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MURTAGH'S GENERAL PRACTICE 7E
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Table of Contents

The authors v
Foreword viii
Acknowledgments xi
Preface xii
Making the most of your book xiii
Reviewers xvii
Laboratory reference values xx
Normal values: worth knowing by heart xxii
Abbreviations xxiii


Part 1 The basis of general practice 1
Chapter 1 The nature, scope and content
of general practice 2
Chapter 2 The family 6
Chapter 3 Consulting skills 13
Chapter 4 Communication skills 19
Chapter 5 Counselling skills 27
Chapter 6 Difficult, demanding and angry patients 38
Chapter 7 Health promotion and patient education 43
Chapter 8 The elderly patient 48
Chapter 9 Prevention in general practice 64
Chapter 10 Nutrition in health and illness 75
Chapter 11 Palliative care 83
Chapter 12 Pain and its management 93
Chapter 13 Research and evidence-based medicine 107
Chapter 14 Travel medicine 117
Chapter 15 Tropical medicine and the returned traveller 130
Chapter 16 Inspection as a clinical skill 142
Chapter 17 A safe diagnostic strategy 148
Chapter 18 Genetic conditions 157


Part 2
Diagnostic perspective in general practice 177
Chapter 19 Depression 178
Chapter 20 Diabetes mellitus 187
Chapter 21 Drug and alcohol problems 205
Chapter 22 Anaemia 222
Chapter 23 Endocrine and metabolic disorders 230
Chapter 24 Spinal dysfunction 243
Chapter 25 Urinary tract infection 246
Chapter 26 Malignant disease 255
Chapter 27 HIV/AIDS-could it be HIV? 264
Chapter 28 Baffling viral and protozoal infections 276
Chapter 29 Baffling bacterial infections 283
Chapter 30 Infections of the central nervous system 297
Chapter 31 Chronic kidney failure 303
Chapter 32 Connective tissue disease and the systemic vasculitides 311
Chapter 33 Neurological dilemmas 321


Part 3
Problem solving in general practice 339
Chapter 34 Abdominal pain 340
Chapter 35 Arthritis 363
Chapter 36 Anorectal disorders 385
Chapter 37 Thoracic back pain 394
Chapter 38 Low back pain 408
Chapter 39 Bruising and bleeding 429
Chapter 40 Chest pain 439
Chapter 41 Constipation 461
Chapter 42 Cough 472
Chapter 43 Deafness and hearing loss 487
Chapter 44 Diarrhoea 497
Chapter 45 The disturbed patient 515
Chapter 46 Dizziness/vertigo 535
Chapter 47 Dyspepsia (indigestion) 545
Chapter 48 Dysphagia 555
Chapter 49 Dyspnoea 560
Chapter 50 The painful ear 573
Chapter 51 The red and tender eye 587
Chapter 52 Pain in the face 603
Chapter 53 Fever and chills 613
Chapter 54 Faints, fits and funny turns 623
Chapter 55 Haematemesis and melaena 632
Chapter 56 Headache 635
Chapter 57 Hoarseness 653
Chapter 58 Jaundice 657
Chapter 59 Nasal disorders 674
Chapter 60 Nausea and vomiting 684
Chapter 61 Neck lumps 690
Chapter 62 Neck pain 695
Chapter 63 Shoulder pain 709
Chapter 64 Pain in the arm and hand 722
Chapter 65 Hip, buttock and groin pain 739
Chapter 66 Pain in the leg 752
Chapter 67 The painful knee 770
Chapter 68 Pain in the foot and ankle 790
Chapter 69 Walking difficulty and leg swelling 807
Chapter 70 Palpitations 814
Chapter 71 Sleep disorders 828
Chapter 72 Sore mouth and tongue 839
Chapter 73 Sore throat 850
Chapter 74 Tiredness/fatigue 859
Chapter 75 The unconscious patient 866
Chapter 76 Urinary disorders 875
Chapter 77 Visual failure 887
Chapter 78 Weight gain 900
Chapter 79 Weight loss 909


Part 4
Chronic disorders: continuing management 917
Chapter 80 Allergic disorders including hay fever 918
Chapter 81 Anxiety disorders 926
Chapter 82 Asthma 935
Chapter 83 Chronic obstructive pulmonary disease 948
Chapter 84 Epilepsy 956
Chapter 85 Cardiovascular disease 965
Chapter 86 Hypertension 969
Chapter 87 Dyslipidaemia 986
Chapter 88 Chronic heart failure 991
Chapter 89 Osteoporosis 998
Part 5 Child and adolescent health 1003
Chapter 90 An approach to the child 1004
Chapter 91 Specific problems of children 1014
Chapter 92 Surgical problems in children 1030
Chapter 93 Common childhood infectious diseases (including skin eruptions) 1041
Chapter 94 Behavioural and developmental
issues and disorders in children 1054
Chapter 95 Child abuse 1067
Chapter 96 Emergencies in children 1075
Chapter 97 Adolescent health 1090


Part 6 Women's health 1097
Chapter 98 Cervical cancer screening 1098
Chapter 99 Family planning 1107
Chapter 100 Breast pain (mastalgia) 1118
Chapter 101 Lumps in the breast 1123
Chapter 102 Abnormal uterine bleeding 1135
Chapter 103 Lower abdominal and pelvic pain in women 1143
Chapter 104 Premenstrual syndrome 1156
Chapter 105 The menopause 1160
Chapter 106 Vaginal discharge 1168
Chapter 107 Vulvar disorders 1176
Chapter 108 Basic antenatal care 1184
Chapter 109 Postnatal care 1193


Part 7 Male health 1201
Chapter 110 Male health: an overview 1202
Chapter 111 Scrotal pain 1206
Chapter 112 Inguinoscrotal lumps 1211
Chapter 113 Disorders of the penis 1222
Chapter 114 Disorders of the prostate 1230


Part 8 Sexual health 1241
Chapter 115 The subfertile couple 1242
Chapter 116 Sexual health 1250
Chapter 117 Sexually transmitted infections 1260
Chapter 118 Intimate partner violence and sexual assault 1273


Part 9 Problems of the skin 1279
Chapter 119 A diagnostic and management approach to skin problems 1280
Chapter 120 Pruritus 1290
Chapter 121 Common skin problems 1300
Chapter 122 Acute skin eruptions 1322
Chapter 123 Skin ulcers 1334
Chapter 124 Common lumps and bumps 1344
Chapter 125 Pigmented skin lesions 1362
Chapter 126 Hair disorders 1372
Chapter 127 Nail disorders 1383


Part 10
Accident and emergency medicine 1393
Chapter 128 Emergency care 1394
Chapter 129 The doctor's bag and other emergency equipment 1410
Chapter 130 Stroke and transient ischaemic attacks 1415
Chapter 131 Thrombosis and thromboembolism 1422
Chapter 132 Common skin wounds and foreign bodies 1428
Chapter 133 Common fractures and dislocations 1442


Part 11 Health of specific groups 1467
Chapter 134 The health of Aboriginal and Torres Strait Islander peoples 1468
Chapter 135 Refugee health 1477


Appendix 1483
Index 1488


About the Author

Professor John Murtagh AM

MBBS, MD, BSc, BEd, FRACGP, DipObstRCOG

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

MBBS, FRACGP, MPH

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

MBBS, FRACGP

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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