LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page i E S S E N T I A L S O F FA M I LY M E D I C I N E SIXTH EDITION PHILIP D. SLOANE, MD, MPH Elizabeth and Oscar Goodwin Distinguished Professor Department of Family Medicine University of North Carolina at Chapel Hill Chapel Hill, North Carolina LISA M. SLATT, MEd Associate Professor Associate Director, Medical Student Programs Department of Family Medicine University of North Carolina at Chapel Hill Chapel Hill, North Carolina MARK H. EBELL, MD, MS Associate Professor, Department of Epidemiology and Biostatistics College of Public Health The University of Georgia Editor-in-chief, Essential Evidence Deputy Editor, American Family Physician MINDY A. SMITH, MD Professor, Department of Family Medicine Michigan State University College of Human Medicine East Lansing, Michigan Associate Editor, FP EssentialsTM DAVID V. POWER, MB, MPH Associate Professor, Director of Medical Student Education Department of Family Medicine and Community Health University of Minnesota Medical School Minneapolis, Minnesota ANTHONY J. VIERA, MD, MPH Assistant Professor Department of Family Medicine University of North Carolina at Chapel Hill Chapel Hill, North Carolina LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page ii Acquisitions Editor: Susan Rhyner Product Managers: Catherine Noonan Marketing Manager: Joy Fisher-Williams Vendor Manager: Alicia Jackson Manufacturing Manager:Margie Orzech Designer: Holly McLaughlin Compositor: Aptara, Inc. Sixth Edition Copyright © 2012, 2008, 2002, 1998, 1993, 1988 Lippincott Williams & Wilkins, a Wolters Kluwer business 351 West Camden Street Two Commerce Square, 2001 Market Street Baltimore, MD 21201 Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, includ- ing as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individ- uals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Essentials of family medicine / [edited by] Philip D. Sloane ... [et al.]. –6th ed. p. ; cm. Includes bibliographical references and index. Summary: “Perhaps more remarkable is how much hasn’t changed in the past quarter century. The patient-centered encounter remains the backbone of effective care, whether in the office, on the telephone or online. In these encounters, attentiveness to the interaction between bio- logical, socioeconomic, and psychological factors is as crucial and relevant as ever. Family medicine residency programs continue to provide excellent preparation for physicians interested in caring for individuals of all ages and their families within a broad range of practice settings, styles, and populations. Primary medical care continues to be recognized as the cornerstone of an effective health care system, although integra- tion of primary care into the broader US system remains far from ideal” –Provided by publisher. ISBN 978-1-60831-655-7 1. Family medicine. I. Sloane, Philip D. [DNLM: 1. Family Practice. WB 110] RC46.E88 2012 616—dc22 2011003428 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and rec- ommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accor- dance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the rec- ommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030or fax orders to (301) 223-2320.International customers should call (301)223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page iii To the family physicians in practice nationwide who, despite ever-increasing work demands, continue to teach and mentor students. And to Sheryl, my wife, partner, and inspiration. P. S. To my husband, Alan Spanos L. M. S. To my wife, Laura Bierema and my late son, Lukas Willem M. H. E. To the many students, residents, and fellows who I have been privileged to learn from and teach. M. A. S. To my family: Dianna, Rhetta, Oran D. V. P. To my wife, Julie and our daughters, Kaitlyn and Kristen A. J. V. LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page iv A B O U T T H E E D I T O R S Philip D. Sloane, MD, MPH, is the Elizabeth and Oscar Goodwin Distinguished Professor of Family Medicine at the University of North Carolina at Chapel Hill. Jointly certified in family medicine and geriatric medicine, he continues to see patients of all ages in multiple settings and has published over 200 articles and 15 books. Philip D. Sloane, MD, MPH Lisa M. Slatt, MEd, is Associate Professor in the Department of Family Medicine at the University of North Carolina at Chapel Hill. Her interests focus on competency- based education and assessment. Lisa M. Slatt, MEd Mark Ebell, MD, MS, is Associate Professor in the Department of Epidemiology and Biostatistics in the College of Public Health at the University of Georgia. He is Editor- in-Chief of EssentialEvidenceand Deputy Editor of American Family Physician. Mark Ebell, MD, MS iv LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page v ABOUT THE EDITORS v Mindy A. Smith, MD, MS, is Professor in the Department of Family Medicine at Michigan State University (MSU), College of Human Medicine; Associate Medical Editor of the AmericanAcademy of Family Physician FP Essentials™; and Deputy Editor of EssentialEvidence. Teaching is one of her passions, and she cur- rently teaches research and writing skills to faculty fellows in the MSU Primary Care Faculty Development Program and chair’s the mock study section portion of the Grant Generating Project. Mindy A. Smith, MD, MS David V. Power, MB, MPH, is Clerkship Director, Director of Medical Student Education, and an Associate Professor in the Department of Family Medicine and Community Health, University of Minnesota Medical School. He has received a number of teaching awards including a 2009 Leonard Tow Humanism in Medicine award and has published widely on medical student-related and various clinical and international health topics. David V. Power, MB, MPH Anthony J. Viera, MD, MPH, is an Assistant Professor in the Department of Family Medicine and an Associate Director of the MD-MPH Program at the University of North Carolina at Chapel Hill. In addition to practicing full-scope family medicine and conducting cardiovascular disease prevention research, he is passionate about teaching medical students, graduate students, and residents. Anthony J. Viera, MD, MPH LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page vi C O N T R I B U T I N G A U T H O R S Cathleen Abbott, MD Molly Cohen-Osher, MD Assistant Professor, Department of Family Medicine Assistant Professor, Department of Family Medicine Michigan State University Tufts University School of Medicine East Lansing, Michigan Boston, Massachusetts Department of Family Medicine Faculty Physician, Department of Family Medicine Sparrow Hospital Tufts University Family Medicine Residency Program at Cambridge Lansing, Michigan Health Alliance Malden, Massachusetts Albert Asante, MD, MPH Physician (Resident), Department of Gynecology and Obstetrics Timothy P. Daaleman, DO, MPH Emory University Hospital Professor and Vice Chair, Department of Family Medicine Atlanta, Georgia University of North Carolina at Chapel Hill Attending Physician, Department of Family Medicine Henry C. Barry, MD, MS University of North Carolina Hospitals Associate Professor, Department of Family Medicine Chapel Hill, North Carolina Michigan State University College of Human Medicine East Lansing, Michigan Amy C. Denham, MD, MPH Assistant Professor, Department of Family Medicine Timothy J. Benton, MD University of North Carolina at Chapel Hill, Program Director and Associate Professor, Chapel Hill, North Carolina Department of Family Medicine Texas Tech University Health Sciences Center Philip M. Diller, MD, PhD Amarillo, Texas Professor & Interim Chair, Department of Family & Community Medicien George R. Bergus, MD, MA(Ed) University of Cincinnati Professor, Department of Family Medicine Chief, Department of Family Medicine University of Iowa The Christ Hospital Staff Physician, Department of Family Medicine Cincinnati, Ohio University of Iowa Hospital & Clinics Iowa City, Iowa Katrina E. Donahue, MD, MPH Associate Professor, Department of Family Medicine Larissa S. Bucculo, MD University of North Carolina at Chapel Hill HCA Physician Services Chapel Hill, North Carolina Jacksonville, Florida Marguerite Duane, MD, MHA, FAAFP Elizabeth A. Burns, MD, MA Adjunct Associate Professor, Department of Family Medicine Professor of Family Medicine Georgetown University Dean, President and CEO Washington, D.C. Michigan State University/Kalamazoo Center of Medical Studies Kalamazoo, MI Brian R. Forrest, MD Adjunct Associate Professor, Department of Family Medicine Beth Choby, MD, FAAFP University of North Carolina at Chapel Hill Associate Professor, Clerkship Director Department of Family Medicine Chapel Hill, North Carolina University of Tennessee College of Medicine-Chattanooga Chattanooga, TN Linda French, MD Professor and Chair, Department of Family Medicine Sandra C. Clark, MD University of Toledo Family Physician/Provider Chief, Department of Family Medicine Piedmont Health Services University of Toledo Medical Center Carrboro, North Carolina Toledo, Ohio Adjuvant Attending, Department of Family Medicine University of North Carolina Hospitals Chapel Hill, North Carolina vi LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page vii CONTRIBUTING AUTHORS vii Stephen H. Gamboa, MD, MPH Robert E. Gwyther, MD, MBA Adjunct Assistant Professor, Department of Family Medicine Professor of Family Medicine, Department of Family Medicine University of North Carolina at Chapel Hill University of North Carolina at Chapel Hill Staff Physician, Department of Emergency Medicine Chapel Hill, North Carolina University of North Carolina Chapel Hill, North Carolina Peter S. Ham, MD Assistant Professor, Department of Family Medicine Frank Ganzhorn, MD University of Virginia Department of Pulmonary Medicine Clinical Faculty, Department of Family Medicine Salinas Valley Memorial Hospital University of Virginia Health System Salinas, California Charlottesville, Virginia David L. Gaspar, MD, MPH Steven W. Harrison, MD Director, Medical Student Education Service Chief, Department of Family Practice and Assistant Director Department of Family Medicine Medicine Residency Program University of Colorado School of Medicine Natividad Medical Center Aurora, Colorado Salinas, California Christina Gillespie, MD, MPH Parul Harsora, MD Assistant Professor, Department of Family Medicine Assistant Professor, Department of Family Medicine Georgetown University University of Texas Southwestern Medical Center Program Director, Family Medicine Residency Dallas, Texas Providence Hospital Washington, D.C. Caryl J. Heaton, DO Associate Professor, Department of Family Medicine John R. Gimpel, DO, MEd New Jersey Medical School-UMDNJ President Vice Chair, Department of Family Medicine National Board of Osteopathic Medical Examiners University Hospital Conshohocken, Pennsylvania Newark, New Jersey Attending Physician, Department of Family Medicine The Bryn Mawr Hospital Iryna Sophia Hepburn, MD Byrn Mawr, Pennsylvania Fellow Gastroenterology and Hepatology, Department of Medicine Adam Oliver Goldstein, MD, MPH Medical College of Georgia Professor, Department of Family Medicine Augusta, Georgia University of North Carolina at Chapel Hill Chapel Hill, North Carolina William Y. Huang, MD Associate Professor, Department of Family and Community Medicine Mark Duane Goodman, MD Baylor College of Medicine Associate Professor and Interim Chair, Department of Family Medicine Houston, Texas Creighton University School of Medicine Omaha, Nebraska William J. Hueston, MD Professor and Chair, Department of Family Medicine Gary R. Gray, DO Medical University of South Carolina Associate Clinical Professor, Department of Family and Community Charleston, South Carolina Medicine University of California, San Francisco Robert Jackman, MD San Francisco, California Assistant Professor of Family Medicine Chief Medical Officer Associate Director/Clinical Medical Director Natividad Medical Center Cascades East Family Medicine Salinas, California Oregon Health & Science University Staff, Department of Family Medicine Larry A. Green, MD Skylakes Medical Center Epperson Zorn Chair for Innovation in Family Medicine and Primary Klamath Falls, Oregon Care Department of Family Medicine Anila Jamal, MD University of Colorado Denver Chief Resident, Department of Family Medicine Denver, Colorado Medical College of Georgia Augusta, Georgia Lee Green, MD, MPH Professor, Department of Family Medicine University of Michigan Ann Arbor, Michigan LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page viii viii CONTRIBUTING AUTHORS Robert J. Johnson, MD Arch G. Mainous III, PhD Professor, Department of Family Medicine and Community Health Professor, Department of Family Medicine University of Minnesota Medical University of South Carolina Fellowship Director of Sports Medicine Charleston, South Carolina Department of Family Medicine Hennepin County Medical Center Otto R. Maarsingh, MD, PhD Minneapolis, Minnesota Family Physician and Researcher, Department of Family Practice VU University Medical Center Mollie L. Kane, MD, MPH Amsterdam, The Netherlands Assistant Professor, Department of Pediatrics University of Wisconsin Ranit Mishori, MD, MHS Department of Pediatrics Assistant Professor, Department of Family Medicine University of Wisconsin Hospitals Georgetown University School of Medicine Madison, Wisconsin Staff Physician, Department of Obstetrics and Gynecology/Family Medicine Daniel I. Kaufer, MD Georgetown University Hospital, MedStar Health Associate Professor and Division Chief, Cognitive Neurology & Washington, D.C. Memory Disorders Department of Neurology Donald E. Nease, Jr., MD University of North Carolina at Chapel Hill Associate Professor, Department of Family Medicine Chapel Hill, North Carolina University of Michigan Associate Professor, Department of Family Medicine Jennifer Keehbauch, MD, FAAFP University of Michigan Health System Assistant Professor, Department of Family Medicine Ann Arbor, Michigan Loma Linda University School of Medicine Loma Linda, California Warren Polk Newton, MD, MPH Director Woman’s Health Fellowship Vice Dean for Medical Education Graduate Medical Education William Aycock Distinguished Professor & Chair of Family Medicine Florida Hospital University of North Carolina at Chapel Hill Orlando, Florida Chapel Hill, North Carolina Jennifer B. Kessman, MD Mary B. Noel, MPH, PhD, RD Staff Physician, Department of Family Medicine Professor and Senior Associate Chair, Department of Family Medicine Medical Clinics of North Texas College of Human Medicine, Michigan State University Dallas, Texas East Lansing, Michigan Christine Mazzola Khandelwal, DO James T. Pacala, MD, MS Clinical Assistant Professor, Department of Family Medicine Distinguished Teaching Professor and Associate Head University of North Carolina at Chapel Hill Department of Family Medicine & Community Health University of North Carolina Hospitals at Chapel Hill University of Minnesota and Community Health Chapel Hill, North Carolina Minneapolis, Minnesota Scott Kinkade, MD, MSPH Louise Parent-Stevens, PharmD, BCPS Associate Professor, Department of Family Medicine and Community Clinical Assistant Professor, Department of Pharmacy Practice Medicine College of Pharmacy, University of Illinois University of Missouri School of Medicine Clinical Pharmacist, Family Medicine C enter Columbia, MO University of Illinois at Chicago Medical Center Chicago, Illinois Kathleen Klink, MD Director, Division of Medicine and Dentistry Vinod Patel, MBBS HRSA, Bureau of Health Professions Jefferson Family Medicine Rockville, Maryland Buffalo, New York Charles Kodner, MD Katharine Miles Patsakham, MPH, CTTS Associate Professor, Department of Family and Geriatric Medicine Social Clinical Research Specialist, Department of Family Medicine University of Louisville School of Medicine University of North Carolina at Chapel Hill Louisville, Kentucky Chapel Hill, North Carolina Caroline Jane LeClair, DO Janey M. Purvis, MD Senior Instructor, Department of Family Medicine Adjunct Assistant Clinical professor, Department of Family Medicine University of Colorado Denver Oregon Health & Sciences University Faculty, Department of Family Medicine Portland, Oregon University of Colorado Hospital Clinic Physician, Cascades East Family Medicine Residency Program Denver, Colorado Klamath Falls, Oregon