most medical conditions under the sun
EXCLUDES CONTROLLED SUBSTANCES
excludes opioids unless cancer or terminal illness
excludes stimulants, sedative hypnotics
EXCLUDES OBSTETRICS
THESE CONDITIONS ARE REFERRED OUT TO SPECIALISTS
PRIMARY HEALTHCARE
SICK VISIT
SICK VISIT
Routine or Urgent symptoms, issues, and problems
(Emergencies -> call 911 or go to Emergency at the hospital.)
EXAMPLES
NONSPECIFIC
Pain (including back, abdomen, head, foot, chest, knee, wrist, arm, leg, neck, finger)
Fatigue, Dizziness, Fainting
Pink Eye, Ear Plugged, Runny Nose, Sore Throat, Cough, Fever, Chills, Shortness of Breath, Snoring, Abnormal Lump
DIGESTIVE
Acid Reflux, Constipation, Diarrhea, Gallstone, Nausea/Vomiting, Hemorrhoid
MUSCULAR
Weakness
INTEGUMENTARY
Acne, Rash, Wound
LYMPHATIC
Allergies, Infection
ENDOCRINE
Diabetes, Thyroid, Hirsutism
NERVOUS
Depression (treatment) [Lifeline 800.273.8255 text 998], Anxiety, Grief, Numbness, Weakness
SKELATAL
Fracture, Arthritis, Sprain
MALE REPRODUCTIVE
Erectile Dysfunction
FEMALE REPRODUCTIVE
Vaginal Discharge, Abnormal Menstruation
RESPIRATORY
Asthma, Chronic Obstructive Pulmonary Disorder
URINARY
Urine Infection
CIRCULATORY
Heart Failure, Abnormal Heart Rhythm
EMERGENCIES: call 911
FOLLOW UP: if problem not resolving, if new symptom arises, and for routine wellness
Medicine follows an step-by-step algorithm so if conservative treatment fails, escalated testing and/or treatment may be indicated.
FOLLOW UP
EMERGENCIES: call 911 or go to closest Emergency (our associated hospital is Scripps Mercy)
SICK: If problem does not resolve or new problem arises then follow up. Medicine follows a step-by-step algorithm and escalated testing and/or treatment may be indicated.
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WELLNESS: Wellness visits are for routine care and are recommended annually.
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WELL VISIT
WELL VISIT
Routinely screens for and prevents problems based upon preventive guidelines.
Despite pandemic, don't postpone this. We continue to remain open for both In Person and Telehealth (portal, telephone, video) visits.
United States Preventive Task Force (USPTF) guidelines
depending upon your age and risk factors
Since the Affordable Care Act in 2010, most health plans fully cover the cost of this portion of the visit.
EXAMPLES
PSYCHIATRY
Unhealthy Drug
..opioid, cannabis, stimulant, sedative hypnotic
..tobacco
..alcohol
Depression (screening)
Healthy Diet + Physical Activity
CARDIOVASCULAR
Hypertension (annually: age 40+, African, hypertension, overweight/obese; otherwise age 18-39 every 3-5 yrs)
Obesity
Lipid (age 35+ male, risk factors)
Abdominal Aortic Aneurysm (age 65-75 if ever smoker)
Statin for cardiovascular disease 10 year risk 10+%)
INFECTION
Sexually Transmitted Infection Prevention (safe sex: limit partner, verify status, use condom)
HIV (exposure, age 15-65 x 1+, pregnant, Man Sex with Man HIV+ partner, IV drug use, or transactional/commercial sex, inconsistent condom use when not in a mutually monogamous relationship, every 3-6 mo)
..Pre-Exposure Prophylaxis (PrEP): Man Sex with Man, HIV+ partner, inconsistent condom use, syphilis/gonorrhea/chlamydia within 6 mo)
Hepatitis B (exposure, born Asia/Africa, IV Drug Abuse, Men having Sex with Men, pregnant)
Syphilis (exposure, Man Sex with Man, prostitute, HIV+ living partner)
Hepatitis C (age 18-79 x 1+, exposure, born 1945-65, transfuse/transplant, IV Drug Abuse, liver disease)
Chlamydia + Gonorrhea (exposure, female sexually active age <=24 or age 25+ with new/multiple partner(s), symptoms)
Latent Tuberculosis (former resident in country at risk, homeless, prison)
Immunizations (may obtain at pharmacy)
-Pediatric
COVID x 2+ when to get a booster
flu: annual (LIVE VERSION NOT RECOMMENDED FOR IMMUNOCOMPROMISED, inactive version recommended for immunocompromised)
TDaP: every 10 years
MMR (NOT RECOMMENDED FOR IMMUNOCOMPROMISED)
VAR x 2 if no history of vaccination or disease (NOT RECOMMENDED FOR IMMUNOCOMPROMISED)
HepB x 3 (if
PCV15 or PCV20 (if age >=age65 and no history of any pneumococcal vaccination, new CDC recommendation)
..Additional Immunizations for Specific Populations
Pregnant: 1 TDaP each pregnancy week 27-36 (CONTRAINDICATED: LIVE FLU, MMR, VAR, HPV SO DO NOT GET)
Immunocompromised: shingles RZV, pneumococcal (CONTRAINDICATED: LIVE FLU, MMR, VAR SO DO NOT GET)
Chronic Liver Disease: hepA
Healthcare Personnel: shingles RZV
Men who have Sex with Men : shingles RZV age 50+, HPV <=age26, monkeypox if exposure https://myturn.ca.gov/
CANCER
Breast Cancer
..mammogram (biennial age 50-74) may consider biennial age 40-49, option for annual age 40+
..BRCA gene (also for Ovarian Cancer)
--known family BRCA mutation
--Ashkenazi Jewish woman: breast or ovarian cancer in 1st degree relative or two 2nd degree relatives
--1st degree relative(s) with breast cancer: two relatives or one relative with bilateral
--1st or 2nd degree relatives: three with breast cancer or comorbid breast and ovarian cancers or two with ovarian cancer
--male family member with breast cancer
..endocrine Rx new including for
--age 65+ with 1 first-degree relative with breast cancer
--age 45+ with more than 1 first-degree relative with breast cancer or 1 first-degree relative who developed breast cancer before age 50
--age 40+ with a first-degree relative with bilateral breast cancer
--presence of atypical ductal or lobular hyperplasia or lobular carcinoma in situ on a prior biopsy
Cervical Cancer (every 3 yrs age 21-65; every 5 yrs age 30-65 if Pap and HPV normal)
Colon Cancer (newly lowered age 45-75, especially black/native, family history, male, obese, diabetes, smoker, alcohol)
..Options
--high-sensitivity guaiac fecal occult blood test (HSgFOBT) or FIT fecal immunochemical test annually
--stool DNA-FIT (ColoGuard) every 1 to 3 years
--virtual colonoscopy (computed tomography colonography) every 5 years
--flexible sigmoidoscopy every 5 years
--flexible sigmoidoscopy every 10 years + annual FIT
--colonoscopy screening every 10 years (preferred)
Lung Cancer (age 55-80 + 1 Pack / Day x 30 yrs + smoker <=15 yrs)
Prostate Cancer (age 55-69) option for annual blood/exam age 50+ (age 35+ if African or family history)
ABUSE
Intimate Partner Violence (childbearing age female)
ENDOCRINOLOGY
Diabetes (age 35-70 overweight/obese, Family History, ethnicity: African, Native, Asian, Hispanic, Pacific Islanders)
Osteoporosis (age 65+ female)
DERMATOLOGY
Skin Cancer if fair skinned (shade 10AM-4PM, cover, SPF 15+)
PREGNANCY PLANNING
folic acid 400-800ug daily
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