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Am Fam Physician. 2004;69(10):2288

Sprinkled throughout this issue are articles that, considered together, build a picture of the challenges family physicians face in ensuring their patients’ health. Take note of the Graham Center One-Pager on page 2310 of this issue: “What People Want from Their Family Physician.” Patients want their family physician to be honest, able to listen, nonjudgmental, and supportive, and a person who will encourage them to lead a healthier lifestyle. A healthier lifestyle, of course, is the key to prevention.

An editorial in this issue by Sue Binder, M.D., focuses on prevention through avoidance of injury. Next month, the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control will celebrate its 12th anniversary. The vision of the Injury Center is to apply public health methods to prevention and control of injuries. Accidental injuries remain the number one cause of death in Americans up to 44 years of age. Causes of unintentional death include falls, drowning, improper use of firearms, motor vehicle injuries, poisoning, and injuries related to violence.

In her editorial, Dr. Binder presents a case scenario in which a five-year-old child who is unrestrained during a side-impact collision sustains a severe skull fracture. Is this injury an accident? Perhaps the collision itself was accidental, but the head injury could have been prevented by proper use of restraints. Dr. Binder points out that each year 40,000 persons die of injuries resulting from motor vehicle collisions. Proper restraint of passengers and avoidance of driving while impaired by alcohol would help reduce traffic-related deaths. The role of family physicians in prevention includes counseling patients not to mix alcohol and driving, and always to use proper restraints while driving. They also can help family members who need to decide when to end an older adult’s driving privilege.

Family physicians play an important role in identifying patients who are at risk from domestic violence. Family violence includes partner abuse, elder abuse, and child abuse. Patients who are exposed to these situations may have injuries directly resulting from the abuse or they may seek health services for other health problems, such as failure to thrive or behavior problems in children, and gastrointestinal disorders or chronic pain syndromes in women.

The “Point-of-Care Guide” in this issue offers the family physician a simple office tool that can be used for routing screening and that will help them identify patients who are at risk of problems related to alcohol use, domestic violence, and depression. Asking patients six simple questions may help the physician identify patients who are in need of intervention.

Two related articles on depression appear in this issue, one reviewing depression in later life (see page 2375), and one reviewing selection of antidepressants when sexual dysfunction is a concern (see page 2419).

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