LECTURES: SCREENING 50Mcheckup – non smoker, no medications fam hx htn vitals normal wants cholesterol checked what tests - = get baseline labs colonoscopy fasting glucose PSA>? Discussion with patient DRE TSH, CBC, CHEM7 lytes Patient, physician and population factors influence screening decision 4 principles of family medicine = skilled clinician, community based, resource, patient physician relationship clinical guidelines Canadian task force on preventative health Ctfphc.org – Canadian task force UPTODATE CFPC.ca For your practice – clinical practice guidelines Clinicial tools – preventative care checklist PSA TEST Lots of false positives – many things can raise it Trend may be important but is absolute number Finding a cancer that wouldn’t have progressed, been aggressive or impacted life otherwise 5% aggressive Problem of finding one have to do workup and tests and … PSA patient says doesn’t want it, then eventually do it and high So tests : REPEAT, dre, u/s with biopsy Patient dx with prostate cancer = and now because dr didn’t do the test for years = loss of trust and dr – patient relationship Dx with prostate cancer and then resection - Then effects of radiation – radiation proctitis – bleeding, tired – took years to resolve and decreased quality of life When cancer probakbly wouldn’t have cause any problems Level of evidence of PSA = grade D DRE = C Female ca-125 10 guidelines HTN – CHEP – HTN.CA 140/90 dm 130/80 dx 1st visit – ...
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