Integrating prevention education into the medical school curriculum: the role of departments of family medicine

Departments of family medicine--including departments of family and community medicine, departments of family and preventive medicine, and departments of family practice-at U.S. medical schools regularly participate in teaching prevention principles to students, using a variety of formats and methods. Required clinical experiences (i.e., clerkships and preceptorships), required nonclinical courses, and electives frequently include prevention content. Collaborative interdisciplinary clerkships, interdisciplinary nonclinical courses, and courses directed by other departments also enable family medicine faculty to teach prevention principles. This article describes examples of innovative educational programs in which family medicine faculty teach prevention content to medical students. Directions for future educational efforts by family medicine faculty in the prevention area are proposed.

Referrals for depression by primary care physicians. A pilot study

BACKGROUND

Communication between primary care physicians (PCPs) and mental health providers (MHPs) is integral to the management of depressive disorders. Our study investigated referrals from PCPs to MHPs in a rural research network.

METHODS

From April 1997 to September 1997, 5 family physicians tracked 6 weeks of referrals for depression and non-mental health problems and assessed the outcomes of these referrals after 3 months. The referrals were characterized by the nature and extent of communication between the PCP and the MHP and by the effectiveness of the consultation.

RESULTS

Sixty-seven patients (44 with non-mental health disorders and 23 with depressive disorders) were identified and followed. Analysis of the initial referral process showed that the referring physicians felt a greater sense of urgency for the referrals for depression. Written evidence of the referral in the patient's chart at the 3-month survey was more common for non-mental health disorders.

CONCLUSIONS

This pilot study demonstrates that there are communication barriers between PCPs and their mental health colleagues. Enhanced communication might improve satisfaction with the referral process. The details of the referral process need further study.

Children and environmental toxins

Environmental toxins have been shown to produce harmful effects in children, who may be exposed in the home, in public spaces, and by passive contact with adults. This review discusses common toxic substances, including lead, radon, tobacco smoke, asbestos, pesticides, mercury, carbon monoxide, and electric/magnetic fields. The focus is on identification, environmental abatement, and parent education. Practical suggestions for the primary care clinician in a community setting are emphasized.

Cholesterol screening in the elderly: changing attitudes

The purpose of this study was to assess an elderly population's (60-80 years old) attitudes toward health prevention and life-style change with a particular emphasis on cholesterol screening and management. A free cholesterol screen was offered to participants in exchange for completion of a 21-item questionnaire (including medical history, risk factors, attitudes on preventive health, eating patterns and demographic information). This study provides evidence for increasing awareness of elevated cholesterol levels as a risk factor for coronary heart disease. It also demonstrates that there is an attitude of willingness to modify dietary cholesterol and fat intake within this mobile elderly population.

The diagnostic evaluation: history, physical examination, urinalysis, and imaging

Utilizing techniques of history, physical examination, and office laboratory tests, the primary care practitioner can diagnose many urologic disorders. Familiarity with uroradiologic studies as described in this article will further aid the diagnostic process and the interpretation of recommendations from consultants.