Ebook Murtach''s general practice (7/E): Part 1

(BQ0 Part 1 book Murtach''s general practice has contents: The nature, scope and content of general practice, the family, consulting skills, communication skills, counselling skills, difficult, demanding and angry patients, health promotion and patient education,.... and other contents.

1 Sickle cell disorders

2 Sickle cell anaemia

2 Familial adenomatous polyposis

3 Individuals at risk

4 Other cancers where family history is significant

2 Medium risk (suicidal thoughts and intent but no currentplan or immediate means):

3 High risk (continual/specific suicidal thoughts, intent, planand means):

2 NORMOCYTIC ANAEMIA2 (anaemias without change inthe MCV)

5 Acute low back pain6

6 Sciatica with or without low back pain

1 Acute6

5 Blackouts

1 Complex partial seizures

1 Initial therapy of heart failure7,10

6 Pitfalls in management

7 Acute severe heart failure

8 Device-based heart failure treatments1

2 Group 2: uncommon features with high risk requiring urgentreferral

1 Clinical features

2 Management of the convulsion (if prolonged >15 minutes),also for status epilepticus

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To all our medical colleagues, past and present, who have provided thevast reservoir of knowledge from which the content of this book was

made possible

seventh edition

confirm the information contained herein with other sources For example,and in particular, readers are advised to check the product informationsheet included in the package of each drug they plan to administer to becertain that the information contained in this book is accurate and thatchanges have not been made in the recommended dose or in the

contraindications for administration This recommendation is of particularimportance in connection with new or infrequently used drugs

This seventh edition published 2018

First edition published 1994, second edition published 1998, third editionpublished 2003, fourth edition published 2007, fifth edition published

2011, sixth edition published 2015

Text © 2018 John Murtagh

Additional owners of copyright are acknowledged in on-page credits/onthe acknowledgments page

Every effort has been made to trace and acknowledge copyrighted

material The authors and publishers tender their apologies should anyinfringement have occurred

Reproduction and communication for educational purposes

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or marked for the attention of the permissions editor at the address below

Authors: John Murtagh, Jill Rosenblatt, Justin Coleman, Clare

MurtaghTitle: John Murtagh’s General Practice

Printed in China on 70 gsm matt art by 1010 Printing Int Ltd

The authors

MBBS, MD, BSc, BEd, FRACGP, DipObstRCOG

Emeritus Professor in General Practice, School of Primary Health, MonashUniversity, Melbourne

Professorial Fellow, Department of General Practice, University of

Melbourne

Adjunct Clinical Professor, Graduate School of Medicine, University ofNotre Dame, Fremantle, Western Australia

John Murtagh was a science master teaching chemistry, biology andphysics in Victorian secondary schools when he was admitted to the firstintake of the newly established Medical School at Monash University,graduating in 1966 Following a comprehensive postgraduate trainingprogram, which included surgical registrarship, he practised in

partnership with his wife, Dr Jill Rosenblatt, for 10 years in the ruralcommunity of Neerim South, Victoria

He was appointed Senior Lecturer (part-time) in the Department of

Community Medicine at Monash University and eventually returned toMelbourne as a full-time Senior Lecturer He was appointed to a

professorial chair in Community Medicine at Box Hill Hospital in 1988and subsequently as chairman of the extended department and Professor

of General Practice in 1993 until retirement from this position in 2010

He now holds teaching positions as Emeritus Professor in General

Practice at Monash University, Adjunct Clinical Professor, University ofNotre Dame and Professorial Fellow, University of Melbourne He

achieved the Doctor of Medicine degree in 1988 for his thesis ‘The

He was appointed Associate Medical Editor of Australian Family

Physician in 1980 and Medical Editor in 1986, a position he held until

1995 In 1995 he was awarded the Member of the Order of Australia forservices to medicine, particularly in the areas of medical education,

research and publishing

One of his numerous publications, Practice Tips, was named as the

British Medical Association’s Best Primary Care Book Award in 2005 Inthe same year he was named as one of the most influential people in

general practice by the publication Australian Doctor John Murtagh was

awarded the inaugural David de Kretser medal from Monash Universityfor his exceptional contribution to the Faculty of Medicine, Nursing andHealth Sciences over a significant period of time Members of the RoyalAustralian College of General Practitioners may know that the honour ofthe namesake of the College library was bestowed upon him

In 2018 he will host the 40th Annual John Murtagh Update Course forGeneral Practitioners at Monash University

Today John Murtagh continues to enjoy active participation with thediverse spectrum of general practitioners—whether they are students orexperienced practitioners, rural- or urban-based, local or internationalmedical graduates, clinicians or researchers His vast experience with all

of these groups has provided him with tremendous insights into theirneeds, which is reflected in the culminated experience and wisdom of

John Murtagh’s General Practice.

Superintendent

After leaving rural life she came to Melbourne and joined the AshwoodMedical Group, where she practised comprehensive general medicine,and care of the elderly in particular She was appointed Adjunct SeniorLecturer in the Department of General Practice at Monash University in

1980 and a teacher in the GP registrar program

She gained a Diploma of Sports Medicine (RACGP) in 1985 and a

Graduate Diploma of Applied Science in Nutritional and EnvironmentalMedicine from Swinburne University of Technology in 2001

Jill Rosenblatt brings a wealth of diverse experience to the compilation ofthis textbook This is based on 50 years of experience in rural and

metropolitan general practice In addition she has served as clinical

assistant to the Shepherd Foundation, the Menopause Clinics at PrinceHenry’s Hospital and Box Hill Hospital and the Department of

Anaesthetics at Prince Henry’s Hospital Jill has served as an examinerfor the RACGP for 39 years and for the Australian Medical Council for 16years She was awarded a life membership of the Royal Australian College

of General Practitioners in 2010 and a Distinguished Service award of theCollege in 2014

works in Aboriginal and Torres Strait Islander health

Soon after graduating, Justin began writing for the GP newspaper

‘Handy Hints for GPs’, ran for 13 years He even wrote 40 humorouscolumns until the editors lost their sense of humour

Justin is a prolific writer for medical and nonmedical readerships; he haspublished well over 1,000 medical articles in around 50 different

newspapers, magazines, books and journals For five years he served asPresident of the Australasian Medical Writers Association and he

regularly runs writing workshops for medical writers and academics

Since completing a Master of Public Health (UQ 2011, first class hons),Justin has dedicated much of his career to educating other GPs abouthow to improve various aspects of medical practice His interests includeevidence-based medicine, the rational use of medical tests and

treatments, and dealing with uncertainty during a GP consultation Herepresents the RACGP on matters pertaining to conflicts of interest andfiercely guards his own independence, never having accepted paymentfrom a pharmaceutical or medical device company

For the past quarter of a century, Justin has supervised hundreds of

medical students and GP registrars He has taught in the medical schools

of three universities and for a dozen medical education organisations

Justin edited his first medical book 20 years ago and has remained amedical editor ever since He completed a Writing and Editing program

in 2010 (UQ, first class hons) He currently edits Diabetes Management Journal, writes and does peer reviews for the MJA, AJGP (formerly AFP)

and BMJ, and is a member of the Australasian Health and Medical

journal Editors’ Network (AHMEN)

in 2013

A passionate generalist, Clare has special interest in dermatology, travel

In recent years, Clare has gained increasing experience in medical

education as a supervisor of training GPs and as an examiner for theRACGP She has worked as a medical educator at GP Synergy and is alecturer on dermatology

Clare has been an enthusiastic contributor to the ‘Women’s health’,

‘Sexual health’ and ‘Problems of the skin’ sections of the sixth and

seventh edition of Murtagh’s General Practice As the daughter of co-authors John Murtagh and Jill Rosenblatt, she has benefited from theirmentorship and appreciates the genesis and philosophy of the editorialdirection of the textbook

In 1960 a young schoolmaster, then teaching biology and chemistry in asecondary school in rural Victoria, decided to become a country doctor

He was part of the first intake of students into the Medical School of thenewly established Monash University, and at the end of his six-year

undergraduate medical course and subsequent intern and resident

appointments his resolve to practise community medicine remained firm.After more than a decade in country practice with his life partner, Dr JillRosenblatt, during which he meticulously documented the cases he

treated, in 1977 John Murtagh took up an academic position in the newDepartment of General Practice at Monash University He subsequentlymoved through the ranks of Senior Lecturer, Associate Professor andProfessor, now enjoying the title of Emeritus Professor

Through his writing, pedagogy and research, John Murtagh became anational and international authority on the content and teaching of

primary care medicine It was during his tenure as Medical Editor of

Australian Family Physician from 1986 to 1995 that the journal became

the most widely read medical journal in Australia

This textbook provides a distillate of the vast experience gained by a oncerural doctor, whose career has embraced teaching; whose abiding interest

Foreword