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Following an American and then international initiative, the Swiss Society of Internal Medicine launched the « Smarter Medicine » campaign in 2014 with five recommendations of activities to be avoided, focusing on low back pain, antibiotic prescriptions, pre-operative chest x-rays, prostate cancer screening and treatment with proton pump inhibitors. In 2016, 69 % of family physicians reported that they knew the recommendations and levels of agreement were very high. However, physicians reported differences between recommendations in how often they are followed in practice, and there remains room for improvement. We need to put in place training programs at the pre- and post-graduate levels, as well as continuing medical education. It would also be useful to educate patients., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The general internist cannot be a passive bystander of the anticipated medical revolution induced by precision medicine. This latter aims to improve the predictive and/or clinical course of an individual by integrating all biological, genetic, environmental, phenotypic and psychosocial knowledge of a person. In this article, national and international initiatives in the field of precision medicine are discussed as well as the potential financial, ethical and limitations of personalized medicine. The question is not to know if precision medicine will be part of everyday life but rather to integrate early the general internist in multidisciplinary teams to ensure optimal information and shared-decision process with patients and individuals., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

This article comments 9 original publications from year 2014 of interest for the primary care physician in the outpatient setting. The impact of diet such as nut consumption on health outcomes and mortality is developped, and the importance of dietary changes while taking statins is reminded. Red flags in low back pain and their predictive value are re-evaluated. An association between benzodiazepine use and Alzheimer dementia seems probable. New treatments for alcohol abuse, restless legs syndrome and type 2 diabetes are discussed. Finally, β-bloquers' effects on respiratory function in asthmatic patients are beeing reexamined.

A common training plan in general internal medicine was a brave enterprise started in 2011 in accordance with the common objectives of the Swiss Society of General Medicine and the Swiss Society of Internal Medicine. The next challenge will be the dissolution of the two Societies and therefore the creation of an unique new association in 2015. This is an extraordinary opportunity to bring together the specific qualities of each association and to create a new society. Issues, objectives and secondary benefits expected from the creation of the largest national society of a medical discipline are explored as a joint discussion in this article.

After decades of remarkable development, medicine is facing a tough economic reality and new challenges. These challenges include defining the values, objectives and tasks of sustainable medicine. In this context, the concept of "less is more" emerged in North America. "Less is more" is an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health. It is therefore necessary to drive unnecessary and costly practices by streamlining care without rationing.

Polymorbidity affects an increasing number of patients of all ages as demonstrated by a recent epidemiological study and represents a real challenge for the organization of health care. Appropriate management of polymorbid patients requires an interdisciplinary approach associating generalist and specialist physicians, but also nurses, other health professionals and social workers. An improvement in transition care between the community and the hospital is necessary in both directions. Prioritizing the treatment objectives is essential to allow patient adherence and avoid cumulative drug interactions and adverse effects. Those objectives are difficult to attain in the context of our present health care organization. This paper attempts to identify the difficulties involved in caring for polymorbid patients and propose ways to improve it.

Ten articles published in 2012 and of interest for the practice of ambulatory general internal medicine are reviewed in this paper. Topics of public health issues, such as the association between sleep disorders and prediabetes, the association between prediabetes and stroke, and the harmful effects of prolonged sitting are tackled. Other focuses include hepatitis C screening, abdominal aortic aneurysm screening and prostatic cancer screening. Therapeutic aspects are reviewed, such as the management of nongonococcal urethritis, the treatment of iron deficiency without anemia and the substitution of subclinical hypothyroidism. Finally a new study about aspirin and cancer prevention is discussed.

Episodes of heart failure impact on patients' quality of life as well as their morbidity and mortality. This article describes a series of interventions designed by a group of primary care practitioners in Geneva. Some interventions aim to improve patients' autonomy in identifying the first signs of heart failure to act immediately. Others focus on patients' motivation to adopt appropriate behaviours (physical activity, etc.). And finally others have the objective to improve coordination between ambulatory and hospital care, as well as the transmission of clinical information. The implementation of these interventions highlights the need for individualised objectives of care in complex cases where patients have several co-morbidities and/or complicated social situations. In these situations an interdisciplinary approach is also essential.

Since 2007, the number of people living in cities exceeds that of rural areas. Thus, cities and their organizations have a major influence on all spheres of human life, especially health. This influence may generate inequality, suffering and disease, but also represent an opportunity for health and well-being. This paper introduces the concept of urban health, particularly in terms of primary care medicine and presents solutions that encompass a wide field (politics, urban planning, social inequality, education). Improving urban health requires collaboration of medical with non-medical actors, in order to become of development (re-) urban structure and promotes the health of all.

This review of articles published in 2011 covers a large spectrum of topics that are of interest for the practice of general internal medicine and of primary care. Authors discuss public health issues, such as sleep disorders and their relationship with subsequent weight disorders, and the benefits of commercial weight reduction programs. Clinical topics, such as the management of victims of sexual violence and screening strategies for lung cancer, streptococcal pharyngitis, functional bowel disorders and hypertension in ambulatory settings are also reviewed. Besides, authors cover therapeutic issues, such as the treatment of hand arthritis with chondroitin sulfate and the management of plantar warts with salicylic acids and cryotherapy.

Obesity is a major public health problem. Primary care physicians play a key role in managing nutritional disorders. However, they often lack the necessary resources to answer patients' questions. Collaboration with professional nutritionists helps primary care physicians to improve their treatment of patients with problems related to nutrition by means of specific knowledge and therapeutic approaches.

Oral health (OH) is indivisible from general health. Several studies have established the link between morbi-mortality, especially cardiovascular, and bad OH, particularly in the case of edentation. Regrettably, part of the population choses dental care renunciation for financial reasons. The primary care physician (PCP), as the health professionnal with the most frequent and intense contacts with the patients, plays an important role to reinforce prevention measures, OH maintenance and to detect oral pathologies. To fulfill this mission, he has to be trained to endo-buccal examination. Furthermore, both the PCP and the dentist have to proactively build an interprofessional approach to promote patients' OH.

This review of articles published in 2010 covers the new role of dabigatran in atrial fibrillation, the lack of efficacy on pain of chondroïtine/ glucosamine in knee arthrosis, the risk of thrombosis with antipsychotics, the increase cardiovascular risk in case of migraine with aura and the insufficient prescription of adjuvant chemotherapy in elderly with colon cancer. Authors also highlight public health topics such as the association of poor oral hygiene and increased cardiovascular risk, the positive effect of opioid substitution therapy by primary care practitioners on mortality, the high frequency of prenatal violence on pregnant women and the negative impact of financial constraint on the risk of hospitalization.

Hunger strike is not a disease but a common situation in prisons. This article takes a historical look at medical practices in connection with the forced feeding of hunger strikers. We now know the fate of the strikers who were subjected to forced feeding. Depending on the context and the political situation in the country, the fate of these people, mostly political prisoners, is described as humiliating and abominable frequently ending in death or irreparable consequences. Particularly difficult for health professionals, this act raises clinical, ethical and legal questions and refers to the fundamental principles of medicine.

Pulmonary embolism is a difficult diagnosis that may be missed because of an aspecific clinical presentation. Being the most accurate to confirm or exclude the disease is a matter of concern, as effective treatment exists and a possibly fatal outcome without it. Scores and guidelines can help us. However, they cannot replace clinical sense. What are the options when laboratory results put us on the wrong track, such as in a patient with a clinical presentation suggestive of a pulmonary embolism, but whose D-dimers are within the normal range?

The concept of early detection to then intervene and improve the prognostic seems straightforward. Applied to asymptomatic subjects, this concept--screening--is rather complex. This review presents the rational and fundamental principles of screening. It underscores the fundamental principles related to the disease and to the screening test considered, the importance of considering screening as a program rather than a test only, and the validity of measures used to evaluate the efficacy of screening. Lastly, it reviews the most frequently bias encountered in screening studies and interpretations.

Staff physicians of the Division of Primary care medicine of the University Hospitals of Geneva selected 9 articles published in year 2009 based on that they either brought new insights into the handling of current medical problems or that they broadened current knowledge of complex situations in the ambulatory care setting. Their field covers medication treatment for depression, neuropathic pain, facial palsy, osteoporosis, congestive heart failure, as well as during pregnancy. Updates on cardiovascular prevention, on screening of alcohol abuse and on the impact of social determinants on health are also provided.

Comparatively to office blood pressure measurement, 24h ambulatory blood pressure monitoring (ABPM) provides a more accurate evaluation of the patient's blood pressure and of the burden of the arterial pressure in real life. This measurement is better correlated with cardiovascular risk, with hypertension-related organ damage and its changes with treatment, than does office blood pressure. It allows diagnosis of white coat and masked hypertension, and of alteration in blood pressure's circadian rhythm. This article aims to summarise ABPM's indications, to point out its advantages and give some key practical messages to realize and properly interpret this exam.

Considering that angina is an important symptom of coronary heart disease, exercise stress testing has proven its usefulness and remains a reference exam. Indeed, it is reasonably reliable and accessible, even for non cardiologist physicians, and provides both diagnostic as well as prognostic information. In this article, we review the key points to know about stress testing, in particular patient selection and interpretation of it results. A good comprehension of these different aspects is likely to improve patient care and to help avoid, additional tests that may be unnecessary.

The incidence of facial palsy is about 50/100000/year, i.e. 210 cases/year in Geneva. Clinicians can be puzzled by it, because it encompasses aetiologies with very diverse prognoses. Most patients suffer from Bell palsy that evolves favourably. Some, however, suffer from diseases such as meningitis, HIV infection, Lyme's disease, CVA, that require fast identification because of their severity and of the need for specific treatments. This article proposes an algorithm for pragmatic and evidence-based management of facial palsy.

Training new doctors in general internal medicine represents a challenge. This requires to define future needs, which result from interest that are not necessarily convergent between patients, doctors, insurers and politicians. Problems related to medical demography in Switzerland, with the ageing of the population, the increase in health care costs and the place of Switzerland within the European Community require the implementation of specific objectives to train new physicians in general internal medicine. The success of these opportunities depends on social factors, political choices and choices from physician's association. In this article we will approach these challenges by formulating some proposals--nonexhaustive--in order to guarantee sufficient renewal in general internal medicine.

Kaiser Permanente (California, Etats-Unis) is an integrated health care delivery system, particularly in what is related to the management of chronic conditions. This article describes the strategies developed by this organization in order to improve the quality of care of patients suffering from chronic diseases, through coordination of care, enhancement of a team based approach, self-management education programs, and patient involvement and empowerment.

If the Swiss health care system has reached several important objectives, fragmentation of its organization alter its efficacy, its effectiveness and its quality. Numerous experts put forward the necessity of coordinating care and services, particularly for complex and, most often, chronic diseases. Physicians have a key role to play in that coordination, but the exponential growth of medical knowledge, together with a more and more sophisticated technology, requires this role to be based on interdisciplinarity and network organization. This article proposes a model to implement, around the primary care physician, a first level organization of care to ensure this organization. Such a model may better meet future challenges of the Swiss health care system.

Most patients with chronic heart failure (CHF) can safely engage in sexual activity and be treated for erectile dysfunction with sildenafil, provided that they do not have active coronary ischemia and do not require treatment with nitrates. Clinicians should know the physiological requirements for sexual activity and the impact chronic heart failure has on sexual performance. Fear of cardiac events during intercourse can interfere with patients' ability to perform and enjoy sex, and thus, it is important that the physician be able to counsel patients with chronic heart failure about sexual activity.