional diagnoses. A summary of possible investigations is included for each condition.

Three unusual presentations of interscapular back pain

Three cases of central thoracic back pain are presented. All were diagnostic brain teasers that baffled several practitioners and consultants. The cases represented unusual presentations of malignant disease, myocardial infarction and duodenal ulceration.