clinician regardless of title or certification.
To practice as a family practice clinician, it is important to have a basic understanding first about what is meant by “family” and then how the family is integrated into the plan of care and ultimately often becomes the “patient.” In previous work about home health clinicians, this author found that home health clinicians care for the “patient entity,” which is defined as all those who impact or potentially impact the patient’s health. In family practice, the clinician also cares for and, at the very least, considers the patient entity when developing and pursuing a plan of care for an individual who seeks health care.
The meaning of “family” has undergone significant societal change. Consequently, it is important that the clinician not make assumptions about who is “family” and who is not. It is important to ask the patient who they consider their family. As I write this, society, both nationally and globally, is undergoing the crisis brought on by the coronavirus. Aside from the medical implications, the virus is already having an impact on how people interact with each other. We are required to practice “social distancing,” which requires us to maintain our relationships, whether personal or professional, in other ways besides close proximity or touching. Neighbors are calling to check in on the elderly, especially those who don’t have family nearby, and older adults are checking on the young parents in their neighborhoods who are working from home while trying to manage children who are unable to attend school due to the pandemic. What is the definition of family during a crisis like this? How will we keep each other from becoming socially isolated?
Crises like these imply a new definition of family. Technology allows us to keep in contact despite the prohibition on being physically within six feet of another human being. A crisis like this reminds us how vulnerable we are as human beings, not only to disease but to loneliness and despair. Knowing that others care about us takes on even greater significance. We are reminded that “family,” however we define it, is crucial to our survival.
As clinicians, we are just as vulnerable but have the advantage of a vast store of medical knowledge. As laypersons disseminate misconceptions about how to prevent and treat the virus, nurse practitioners and our health professions colleagues are stepping up to make sure the public has accurate health care information.
Our care of individuals and families does not just take place in the clinic or health care setting. It occurs via every encounter we have with the people in our communities and across cyberspace. The coronavirus crisis illustrates that while we have better means of communication than in years past, we are also vulnerable to more misinformation.
The cases in this book were chosen in an attempt to illustrate mostly typical (and some atypical) cases that occur in family practice. Remembering the impact “family” has on our physical and mental health and that the patient is part of a subsystem within the larger family system can help the reader see that the patient’s illness or condition not only impacts the patient but potentially has a ripple effect on many others both within and outside of the family system.
Abbreviations and Acronyms
AAA:Abdominal aortic aneurysmAACE:American Association of Clinical EndocrinologistsAAP:American Academy of PediatricsABG:Arterial blood gasABI:Ankle brachial indexACC:American College of CardiologyACIP:Advisory Committee on Immunization PracticesACL:Anterior cruciate ligamentACS:Acute coronary syndromeADHD:Attention‐deficit hyperactive disorderad lib:At liberty or whenever the patient wants to do somethingAGS:American Geriatrics SocietyAHA:American Heart AssociationAMI:Acute myocardial infarction or heart attackANA:Anti‐nuclear antibodyAP:Anterior‐posteriorAPA:American Psychiatric AssociationApgar:The score given to newborns at 1 minute and 5 minutes after birth. The newborn is scored on activity (muscle tone), pulse, grimace (reflex irritability), appearance (skin color), and respirations.AS:Active surveillanceBD:Blastomycoses dermatitidisBDI:Beck Depression InventoryBMI:Body mass indexBMP:Basic metabolic panelBP:Blood pressureBS:Bowel soundsBUN:Blood urea nitrogenCAD:Coronary artery diseaseCAM:Complementary and alternative medicine or Confusion Assessment MethodCBC:Complete blood count, with or without diff (differential)CBT:Cognitive behavioral therapyCCB:Calcium channel blockerCCRC:Continuing care retirement communityCKD:Chronic kidney diseaseCLI:Critical limb ischemiaCLIA:Clinical Laboratory Improvement AmendmentCMP:Complete metabolic panelCMT:Cervical motion tendernessCOC:Combined oral contraceptive pillCOPD:Chronic obstructive pulmonary diseaseCOWS:Clinical Opiate Withdrawal ScaleCRP:C‐reactive proteinC‐SSRS:Columbia–Suicide Severity Rating ScaleCT:Computed tomographyCTA:Clear to auscultationCVA:Cerebrovascular accidentCXR:Chest X‐rayD&C:Dilatation and curettageDASH:Dietary Approaches to Stop HypertensionDDVAP:Desmopressin acetate vasopressinDEA:Drug Enforcement AgencyDFA:Direct fluorescent antibody (testing)DMARD:Disease‐modifying antirheumatic drugDMPA:Depo‐ProveraDoD:Department of DefenseDOE:Dyspnea on exertionDRE:Digital rectal examinationDVT/PE:Deep vein thrombosis/pulmonary embolismDXA:Dual‐energy absorptiometryEBV:Epstein‐Barr virusECG:ElectrocardiogramED:Emergency departmentEEG:ElectroencephalogramELISA:Enzyme‐linked immunosorbent assayEM:Erythema migransEMA:Endomysial antibodyEMDR:Eye movement desensitization and reprocessingENT:Ear, nose, and throatEOB:Explanation of benefitsEOM:Extraocular movementEPT:Expedited partner therapyESPGN:European Society for Pediatric Gastroenterology, Hepatology, and NutritionESR:Erythrocyte sedimentation rateETOH:Alcohol (drinking kind)FBG:Fasting blood glucoseFBS:Fasting blood sugarFIT:Fecal immunochemical testFM:FibromyalgiaFROM:Full range of motionFTT:Failure to thriveGABHS:Group A beta‐hemolytic streptococciGAD:Glutamic acid decarboxylaseGC/CHL:Gonorrhea/chlamydiaGCA:Giant cell arteritisGCS:Glasgow Coma ScaleGDMT:Guideline‐directed medical therapyGDS:Geriatric Depression ScaleGERD:Gastroesophageal reflux diseaseGFR:Glomerular filtration rateGI:GastrointestinalGINA:Global Initiative for AsthmaHA1c:Hemoglobin A1cHCV:Hepatitis C virusHPV:Human papilloma virusHR:Heart rateHRI:Heat‐related illnessHSDD:Hypoactive sexual desire disorderHSM:HepatosplenomegalyHSV:Herpes simplex virusHT:Hormone therapyHTN:HypertensionHZO:Herpes zoster opthalmicaIBD:Inflammatory bowel diseaseIBS:Irritable bowel syndromeIgA:Immunoglobulin AIgE:Immunoglobulin EITP:Idiopathic thrombocytopenic purpuraIUC:Intrauterine contraceptionIUD:Intrauterine deviceKOH:Potassium hydroxideKUB:Kidneys, ureters, and bladderLARC:Long‐acting reversible contraceptivesLDH:Lactic acid dehydrogenaseLEAP:Learning Early About PeanutLFT:Liver function testLLSB:Left lower sternal borderLMP:Last menstrual periodLNMP:Last normal menstrual periodLR:Light reflexLRI:Lower respiratory infectionsLROM:Limited range of motionMCI:Mild cognitive impairmentMCP:Metacarpal
