Routine Care of the Healthy Patient + The U.S. Preventive Services Task Force recommends routine periodic screening for hypertension, obesity, dyslipidemia (men 235 years), osteoporosis (women 265 years), abdominal aortic aneurysm (one-time-screening), depression, and HIV infection + The U.S. Preventive Services Task Force recommends routine periodic screening for colorectal cancer (persons 50-74 years of age), breast cancer (women 240 years), and cervical cancer. + The U.S. Preventive Services Task Force recommends that all pregnant women be screened for asymptomatic bacteriuria, iron-deficiency anemia, hepatitis B virus, and syphilis. + The U.S. Preventive Services Task Force recommends against screening for hemochromatosis; carotid artery stenosis; coronary artery disease; herpes simplex virus; or testicular, ovarian, pancreatic, or bladder cancer. + Outside of prenatal, preconception, and newbom care, genetic testing should not be performed in unselected populations because of lower clinical validity; potential for false Positives; and potential for harm, including “genetic labeling.” + For patients for whom genetic testing may be appropriate, referral for genetic counseling should be provided before and after testing, + Ahuman papillomavirus vaccine series is indicated in females ages 9 through 26 years, regardless of sexual activity, for prevention of cervical cancer. + Asingle dose of tetanus-diphtheria-acellular pertussis (Tdap) vaccine should be given to adults ages 19 through 64 years to replace the next tetanus-diphtheria toxoid (Td) booster. + Azzoster (shingles) vaccine is given to all patients 60 years and older regardless of history of prior shingles or varicella infection. + Asymptomatic adults who plan to be physically active at the recommended levels do not need to consult with a physician prior to beginning exercise unless they have a specific medical question. + Smoking status should be determined for all patients. + Patients who want to quit smoking should be offered pharmacologic therapy in additionto counseling, including telephone quit lines. + Routine screening is recommended to identify persons whose alcohol use puts them at risk. + For management of alcohol abuse and dependence, referral for specialty treatment is, recommended; for management of alcohol misuse, brief behavioral counseling may be useful. + Clues for chemical dependency include unexpected behavioral changes, acute intoxication, frequent job changes, unexplained financial problems, family history of substance abuse, frequent problems with law enforcement agencies, having a partner with substance abuse, and medical sequelae of drug abuse + Condom use reduces transmission of HIV, Chlamydia, gonorrhea, Trichomonas, herpesvirus, and human papillomavirus. + Itis important to ask about domestic violence when patients present with symptoms or behaviors that may be associated with abuse + When an abusive situation is identified, address immediate safety needs. Patient Safety + Diagnostic error is typically multifactorial, with an average of 5.9 system-related or cognitive factors contributing to a single diagnostic error. + Strategies for building redundancy into a health care system’s safety processes include checklist systems, time-out policies, and force functions, such as automatic checks and reminders. + The Plan-Do-Study-Act (PDSA) cycle is an effective means for performance improvement teams to implement changes to address specific patient safety problems + Akey strategy for reducing diagnostic error is to compile a complete differential diagnosis to avoid “premature closure.” + The best practice for patient hand-off includes person-to-person communication and information that is accurate and concise,Professionalism and Ethics + The three fundamental principles of medical professionalism are the primacy of patient welfare, patient autonomy, and social justice. + Advance directives include instructions about what kind of care should be provided (living wills) and who should make the decisions if the patient cannot do so (proxy designations). + The three elements required for informed consent include disclosure of relevant information, comprehension by the patient, and lack of coercion. + Decision-making competency assessment can range from less to more stringent, depending on the consequences of the decision, and may include the patient's ability to express a choice, general decision-making capacity, comprehension of specific. information, rational reasons, and reasonable outcomes. + Life support measures need not be started or continued if they are thought to be medically futile; however, legal opinion may vary and if doubt exists, the wishes of the patient or surrogate are usually favored + A request for physician-assisted suicide is often a signal that a patient has unmet needs, including fear, hopelessness, difficult social circumstances, and severe pain and suffering, + Despite mixed public opinion, physician-assisted suicide is illegal in most of the United States, and active euthanasia is illegal in all states. + Discussions of patient information should not take plac public places + The physician should not release any private, identifiable patient information without the patient's consent. + Conflicts of interest include potential for overuse in a fee-for-service setting, for underuse in a managed care setting, acceptance of gifts from pharmaceutical companies or medical device manufacturers, and certain business arrangements regarding referrals. + Conflicts of interest should be avoided, if possible; if avoidance is not possible, they should be disclosed. + Sexual relationships between a physician and a patient are considered unethical because of the inequality of power, potentially placing the patient in a vulnerable and dependent