Goroll_Primary Care Medicine, 8e

PREFACE

T his eighth edition of Primary Care Medicine (PCM), like the first edition 40 years ago, comes at a critical moment for primary care, as health care delivery both in the United States and around the world faces enormous challenges of access, affordability, and quality. With accumulating evidence and a growing appreciation for primary care’s foundational role comes the expectation that it will deliver on cost, quality, access, and patient experience. This is a tall order for a field that has struggled for decades to attract trainees and to receive adequate funding. Fortunately, the situation is changing dramatically with calls to transform and revitalize primary care. It is in this context that we offer the eighth edition of PCM to provide the knowledge base and strategies for delivery of robust primary care. The good news is that there is so much more we can do today for our patients than when PCM was first published in 1981. The bad news is that the knowledge base of primary care medicine has exploded—it once could be contained in a big-print book one third the size of the eighth edition. As daunting as this may seem, we have worked hard to make the content more accessible and up-to-the minute through complementary electronic delivery while holding true to our original design found so useful for learning and practicing primary care. All chapters are problem-based and action-oriented, addressing the clinical challenges one faces daily in primary care practice. The chapters are divided into key sections and subsections addressing basic elements of the care process (diagnosis, differential diagnosis, screening, workup, management strategies, prevention, patient education, and indications for referral). Chapters conclude with bulleted, actionable recommendations based on best available evidence. Important details and frequently raised questions and dilemmas are considered—content relevant to the beginner as well as the experienced clinician is included. Everything needed for decision making is included in one place, with a minimum of referring readers to other sections of the book (except for more detail). For four decades, PCM has sought to promote better personalized health care and better health at lower cost (themes that are particularly relevant in today’s environment) through application of best available evidence—the content of nearly 3,000 new references has been incorporated into this fully rewritten edition. Cost-effectiveness, team care, patient and family education, and coordination have always been central considerations and features of our recommendations. We seek to take the reader beyond the “right answer” to present the “why” as well as the “what,” so that users of PCM will under stand the evidence and rationale behind a recommendation, facilitating both customization of care and coping with a rapidly changing knowledge base. Besides being a decision-support tool for clinical practice, PCM also serves as a textbook, contain ing the essential knowledge needed to understand the scientific basis of primary care practice. Toward this end, we provide a web-based curriculum of core material for learners with reference to specific chapters in PCM. Given the importance of knowledgeable interdisciplinary team delivery to achieving high-performance primary care, such content is meant to be shared at some level by all members of the primary care team. Whether a student or resident in medicine, nursing, nurse partitioning, physician assistantship, pharmacy, or mental health, there is content in PCM relevant to your role in primary patient care. Although handbooks can provide answers, we feel it is critical that you understand the basis for the answer and thus include the supporting evidence and rationale. Yes, it entails a bit more reading than handbooks, but the investment in time should pay dividends in terms of enhanced understanding, which enables you to better personalize care and achieve more meaningful outcomes for the patients you serve. In addition to the book’s full text, quarterly updates, and interdisciplinary curriculum, the Web site also includes materials to support shared decision-making, helping patients make personally meaning ful, informed decisions about their care. We encourage a genuinely collaborative approach between patients and caregivers, an essential feature of patient-centered primary care. The practice of primary care has never been more challenging nor more rewarding. Our goal is to help PCM readers master the knowledge base and use it skillfully. We continue to be humbled and gratified by the responses of our readers over the decades who have found our book helpful in their learning and practice of primary care. It is to them and an exciting new generation of highly motivated future primary care clinicians that we dedicate this edition.

Allan H. Goroll, MD, MACP Albert G. Mulley Jr, MD, MPP Boston, Massachusetts and Hanover, New Hampshire February, 2020

Copyright © 2020 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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