LWBK848-FM_i-xvi:sloane 3/1/11 8:45 PM Page i ESSENTIALS OF FAMILY MEDICINE 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 Essentials TM 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 Baltimore, MD 21201 Two Commerce Square, 2001 Market Street 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, 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 website at lww.com (products and services). 987654321 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