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Table of Contents

The authors vForeword viiiAcknowledgments xiPreface xiiMaking the most of your book xiiiReviewers xviiLaboratory reference values xxNormal values: worth knowing by heart xxiiAbbreviations xxiiiPart 1 The basis of general practice 1Chapter 1 The nature, scope and contentof general practice 2Chapter 2 The family 6Chapter 3 Consulting skills 13Chapter 4 Communication skills 19Chapter 5 Counselling skills 27Chapter 6 Difficult, demanding and angrypatients 38Chapter 7 Health promotion and patienteducation 43Chapter 8 The elderly patient 48Chapter 9 Prevention in general practice 64Chapter 10 Nutrition in health and illness 75Chapter 11 Palliative care 83Chapter 12 Pain and its management 93Chapter 13 Research and evidence-basedmedicine 107Chapter 14 Travel medicine 117Chapter 15 Tropical medicine and the returnedtraveller 130Chapter 16 Inspection as a clinical skill 142Chapter 17 A safe diagnostic strategy 148Chapter 18 Genetic conditions 157Part 2Diagnostic perspective ingeneral practice 177Chapter 19 Depression 178Chapter 20 Diabetes mellitus 187Chapter 21 Drug and alcohol problems 205Chapter 22 Anaemia 222Chapter 23 Endocrine and metabolic disorders 230Chapter 24 Spinal dysfunction 243Chapter 25 Urinary tract infection 246Chapter 26 Malignant disease 255Chapter 27 HIV/AIDS-could it be HIV? 264Chapter 28 Baffling viral and protozoal infections 276Chapter 29 Baffling bacterial infections 283Chapter 30 Infections of the central nervoussystem 297Chapter 31 Chronic kidney failure 303Chapter 32 Connective tissue disease and thesystemic vasculitides 311Chapter 33 Neurological dilemmas 321Part 3Problem solving in generalpractice 339Chapter 34 Abdominal pain 340Chapter 35 Arthritis 363Chapter 36 Anorectal disorders 385Chapter 37 Thoracic back pain 394Chapter 38 Low back pain 408Chapter 39 Bruising and bleeding 429Chapter 40 Chest pain 439Chapter 41 Constipation 461Chapter 42 Cough 472Chapter 43 Deafness and hearing loss 487Chapter 44 Diarrhoea 497Chapter 45 The disturbed patient 515Chapter 46 Dizziness/vertigo 535Chapter 47 Dyspepsia (indigestion) 545Chapter 48 Dysphagia 555Chapter 49 Dyspnoea 560Chapter 50 The painful ear 573Chapter 51 The red and tender eye 587Chapter 52 Pain in the face 603Chapter 53 Fever and chills 613Chapter 54 Faints, fits and funny turns 623Chapter 55 Haematemesis and melaena 632Chapter 56 Headache 635Chapter 57 Hoarseness 653Chapter 58 Jaundice 657Chapter 59 Nasal disorders 674Chapter 60 Nausea and vomiting 684Chapter 61 Neck lumps 690Chapter 62 Neck pain 695Chapter 63 Shoulder pain 709Chapter 64 Pain in the arm and hand 722Chapter 65 Hip, buttock and groin pain 739Chapter 66 Pain in the leg 752Chapter 67 The painful knee 770Chapter 68 Pain in the foot and ankle 790Chapter 69 Walking difficulty and leg swelling 807Chapter 70 Palpitations 814CONTENTSxChapter 71 Sleep disorders 828Chapter 72 Sore mouth and tongue 839Chapter 73 Sore throat 850Chapter 74 Tiredness/fatigue 859Chapter 75 The unconscious patient 866Chapter 76 Urinary disorders 875Chapter 77 Visual failure 887Chapter 78 Weight gain 900Chapter 79 Weight loss 909Part 4Chronic disorders: continuingmanagement 917Chapter 80 Allergic disorders including hay fever 918Chapter 81 Anxiety disorders 926Chapter 82 Asthma 935Chapter 83 Chronic obstructive pulmonary disease 948Chapter 84 Epilepsy 956Chapter 85 Cardiovascular disease 965Chapter 86 Hypertension 969Chapter 87 Dyslipidaemia 986Chapter 88 Chronic heart failure 991Chapter 89 Osteoporosis 998Part 5 Child and adolescent health 1003Chapter 90 An approach to the child 1004Chapter 91 Specific problems of children 1014Chapter 92 Surgical problems in children 1030Chapter 93 Common childhood infectiousdiseases (including skin eruptions) 1041Chapter 94 Behavioural and developmentalissues and disorders in children 1054Chapter 95 Child abuse 1067Chapter 96 Emergencies in children 1075Chapter 97 Adolescent health 1090Part 6 Women's health 1097Chapter 98 Cervical cancer screening 1098Chapter 99 Family planning 1107Chapter 100 Breast pain (mastalgia) 1118Chapter 101 Lumps in the breast 1123Chapter 102 Abnormal uterine bleeding 1135Chapter 103 Lower abdominal and pelvic painin women 1143Chapter 104 Premenstrual syndrome 1156Chapter 105 The menopause 1160Chapter 106 Vaginal discharge 1168Chapter 107 Vulvar disorders 1176Chapter 108 Basic antenatal care 1184Chapter 109 Postnatal care 1193Part 7 Male health 1201Chapter 110 Male health: an overview 1202Chapter 111 Scrotal pain 1206Chapter 112 Inguinoscrotal lumps 1211Chapter 113 Disorders of the penis 1222Chapter 114 Disorders of the prostate 1230Part 8 Sexual health 1241Chapter 115 The subfertile couple 1242Chapter 116 Sexual health 1250Chapter 117 Sexually transmitted infections 1260Chapter 118 Intimate partner violence andsexual assault 1273Part 9 Problems of the skin 1279Chapter 119 A diagnostic and managementapproach to skin problems 1280Chapter 120 Pruritus 1290Chapter 121 Common skin problems 1300Chapter 122 Acute skin eruptions 1322Chapter 123 Skin ulcers 1334Chapter 124 Common lumps and bumps 1344Chapter 125 Pigmented skin lesions 1362Chapter 126 Hair disorders 1372Chapter 127 Nail disorders 1383Part 10Accident and emergencymedicine 1393Chapter 128 Emergency care 1394Chapter 129 The doctor's bag and otheremergency equipment 1410Chapter 130 Stroke and transient ischaemic attacks 1415Chapter 131 Thrombosis and thromboembolism 1422Chapter 132 Common skin wounds and foreignbodies 1428Chapter 133 Common fractures and dislocations 1442Part 11 Health of specific groups 1467Chapter 134 The health of Aboriginal and TorresStrait Islander peoples 1468Chapter 135 Refugee health 1477Appendix 1483Index 1488

About the Author

Professor John Murtagh AM


Emeritus Professor in General Practice, School of Primary Health, Monash University, Melbourne

Professorial Fellow, Department of General Practice, University of Melbourne

Adjunct Clinical Professor, Graduate School of Medicine, University of Notre Dame, Fremantle, Western Australia

John Murtagh was a science master teaching chemistry, biology and physics in Victorian secondary schools when he was admitted to the first intake of the newly established Medical School at Monash University, graduating in 1966. Following a comprehensive postgraduate training program, which included surgical registrarship, he practised in partnership with his wife, Dr Jill Rosenblatt, for 10 years in the rural community of Neerim South, Victoria.

He was appointed Senior Lecturer (part-time) in the Department of Community Medicine at Monash University and eventually returned to Melbourne as a full-time Senior Lecturer. He was appointed to a professorial chair in Community Medicine at Box Hill Hospital in 1988 and subsequently as chairman of the extended department and Professor of General Practice in 1993 until retirement from this position in 2010. He now holds teaching positions as Emeritus Professor in General Practice at Monash University, Adjunct Clinical Professor, University of Notre Dame and Professorial Fellow, University of Melbourne. He achieved the Doctor of Medicine degree in 1988 for his thesis `The management of back pain in general practice'.

He was appointed Associate Medical Editor of Australian Family Physician in 1980 and Medical Editor in 1986, a position he held until 1995. In 1995 he was awarded the Member of the Order of Australia for services to medicine, particularly in the areas of medical education, research and publishing.

One of his numerous publications, Practice Tips, was named as the British Medical Association's Best Primary Care Book Award in 2005. In the same year he was named as one of the most influential people in general practice by the publication Australian Doctor. John Murtagh was awarded the inaugural David de Kretser medal from Monash University for his exceptional contribution to the Faculty of Medicine, Nursing and Health Sciences over a significant period of time. Members of the Royal Australian College of General Practitioners may know that the honour of the namesake of the College library was bestowed upon him.

In 2018 he will host the 40th Annual John Murtagh Update Course for General Practitioners at Monash University.

Today John Murtagh continues to enjoy active participation with the diverse spectrum of general practitioners-whether they are students or experienced practitioners, rural- or urban-based, local or international medical graduates, clinicians or researchers. His vast experience with all of these groups has provided him with tremendous insights into their needs, which is reflected in the culminated experience and wisdom of John Murtagh's General Practice.

Dr Jill Rosenblatt

MBBS, FRACGP, DipObstRCOG, GradDipAppSci

Adjunct Senior Lecturer, School of Primary Health Care, Monash University, Melbourne

Jill Rosenblatt graduated in medicine from the University of Melbourne in 1968. Following terms as a resident medical officer she entered rural practice in Neerim South, Victoria, in partnership with her husband John Murtagh. She was responsible for inpatient hospital care in the Neerim District Bush Nursing Hospital and in the West Gippsland Base Hospital. Her special interests were obstetrics, paediatrics and anaesthetics. Jill has also had a special interest in Indigenous culture and health since she lived at Koonibba Mission in South Australia, where her father was Superintendent.

After leaving rural life she came to Melbourne and joined the Ashwood Medical Group, where she practised comprehensive general medicine, and care of the elderly in particular. She was appointed Adjunct Senior Lecturer in the Department of General Practice at Monash University in 1980 and a teacher in the GP registrar program.

She gained a Diploma of Sports Medicine (RACGP) in 1985 and a Graduate Diploma of Applied Science in Nutritional and Environmental Medicine from Swinburne University of Technology in 2001.

Jill Rosenblatt brings a wealth of diverse experience to the compilation of this textbook. This is based on 50 years of experience in rural and metropolitan general practice. In addition she has served as clinical assistant to the Shepherd Foundation, the Menopause Clinics at Prince Henry's Hospital and Box Hill Hospital and the Department of Anaesthetics at Prince Henry's Hospital. Jill has served as an examiner for the RACGP for 39 years and for the Australian Medical Council for 16 years. She was awarded a life membership of the Royal Australian College of General Practitioners in 2010 and a Distinguished Service award of the College in 2014.

Dr Justin Coleman


General Practitioner, Inala Indigenous Health Service, Brisbane

Senior Lecturer, Griffith University

Senior Lecturer, University of Queensland

Editor, Diabetes Management Journal

Chair of Choosing Wisely working group, RACGP

Justin Coleman graduated from Melbourne University medicine in 1992 and spent the next two decades

as a rural GP in Victoria and the remote Northern Territory before settling in Brisbane, where he works in Aboriginal and Torres Strait Islander health.

Soon after graduating, Justin began writing for the GP newspaper Medical Observer and hasn't stopped since. One of his weekly columns, `Handy Hints for GPs', ran for 13 years. He even wrote 40 humorous columns until the editors lost their sense of humour.

Justin is a prolific writer for medical and non-medical readerships; he has published well over 1,000 medical articles in around 50 different newspapers, magazines, books and journals. For five years he served as President of the Australasian Medical Writers Association and he regularly runs writing workshops for medical writers and academics.

Since completing a Master of Public Health (UQ 2011, first class hons), Justin has dedicated much of his career to educating other GPs about how to improve various aspects of medical practice. His interests include evidence-based medicine, the rational use of medical tests and treatments, and dealing with uncertainty during a GP consultation. He represents the RACGP on matters pertaining to conflicts of interest and fiercely guards his own independence, never having accepted payment from a pharmaceutical or medical device company.

For the past quarter of a century, Justin has supervised hundreds of medical students and GP registrars. He has taught in the medical schools of three universities and for a dozen medical education organisations.

Justin edited his first medical book 20 years ago and has remained a medical editor ever since. He completed a Writing and Editing program in 2010 (UQ, first class hons). He currently edits Diabetes Management Journal, writes and does peer reviews for the MJA, AJGP (formerly AFP) and BMJ, and is a member of the Australasian Health and Medical journal Editors' Network (AHMEN).

Justin was honoured to be invited by Professor John Murtagh to help edit Australia's seminal textbook on general practice. This represents the grand intersection of every one of his aforementioned interests.

Dr Clare Murtagh


General Practitioner, Your Doctors, Leichhardt

Clare Murtagh completed her medical studies at Monash University in 2007 and spent her early career working in hospitals in Geelong and rural Victoria. Following experience as a medical officer for trekkers in Nepal, she moved to Sydney where she completed her General Practice training in 2013.

A passionate generalist, Clare has special interest in dermatology, travel medicine, women's health and paediatrics. She holds a Diploma of Dermatology and Certificates in Sexual and Reproductive Health, and Medical Education. In her practice at Your Doctors in Sydney's inner west, she cares for a wide variety of patients and is an antenatal shared care provider.

In recent years, Clare has gained increasing experience in medical education as a supervisor of training GPs and as an examiner for the RACGP. She has worked as a medical educator at GP Synergy and is a lecturer on dermatology.

Clare has been an enthusiastic contributor to the `Women's health', `Sexual health' and `Problems of the skin' sections of the sixth and seventh edition of Murtagh's General Practice. As the daughter of co-authors John Murtagh and Jill Rosenblatt, she has benefited from their mentorship and appreciates the genesis and philosophy of the editorial direction of the textbook.

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