By P. Benito. Washington University in Saint Louis.

The third group was later called general practitioners generic gasex 100 caps fast delivery, and before the turn of century they Copyright © 2005 order 100caps gasex visa, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. As a result, citizens had no longer free passage to hospital care without seeing a general practitioner first. Reengineering the One-W ay Information Process: A Case Study In the following example we concentrate to analyze the factors behind the startling change that took place when paper referrals were replaced with electronic referrals. Our example is based on a study that took place in southern Finland focusing on cross- functional processes within two healthcare units (Harno, Paavola, Carlson, & Viikinkoski, 2000). The process chosen for the study was simple: a health center general practitioner referring a patient to a specialist at a regional hospital. While one unit began to utilize information system when referring a patient to hospital, the other send referrals tradition- ally by ordinary mail. Parts of the study are reported in TQM and Human Factors conference, Sweden (Lillrank, Paavola, Harno, & Holopainen, 1999). Both healthcare units, Peijas Hospital and Hyvinkää Hospital, consist of a hospital and several health centers serving 150,000 people. Both healthcare units use similar internal administrative processes, however, Peijas has an Intranet-type system connecting the hospital with health centers while the information process between the parties in unit Hyvinkää is done traditionally with paper documents. All internal medicine cases that were referred from health centers to the hospitals during the study are included. First, in health center a general practitioner begins to diagnose by taking the anamnesis, that is, a preliminary case history of a medical or psychiatric patient. Patient explains the matter in his or her own words and general practitioner uses interviewing technique to lead the conversation in order to confirm or dispatch any presentiments of diagnosis that well forth in mind. Based on the anamnesis and verbal communication general practitioner can also decide to take laboratory tests in order to make the diagnosis more accurate. The behavior behind the sending of a referral can be explained by several factors that may all have an effect to tip the scale in favor of referring (Coulter, Noone & Goldacre, 1989). At the hospital, after examining an incoming referral, the specialist decides its level of urgency, again in one out of the three categories.

Your Doctor Visit (shoulder or left arm pain) What your doctor will ask you about: chest pain generic gasex 100caps with amex, muscle pain buy discount gasex 100 caps online, pain in other joints, pain spreading to other joints. Your doctor will want to know if you or anyone in your family has had any of these conditions: diabetes, high blood pressure, heart disease, past shoulder dislocations, or episodes of bursitis. Your Doctor Visit (hip pain) What your doctor will ask you about: ability to walk, low back pain, muscle pain, pain in other joints, pain spreading to other joints. Your doctor will want to know if you or anyone in your family has had any of these conditions: sickle-cell disease, past surgery on or near hip. Your doctor will want to know if you or anyone in your family has had any of these conditions: hemophilia, past knee injury or surgery. Your Doctor Visit (calf or leg pain) What your doctor will ask you about: muscle pain, pain in other joints, pain spreading to other joints, calf swelling or tenderness, low back pain, pain worsened by coughing. Your doctor will want to know if you or anyone in your family has had any of these conditions: heart disease, chronic lung dis- ease, recent surgery or prolonged immobilization, thrombophlebitis. Your Doctor Visit (general joint pain) What your doctor will ask you about: muscle pain, pain in other joints, pain spreading to other joints, fever, stiffness of joints in the morning, skin lesions, back pain, cough, runny nose, diarrhea, headache, finger pain, discoloration in the cold. Your doctor will want to know if you or anyone in your family has had any of these conditions: rheumatoid arthritis, gout, gon- orrhea, past trauma or surgery to painful area, rheumatic fever, gen- ital discharge. Your doctor will want to know if your pain gets worse at the end of the day or if you feel especially stiff in the morning and, if so, for how long. Your doctor will want to know how long your pain has occurred, and if you were recently exposed to deer ticks or strep throat. JOINT PAIN 135 Your doctor will do a physical examination including the following: • Pain in arms or legs: checking for swelling, tenderness, defor- mity, discoloration or warmth, range of motion. GENERAL JOINT PAIN CAUSE WHAT IS IT YPICAL SYMPTOMS Osteoarthritis Joint inflammation Persistent pain in one or associated with aging more joints, seldom in wrists or elbows or shoul- ders, occurs more com- monly in people over 40 Virus Joint pain associated with Joint pain associated with a viral infection, such as flu-like symptoms, pain the common cold often disappears within a few minutes Post-infectious Joint pain occurring after Pain in at least one joint, arthritis some type of bacterial history of infection with infection the bacteria that cause gonorrhea, history of dis- charge from the vagina or urethra (the tube that car- ries urine out of the body), fever, skin rashes, warmth and tenderness in joints Gout Joint pain caused by Warm and red joints, ten- abnormal breakdown of der and swollen joints, substances by the body pain in at least one joint, family history of gout, tends to occur in big toe 136 JOINT PAIN WHAT CAN CAUSE JOINT PAIN, AND WHAT IS TYPICAL FOR EACH CAUSE? Loss of consciousness most often results from head injury, drug over- dose, or drinking too much alcohol. Your Doctor Visit What the doctor will ask about: fever, shaking chills, headache, sweating, tremulousness, convulsion, trouble breathing, cough, nau- sea, vomiting, painful or difficult urination, dark urine, recent change in urine quantity, change in sensation or movements. The doctor will want to know if the patient or anyone in his fam- ily has had any of these conditions: any chronic disease, convul- sions or seizures, emotional problems, nervous system disease, dia- betes, high blood pressure, renal or liver disease, alcoholism, lung disease, heart disease.