Outpatient / General Medicine
Preventative Health
#Preventative (Male)
Cardiovascular
-- Lipid Screening: *** (>20 q5y; >45 q1-2y; >65 qy) goal reduce LDL >50% or <100
-- DM Screening: *** (>45 OR BMI >25 and risk factor)
Infectious
-- HIV/STD: *** (15-65 once, high risk annually)
-- HCV Screening: (adults once)
Cancer
-- Colon: *** (colonoscopy 45-75 q10 vs sigmoid q5 vs FIT q1)
-- Lung: *** (low dose CT 50-80 >20 pack years)
-- PSA: *** (55-69, share-decision making)
Vaccine
-- COVID: *** (first booster 8 months after vaccines)
-- Flu Shot: *** (annual)
-- HPV Vaccine: *** (up to 26)
-- TDaP Vaccine: *** (Tdap once then Td booster q10)
-- Zoster Vaccine: *** (>50 RZV)
-- Pneumococcal Vaccine: *** (>65 1 dose PPSV23, 19+ if risks)
Other
-- Depression: *** (little interest or pleasure, feeling down/depressed/hopeless)
-- Substance Use: *** (EtoH, smoking, other)
-- Sexual Activity: *** (5 P's - partners, practices, past STI, pregnancy plans, protection against STIs)
-- Diet & Exercise: *** (current, goals)
#Preventative (Female)
Cardiovascular
-- Lipid Screening: *** (>20 q5y; >45 q1-2y; >65 qy) goal reduce LDL >50% or <100
-- DM Screening: *** (>45 OR BMI >25 and risk factor)
Infectious
-- HIV/STD: *** (15-65 once, high risk annually)
-- HCV Screening: (adults once)
-- STI (<24 chlamydia, gonorrhea, syphilis)
Cancer
-- Colonoscopy: *** (45-75 q10 vs sigmoid q5 FIT q1)
-- Pap Smear: *** (21-29 q3, 30-65 q5 with HPV)
-- Mammogram: *** (50-74 q2)
Vaccine
-- COVID: *** (booster 8 months after vaccines)
-- Flu Shot: *** (annual)
-- HPV Vaccine: *** (up to 26)
-- TDaP Vaccine: *** (Tdap once then Td booster q10)
-- Zoster Vaccine: *** (>50 RZV)
-- Pneumococcal Vaccine: *** (>65 1 dose PPSV23, 19+ if risks)
Other
-- DEXA: *** (>65 once)
-- Depression: *** (PHQ2: little interest or pleasure, feeling down/depressed/hopeless)
-- Domestic Violence Screen: *** (feel safe in home)
-- Substance Use: *** (EtoH, smoking, other)
-- Sexual Activity: *** (5 P's - partners, practices, past STI, pregnancy plans, protection against STIs)
-- Diet & Exercise: *** (current, goals)
Template Coming Soon!
Patient Guidance and Information
Mammogram Screening Message
Hello ***. You are due for a mammogram to screen for breast cancer. A mammogram is a specialized X-ray that can look for early signs of breast cancer. If normal, we can plan to screen again in 2 years. If there is anything abnormal, we may recommend additional imaging or a biopsy.
Please call *** to schedule.
You can view this CDC website to lean more.
Colonoscopy Screening Message
Hello ***. You are due for a colonoscopy to screen for colon cancer. During the procedure, you will have images taken of your rectum and large intestine, and the doctor may decide to take biopsies of any concerning findings or remove any polyps that may later turn into a cancer.
You will need to prepare for the procedure using a colon prep to clear out stool to ensure that the camera can see the entire colon.
Please call *** to schedule.
In some situations, there are non-invasive alternatives to colonoscopy. Please let me know if you'd like to discuss these options.
You can also view the American Cancer Society website to learn more.
If You Remember Nothing Else
Clinical Pearls
Risk Factors to Get Pnuemococcal Vaccine 19+ (CDC)
- Alcoholism
- Cerebrospinal fluid leak
- Chronic heart disease, including congestive heart failure and cardiomyopathies
- Chronic liver disease
- Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
- Chronic renal failure*
- Cigarette smoking
- Cochlear implant
- Congenital or acquired asplenia*
- Congenital or acquired immunodeficiency*
- B- (humoral) or T-lymphocyte deficiency
- Complement deficiency, particularly C1, C2, C3, or C4 deficiency
- Phagocytic disorder, excluding chronic granulomatous disease
- Diabetes mellitus
- Generalized malignancy*
- HIV infection*
- Hodgkin disease*
- Iatrogenic immunosuppression, including long-term systemic corticosteroids and radiation therapy*
- Leukemia*
- Lymphoma*
- Multiple myeloma*
- Nephrotic syndrome*
- Sickle cell disease or other hemoglobinopathies*
- Solid organ transplant*
Trials and Literature
- NLST (NEJM, 2011) - CT vs CXR to screen for lung cancer in patients at high risk for lung cancer (age 55-74 and 30+ pack years smoking and/or quit within last 15 years); showed mortality benefit but flase positives lead to extra testing and harms
- NELSON Trial (NEJM, 2020) - CT screening year 1, 3, 5.5 vs no screening - showed mortality benefit
- Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death (NEJM, 2022) - randomized trial of an intervention to invite patients in Nordic countries (and Poland) to have colonoscopy - the invitation intervention showed negative results (less likely to have colorectal cancer, but not mortality), but in those who actually did get colonoscopy there was a mortality benefit; some controvery over whether 10 years is enough time to see benefit
- Low Dose CT Scan for Lung Cancer Screening - NNT - NNT 219 vs CXR to save life, NNH - 19 for incidental finding, 78 for false pos cancer on scan
- Screening Mammography for Reducing Breast Cnacer Death - NNT - suggests no patients helped, but NNH was 2 for false positive over 10 years, 5 get unnecessary procedure over 10 years
- PSA - NNT - suggests no benefit and 1/5 had harm via prostate biopsy
Other Resources
- CDC Adult Vaccination Schedule
- PSA Screening Info - cancer.net
- PHQ-9 PDF - validated to be filled out by patient
- Clinician's Guide to Sexual History Taking
Tweetorials
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