Primary Care Medicine Office Evaluation and Management of the Adult Patient 2 Primary Care Medicine Office Evaluation and Management of the Adult Patient SEVENTH EDITION Allan H. Goroll, MD, MACP Professor of Medicine Harvard Medical School Physician Massachusetts General Hospital Boston, Massachusetts Albert G. Mulley, Jr., MD, MPP Director, The Dartmouth Center for Health Care Delivery Science, and Professor of Medicine, the Geisel School of Medicine at Dartmouth Hanover, New Hampshire 3 4 Executive Editor: Rebecca Gaertner Senior Product Development Editor: Kristina Oberle Development Editor: Tom Conville Production Project Manager: David Saltzberg Senior Manufacturing Manager: Beth Welsh Marketing Manager: Stephanie Manzo Design Coordinator: Holly McLaughlin Production Services: SPi Global 7th Edition Copyright © 2014 Wolters Kluwer Health © 2009 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business © 2006 and 2000 by Lippincott Williams & Wilkins © 1995, 1987, and 1981 by JB Lippincott 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, including 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 individuals 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 our website at lww.com (products and services). Printed in China Library of Congress Cataloging-in-Publication Data Primary care medicine : office evaluation and management of the adult patient / [edited by] Allan H. Goroll, Albert Mulley. — Seventh edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4511-5149-7 I. Goroll, Allan H., editor of compilation. II. Mulley, Albert G., editor of compilation. [DNLM: 1. Primary Health Care—methods. 2. Ambulatory Care—methods. W 84.61] RC46 616—dc23 2013036271 Care has been taken to confirm the accuracy of the information presented 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 recommended 5 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 accordance 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 recommended 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 his or her clinical practice. LWW.com 10 9 8 7 6 5 4 3 2 1 6 Dedicated to an exciting new generation of primary care physicians, nurse practitioners, physician assistants, nurses, and other allied-profession team members, who are leading the way towards revitalizing and transforming primary care in the 21st century. 7 Contributors Jeremy S. Abramson, MD, MMSc Assistant Professor Department of Medicine Harvard Medical School Director, Lymphoma Program Cancer Center Massachusetts General Hospital Boston, Massachusetts Karin Andersson, MD Instructor Department of Medicine Harvard Medical School Hepatologist Massachusetts General Hospital Boston, Massachusetts Ernie-Paul Barrette, MD, FACP Associate Professor Department of Medicine Washington University Medical Director Primary Care Medicine Clinic Barnes-Jewish Hospital St. Louis, Missouri Michael J. Barry, MD Clinical Professor Department of Medicine 8 Harvard Medical School Medical Director John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital Boston, Massachusetts Hasan Bazari, MD Associate Professor of Medicine Department of Medicine Harvard Medical School Physician, Program Director Internal Medicine Residency Massachusetts General Hospital Boston, Massachusetts Susan E. Bennett, MD Assistant Professor Department of Medicine Harvard Medical School Associate Physician Department of Medicine Massachusetts General Hospital Boston, Massachusetts Neil Bhattacharyya, MD, FACS Professor Department of Otology and Laryngology Harvard Medical School Associate Chief Division of Otolaryngology Brigham and Women’s Hospital Boston, Massachusetts Michael F. Bierer, MD, MPH Assistant Professor Harvard Medical School Associate Physician Department of Medicine Massachusetts General Hospital Boston, Massachusetts 9 Shana L. Birnbaum, MD Instructor Department of Medicine Harvard Medical School Assistant Physician Department of Medicine Massachusetts General Hospital Boston, Massachusetts Stephen L. Boswell, MD Assistant Professor of Medicine Department of Infectious Diseases Massachusetts General Hospital President and CEO Fenway Health Boston, Massachusetts Ilana M. Braun, MD Assistant Professor Department of Psychiatry Harvard Medical School Chief Department of Psychosocial Oncology and Palliative Care Dana-Farber Cancer Institute Boston, Massachusetts David C. Brewster, MD Clinical Professor of Surgery Department of Vascular and Endovascular Surgery Harvard Medical School Attending Surgeon Department of Surgery Massachusetts General Hospital Boston, Massachusetts W. Scott Butsch, MD, MS Instructor in Medicine Department of Medicine Harvard Medical School Assistant in Medicine 10