School of Medicine

Rare Case of Male Breast Cancer

• Male breast cancer represents 1% of all breast cancer nationally.  This case presentation describes a healthy 51 year old African American man who presented with a 3-day history of arm pain.
• On physician examination the patient was found to have a mass in his left breast as an incidental finding. The differential diagnosis includes osteoarthritis, tendonitis, bursitis, and metastatic bone cancer.  A biopsy confirmed the diagnosis of breast cancer. 
• The patient received chemotherapy and radiation therapy and is alive 3 1/2 years after his diagnosis. Overall 5 year survival rate for this stage IV cancer is 0-25%. 

Morris P, Markova T, Roe T. Bone pain and a worrisome family history.  Patient Care. 2006; 40 (2): 65-66.

Organizational and Learning Environments in Ambulatory Clinics

• Investigations of teaching quality in ambulatory clinics have generally focused on faculty and medical student perspectives.  We surveyed faculty, residents and nursing staff to explore clinic employees’ perspectives on organizational and learning environments and quality of teaching.
• Opinions about availability of structured learning opportunities for residents explained the most variance (35.2%) in the overall assessment of teaching quality.  The addition of job satisfaction brought the explained variance up to 46.4%.  Improvement in residents’ In-training Examination scores corresponded with higher learning and organizational environment assessment scores.
• Learning opportunities should be structured so that residents are oriented to the ambulatory clinic, have their knowledge assessed regularly, are helped to meet individual goals, and are given appropriate levels of responsibility.  Prioritizing efforts to improve job satisfaction for all employees is important because of its potential to influence quality of teaching and learning.

Roth LM, Severson RK, Probst J, Monsur J, Markova T, Kushner S, Schenk M. Exploring physician and staff perceptions of the learning environment in ambulatory residency clinics.  Family Medicine. 2006; 38 (3):177-184.

Symptoms and Emotional Abuse

• In this cross-sectional, multicenter study of victimization, 47 adult women meeting criteria for emotional abuse (past year) and no physical abuse were matched demographically with 47 non-abused women, and compared on physical and emotional symptoms, alcohol use problems, and social support problems.
• Emotionally abused women reported more physical and psychological symptoms than non-abused controls and more social support problems than non-abused controls. 
• This study supports literature that demonstrates an association between emotional abuse and physical and emotional symptoms in women who are currently suffering emotional abuse.  We recommend that physicians inquire about emotional abuse in female patients with multiple psychosocial and physical symptoms.

Porcerelli JH, West P, Binienda J.  Physical and psychological symptoms in emotionally abused and non-abused women.  Journal of the American Board of Family Medicine. 2006; 19 (2):201-204.

Health Care Attitudes and Behaviors of Immigrant Women

• We surveyed women patients seeking health care in Hamtramck, Mich. about health-seeking behaviors and satisfaction with the U.S. health care system. 43% were immigrants, primarily Bangladeshi, Yemeni and Bosnian.
• Compared with U.S.-born women, immigrant women reported greater satisfaction with our health care system and were more likely to visit their physician when feeling ill and more likely to bring a friend or relative to help alleviate communication problems. Immigrant women were also more likely to express a desire for a female physician and one from a similar cultural background.
• Family and social support play an important role in how and when immigrant women seek health care. As the immigrant population in the U.S. continues to grow, it is important for physicians to understand cultural and socioeconomic patient environment in order to provide quality patient-centered care.

Markova T, Dean F, Neale AV. Health care attitudes and behaviors of immigrant women and U.S.-born women in Hamtramck: A MetroNet study. Ethnicity and Disease. 2007; 7: 650-656.

Common Health Care Issues for Geriatric Patients

• The number of persons aged > 65 in the U.S. will double during the next 30 years, requiring family physicians to competently address the health care needs of the elderly.
• This publication focuses on 4 geriatric health care problems commonly seen in the family medicine setting: osteoporosis, pressure ulcers, dementia, and complications from polypharmacy.
• The most current, evidenced-based treatment guidelines are presented.

Morris P. Common health care issues for geriatric patients. Hospital Physician Board Review Manual. 2007; 7 (3): 1-13.

Personality Disorders in Primary Care

• Personality disorders (PDs) have an estimated incidence as high as 24% in primary care, are difficult to assess, pose a threat to the doctor-patient relationships, and if  unrecognized, can lead to significant functional impairment.
• This paper focuses on 4 PDs that have the potential to cause significant problems for both physicians and patients: paranoid, antisocial, borderline, and dependent disorders.
• We describe these PDs, review the prevalence and comorbidities, provide a case example, and discuss treatment/management strategies.

Porcerelli JH, Huprich SK. Approach to personality disorders in primary care. Hospital Physician. 2007; 43, 2-11.