Zebras on the commons: rare conditions in family practice.
BACKGROUND
Family physicians (FPs) specialize in the management of common problems, but we know little about their role in the care of patients with rare conditions.


OBJECTIVE
To describe the roles FPs play in the identification and management of patients with rare conditions in a typical practice.


METHODS
Office record review of 100 patients with rare conditions in the everyday, community-based, private practice of 4 FPs. Analysis of patient demographic characteristics, diagnoses, and the roles played by the FP in the patient's care, including diagnosis, treatment, referral, and long-term patient management.


RESULTS
These FPs cared for patients with a wide variety of rare disorders across the spectrum of patient age and sex, organ system involved, and medical specialty area. FPs identified the problem in 89%, diagnosed the disorder in 54%, provided acute care in 56%, and provided continuing care for 76% of patients. FPs consulted other physicians in 85% of cases. The condition was life threatening in 58% of patients.


CONCLUSIONS
Family physicians provide a broad range of services to a wide variety of patients with rare medical problems.
Phillips
William R
WR
Department of Family Medicine, University of Washington, Seattle, 98195-6390, USA. wphllps@u.washington.edu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011331:Private Practice; D035583:Rare Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013038:Specialization