This Issue: Important Clinical Studies with New Useful Information on Problems Encountered Daily by Family Physicians

We all know that patients attempt to and sometimes successfully deceive physicians into writing inappropriate prescriptions. However, the impact is still strong when reading the study of doctor shopping and young adults' attempts to deceive doctors by Stogner et al¹. Unfortunately, 1 of 25 young adults reported attempted deception to gain a prescription, some for personal use and some with the intent to sell the drugs. Such deceptions for prescriptions are most often for controlled substances. Recreational drug abusers were more likely to be deceivers. Read and weep: most reported being successful at least once—hopefully the insights here can help providers recognize potential deceptions. In another study, Fink-Miller et al² compared initial treatment seekers with chronic pain patients in family medicine versus a specialist clinic. The patients were similar based on identical initial risk screening instruments, although those seeing family physicians were younger and actually reported more severe pain. Importantly, there were no significant differences in measured risk of misuse or abuse.

We have 2 articles that present very different aspects of patient- and family-friendly obstetrics: one from rural Alabama and one from inner-city Boston. Alabama's investment in supporting fellowship training for family physicians has paid off for rural areas in terms of patient convenience (less travel), economics (both the doctors and the communities gained), and possibly better outcomes (untested in this study by Avery et al³). Further, it is not every day that this journal receives an article whose lead author is the chair of a department of obstetrics and gynecology! The estimate was almost a $400 positive impact for each $1 invested. Having fellowship-trained family physicians doing deliveries in rural environments is an all-around winner. The Boston-based article provides a detailed report on the components and implementation of “gentle caesarian” deliveries. This may be an unfamiliar term, but the concept comes alive in the article by Magee et al.⁴

Depression is such an important topic for family physicians that we continue to get excellent manuscripts exploring important intricacies of depression care. For example, Jerant et al⁵ provide data that strongly suggest we consider the possibility of negative outcomes from depression screening in family physician offices. In a randomized trial of nonmedication treatment for depression, Keeley et al⁶ successfully trained family physicians in motivational interviewing techniques, which increased patient change talk and physical activity. Kessler et al⁷ explored how mental health services are delivered in patient-centered medical homes. In another randomized trial, Yalcin et al⁸ report that the addition of anger and stress management training improved smoking cessation rates: one-third more smokers quit.

Sadly, almost 20% of men report perpetrating intimate partner violence.⁹ The men who did so were more likely to have had experience with family violence when they were young, to abuse substances, and to have irritable bowel syndrome and insomnia. This article can potentially help primary care clinicians identify and question these patients sooner to assist with intervention.

The burden of chronic diseases can decrease the rate at which screening tests are accomplished. However, as discovered by Liu et al,¹⁰ the type of chronic disease seems to have differential effects by screening test, and the associations are not all negative. Cervical cancer screening was most negatively affected. The authors speculate on reasons for this, but even the information presented could trigger readers to consider whether their patients with one or more of these chronic conditions are appropriately up to date for various preventive measures. Mauer et al¹¹ explored how well family physicians know 10 of the tests considered overused by the Choosing Wisely campaign. While reading this, refresh your own knowledge on the recommendations. And, which part of the US Food and Drug Administration drug labels is most read by family physicians?¹²

Cheaper and easier: Wang et al¹³ report data that supports using immunoglobulin G levels (a blood test) to both diagnose and follow for eradication of Helicobacter pylori after treatment rather than the urea breath test (more expensive, less convenient).

Chapman and Lauzardo¹⁴ provide a terrific clinical review on latent tuberculosis that goes beyond what is readily available on the Centers for Disease Control and Prevention's website and provides information that is more specific for the primary care clinician. The information on the newer testing methods may be particularly helpful.

Finally, in a reflections piece, Ventres¹⁵ provides a reasoned discussion of what it means and how to undertake a “pedagogy of dying” to help our patients and their families with the dying process.