The reasons for referral of 189 patients referred to the Primary Care Out-patient Clinics, University Hospital Kuala Lumpur, were studied. 55.6% of them were from private general practitioners. 51.0% of the referrals were for evaluation of symptoms and 46.5% were for management of diseases. The profile of the referrals helps in curriculum planning of Primary Care Medicine. Other applications of the results are discussed.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A 32 year old HIV positive intravenous drug user (IVDU) with a promiscuous lifestyle in the past presented with altered behaviour and was diagnosed to have pulmonary tuberculosis, tuberculous meningitis and tuberculous osteomyelitis. After initial response to anti-tuberculous therapy, his symptoms recurred with the appearance of cerebral mass lesions. A presumptive diagnosis of toxoplasma encephalitis was made based on clinical, serological and radiological evidence. He showed clinical improGement with anti-toxoplasmic therapy.
1) A variety of surgical lesions can occur in infants and children. 2) The first step in the management is to arrive at an accurate diagnosis. Most lesions can be diagnosed or suspected through "pattern recognition" 3) Some lesions can be treated by the general practitioners / family physicians for e.g. umbilical granuloma. 4) Lesions that can be observed over time for spontaneous resolutions are umbilical hernia, congenital hydrocele and haemangioma. 5) Lesions or conditions that require prompt referral are undescended testis, inguinal hernia, neonatal jaundice and large cystic hygJ1Qmas 6) Thyroglossal cyst, hypospadias and small cystic hygromas can be referred to a specialist at a time convenient for the family. 7) Phimosis may require an expert consultation 8) Expert consultation should be sought when in doubt; for example when difficulty is encountered in differentiating a retractile testis from an undescended testis. 9) As a general rule, all skin and subcutaneous swellings, except a hemangioma should be referred to a specialist, as soft tissue malignancy is a possibility even in infants. 10) Family physicians should be aware of the potential long-term problems of some conditions such as undescended testis and biliary atresia.
In the light of present HIV worldwide epidemic. there is a need to teach the busy general practitioners how to recognise HIV & AIDS. Due to the deadly nature of this infection and its manifold presentations from opportunistic diseases. the busy general practitioners in primary care may be misled in making the correct diagnosis. In Malaysia. the doctors in the primary care level constitute 70 to 75% of the doctors' population. The rest are specialists in secondary and tertiary care institutions. Family Physicians from the Font liners to recognise and detect early cases of HlV in all its early manifestalions on the various systems. Any doctors in primary medicine whether from private or public sector, amy be confronted by patients who present with trivial complaints. These patients may be fee-paying, or particularly those doctors involved with welfare and health of factory workers and the other forms of the main work force should well arm themselves with updates in HIV and AIDS.