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

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.

WELLNESS: Wellness visits are for routine care and are recommended annually.

WELL VISIT

Routinely screens for and prevents problems based upon preventive guidelines.

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.

BASIC CATEGORIES

PSYCHIATRY

Unhealthy Drug

..opioid, cannabis, stimulant, sedative hypnotic

..tobacco

..alcohol

Depression (Lifeline 800.273.8255, text 998)

CARDIOVASCULAR

Hypertension (annually: age 40+, African, hypertension, overweight/obese; otherwise age 18-39 every 3-5 yrs)

Overweight/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)

PrEP reduces relative risk by 54% (73% if compliance is >=70%) so still limit partners, verify status, and use condom

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

..Adult

COVID

flu (annual) (LIVE VERSION CONTRAINDICATED: PREGNANT, IMMUNOCOMPROMISED, or CLOSE CONTACT WITH IMMUNOCOMPROMISED), inactive version recommended for pregnant/immunocompromised)

TDaP (every 10 years, pregnancy gest week 27-36)

MMR (CONTRAINDICATED: PREGNANT OR IMMUNOCOMPROMISED)

VAR x 2 if no history of vaccination or disease (CONTRAINDICATED: PREGNANT OR IMMUNOCOMPROMISED)

HepB x 3 (if exposure, born Asia/Africa, IV Drug Abuse, Men having Sex with Men, pregnant)

PCV15 or PCV20 (if age >=age65 and no history of any pneumococcal vaccination, new CDC recommendation)

RZV x 2 Recombinant Zoster Vaccine shingles (age 50+, immunocompromised) new

..Additional Immunizations for Specific Populations

Pregnant: 1 TDaP each pregnancy week 27-36 (CONTRAINDICATED: LIVE FLU, MMR, VAR, HPV)

Immunocompromised: shingles RZV, pneumococcal (CONTRAINDICATED: LIVE FLU, MMR, VAR)

Chronic Liver Disease: hepA

Healthcare Personnel: shingles RZV

Men who have Sex with Men : HPV <=age26, monkeypox if exposure https://myturn.ca.gov/

CANCER

Breast Cancer

..mammogram: (women age 50-74 biennial will soon change to 40-74 biennial) option age 40+ every 1-2 years (annual preferred)

if silicone implants, in addition to mammogram with additional views also post-operatively MRI or ultrasound at 5-6 years then every 2-3 years (implant rupture risk during mammography is 1%)

..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 with breast cancer

2 relatives

1 relative with bilateral breast cancer

1st or 2nd degree * relatives

3 relatives with breast cancer

comorbid breast and ovarian cancers

2 relatives with ovarian cancer

male family member with breast cancer

personal history breast/ovarian cancer

* 1st Degree = parent, sibling, child; 2nd Degree = grandparent, aunt, uncle, half sibling, grandchild, niece, nephew

..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 (women every 3 yrs age 21-65; every 5 yrs age 30-65 if Pap and HPV normal)

please reschedule if menstruating and ideally abstain from sex 48 hours prior to pap

Colon Cancer (age 45-75), newly lowered age +/- age 76-85

..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) risk of perforation is 1%

Lung Cancer (age 50-80 + 20 pack yrs + smoker <=15 yrs)

Prostate Cancer men exam/lab +/- annual age 35+

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 30+

inform doctor if any suspicious lesions including using ABCDE pneumonic:

Asymmetry, Border irregular, Color black or varying, Diameter >5mm, Evolving/Enlargement/Elevation

PREGNANCY PLANNING

folic acid 400-800ug daily

MORE INFORMATION

Guideline Clearinghouse

Prevention and Wellness

Annual Wellness Visits are recommended. In the US, wellness visits and preventive health screenings have not returned to pre-pandemic levels. ~ JAMA We have always remained open for In Person visits and since the beginining of the pandemic we added Telehealth (portal, telephone, video) visits.