Tag Archives: too much medicine

Bruce Arroll is a Professor of General Practice at the University of Auckland and a GP at the Greenstone Family Clinic in Manurewa Auckland

 

My first clinical impression of primary care was of lots of symptom clusters that did not appear in Harrisons Textbook of Medicine. These symptoms would fluctuate and I would investigate some and often find no satisfactory answers from my investigations and referrals. I gradually learned to use time as my diagnostic test and some of these symptoms would disappear while others would stay. Many of them did not follow any anatomical or physiological pattern. I now prefer the term illness without disease1 as Medically Unexplained Symptoms (MUS) sounds like if you did just one more (or the right) scan/xray/referal/consultation you'd find the answer. There was a qualitative study on what patients liked when they had MUS. Their preference was for some sort of explanation ...continue reading

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Greiver_photoMichelle Greiver is a family physician with the North York Family Health Team in Toronto

 

As a family doctor, I sometimes wonder if I provide too much care for some patients in my practice. Do my elderly patients with diabetes need very low A1Cs? What about the risk of falls and fractured hips due to hypoglycemia associated with enthusiastic use of diabetic medications? Should patients over the age of 90 really be on a statin? Should they be on anything that does not improve their quality of life? Perhaps I should be asking them what they would like? ...continue reading