Domestic and intimate partner violence

This is common and includes physical, sexual, emotional, and psychological abuse. It is rarely an isolated event, and often escalates in severity and frequency. Do not hesitate to ask directly about this in consultations. Distinguish between generalized aggressors, family only aggressors, and non-family only aggressors. Once violent always violent?

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Why do patients change their doctor?

The most common reasons are that either the patient has moved, or the doctor has retired or is perceived to be too far away. There are additional reasons:

Patient needs:
One doctor for all the family	5%
Wants woman doctor	4%
Wants alternative medicine	2%
Obstetric needs	1%

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Health promotion by nurses

Nurses are the experts in this field but even they are not very effective in reducing coronary risk. In the community-based OXCHECK randomized trial (N = 6124, aged 35-64) serum cholesterol fell by only 0.08-0.2mmol/L and there was no significant difference in rates of giving up smoking, or in body mass index. Systolic (and diastolic) BP fell by ~2.5% in the intervention group receiving dietary and lifestyle advice.

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Reducing alcohol intake

With the toll that excess alcohol takes in terms of personal misery and the national purse (>1600 million/yr in the UK), the need to reduce alcohol intake should rank as one of the leading aims of preventive care. The reason why alcohol is not at the top of the agenda is not just that doctors are so fond of it (the profession has three times the national rate of cirrhosis),

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Helping people quit smoking

(AAAA=ask, advise, assist, arrange follow-up.)RCT78 Ask about smoking in all consultations, not just those on smoking-related diseases (be subtle; patients won't listen if you do not share agendas).

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Useful Agents in Terminal Care

Pain

Remember that pain has physical, emotional, and spiritual components: all aspects need to be addressed. Diagnose and monitor each pain separately.

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