Recording Patients' Consumption of Social Drugs in a Family Medicine Residency: a Longitudinal Study

Rodney W M (Department of Family Practice, San Bernardino CountyMedical Center, 780 East Gilbert Street, San Bernardino, CA92415-0935, USA), Nutter D and Widoff B. Recording patients'consumption of social drugs in a family medicine residency:a longitudinal study. Family Practice 1985; 2: 86–90. ‘Social drugs’ such as nicotine, alcohol and caffeinemay be risk factors in a variety of disorders. Over a five-yearperiod an audit of 954 medical records was carried out in auniversity-based family medicine training programme. The aimwas to investigate ways of improving physicians' compliancewith the recording in the data base of the consumption of thesesubstance by patients. Instruction through lectures and remindersproduced no change in the recording of social drug usage inyear 2, but the distribution of model dictations led to a significantchange in year 3 for the recording of nicotine and alcohol consumption.This effect was sustained in years 4 and 5. Visual cues in themedical record led to a significant improvement in the notationof caffeine usage in year 4 and the effect was sustained inyear 5. Additional audit sessions did not increase compliancewith caffeine notation. Faculty and resident compliance withthe recording of social drug history were not significantlydifferent.     

Esophageal P-Synchronous Pacing

An esophageal electrode can be employed to provide atrial sensing which then can be used to change from temporary right ventriculor (VVI) pacing to P-synchronous (VAT) pacing. Two cases of postoperative aortic valve replacement, each with new complete heart block (CHB) and dopamine dependency, are presented. In both cases, establishment of P-synchronous pacing resulted in improved hemodynamic status characterized by successful weaning from dopamine and maintenance of adequafe cardiac output (CO).     

Malignant melanoma in East Anglia, England

A series of 137 patients with primary malignant melanoma of skin occurring in the Cambridge area in 1961–71 is reviewed. The histological material has been classified into lentigo maligna melanoma, superficial spreading melanoma and nodular melanoma, using the criteria of Clark et al. (1969). Consideration of type, site and incidence of melanoma when compared with previously reported series from Boston and Sydney supports the hypothesis that sunlight induces malignant melanoma in unexposed skin.     

Obstetric Malpractice Fee Phobia Among Medical Students in the United States

Sixty-three consecutive fourth-year medical students applyingfor a family medicine training programme based in a county hospitalquestioned about their anticipated practice style and the projectedcost of malpractice insurance premiums during their first yearof practice. Those who felt committed to providing obstetricservices within their family practice estimated a much lowerfirst-year dollar cost for malpractice insurance than thosewho were not committed to obstetric services. The differencein estimates was greater than $10000 per year. Both groups farexceeded the actual quoted first year cost by three separatemalpractice insurance companies. This study suggests that medicalstudents may be influenced by unrealistic estimates of malpracticeinsurance costs prior to real world experiences. Furthermore,these estimates may indicate widespread ignorance and/or misinformationamong medical students considering a family medicine career.Malpractice suits and the fear of them remain, however, an importantdistraction from the provision of patient care services in theUnited States.