Efficiency in examining adult patients on preceptorship.
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Biomedical subjects
Publications and source records attributed to S E Sivertson.
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For 109 Wisconsin family practices, 18% of all contacts were with patients 65 years of age and older. Of these contacts, 45% took place in the office and 40% in the hospital; the patient was female in 58.7%. The number of problems or diagnoses was 2.28 per patient contact. Comparison of the geriatric problem profile from the Wisconsin study with similar data from Virginia showed striking similarity. The diagnostic category "diseases of the circulatory system" contained more than 30% of patient problems. No other category contained 10% or more problems in either study. The problem profiles for men and women were almost identical, suggesting little difference in medical care needs according to sex.
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Studies of family practice in Wisconsin and elsewhere show that the clinical content of family practice has about 20 to 45 patient contacts per day and about two to six diagnoses per patient contact. Seventy-five percent of patient contacts are in the office and on the telephone, 15 to 20 percent in the hospital, and 5 to 10 percent elsewhere. There is a broad array of patient problems. Special Conditions and Examinations Without Illness contain the largest number of patient problems. About 60 percent of patients are female and present more endocrine and genitourinary problems. Men present more trauma, circulatory, and respiratory problems, and less health maintenance care. Well-baby and well-child examinations stop at age 15 years. Pre and postnatal care decline sharply at age 35 years, at which time surgical care increases. Infectious disease and trauma, ranking high in the young, are low in the elderly. Circulatory problems, obesity, diabetes, and arthritis increase greatly with age. There is no major difference in type of patient problems related to town size (ie, population). However, comparative studies may uncover different disease occurrence rates between regions.
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A study of 100 selected Wisconsin family physicians demonstrated that younger physicians generally had more contact with younger patients, middle-aged physicians had an even distribution of patient age contacts, and older physicians had more contact with older patients. The increase in older patients became pronounced for 56 to 60-year-old physicians. Generally a ten-year increase in physician age was accompanied by a five-year increase in patient age. The rising average age of the American population, combined with the direct physician-patient age relationship demonstrated here suggest that geriatrics will become increasingly relevant not only in the continuum of medical education but also for the individual practicing physician.
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