South African family practice manual

Author/s: Mash B, Brits H, Naidoo M, Ras T

Edition: 4

ISBN: 9780627039799

eISBN: N/A

ePub ISBN: 9780627039805

Pages: 840

Published: 2023

Print Recommended Retail Price: R1030.00

eBook Recommended Retail Price: R927.00

South African Family Practice Manual is a practical text that focuses on the “how to” of working in the district health services. It includes the core skills required of family physicians, which registrars in family medicine need to acquire during their training, as well as additional skills relevant to family practice in different settings. It is also relevant to other clinicians working in district health services, such as medical officers, general practitioners, nurse practitioners and clinical associates, in both primary health care and district hospital environments. The majority of skills are clinical and cover health promotion, disease prevention, therapeutics and interventions, rehabilitation and palliative care for both adults and children. There are also sections that deal with skills related to supporting community-oriented primary care, clinical training and teaching as well as leadership and clinical governance.

South African Family Practice Manual is a project of the South African Academy of Family Physicians, which is the national professional body for family medicine, and has been a key resource for family medicine training in this country as well as many others across Africa. This fourth edition has three new section editors and a wide variety of new authors to ensure that the content is relevant to the next generation of family physicians. New topics have been added, such as history taking in sexual health, point-of-care ultrasound, helping people with impairments, and mentoring and helping the learner in difficulty. All chapters have been revised to ensure that they are up to date.

South African Family Practice Manual is relevant for medical students, interns, medical officers, registrars, general practitioners and family physicians, as well as nurse practitioners and clinical associates, all of whom will find many of the skills essential to their development and practice.

SECTION 1: THE CONSULTATION
1. How to communicate effectively in the consultation
2. How to consult a child or adolescent
3. How to take a sexual history
4. How to perform a brief, appropriate neurological examination
5. How to examine the feet of patients with diabetes
6. How to do a rapid musculo-skeletal screening examination
7. How to examine and assess low back pain
8. How to do brief behaviour change counselling
9. How to break bad news
10. How to develop a counselling style
11. How to work with an interpreter
12. How to manage the difficult patient
13. How to assess family structure and resources
14. How to assess family function
15. How to hold a family conference

SECTION 2: COMMUNITY-ORIENTATED PRIMARY CARE
16. How to support the implementation of community-orientated primary care
17. How to provide support to primary health care teams in your community
18. How to link the primary health care teams to the rest of the health system, other sectors and the community

SECTION 3: CHILD HEALTH
19. How to do a developmental assessment
20. How to assess growth and classify malnutrition in children
21. How to do childhood immunisation
22. How to administer an intramuscular injection to a child
23. How to do a suprapubic bladder aspiration in a a young child
24. How to get intravenous access in a child
25. How to establish an intraosseous infusion in a child
26. How to perform a lumbar puncture in a child
27. How to assess a child’s chest radiograph
28. How to do a skin test for tuberculosis in a child
29. How to assess and manage child abuse
30. How to use the Road to Health booklet
31. How to do a well newborn check
32. How to assess gestational age at birth
33. How to resuscitate a newborn
34. How to insert an umbilical vein catheter
35. How to establish kangaroo mother care for preterm infants
36. How to manage phototherapy
37. How to use the Integrated Management of Childhood Illness chart booklet

SECTION 4: WOMEN’S HEALTH
38. How to use the antenatal growth chart
39. How to examine a pregnant woman
40. How to do a single screening ultrasound in pregnancy
41. How to assess foetal wellbeing through its movements
42. How to assess foetal wellbeing during labour
43. How to use a partogram and assess progress of labour
44. How to conduct a normal vaginal delivery
45. How to conduct an assisted vaginal delivery
46. How to do a Caesarean section
47. How to do and suture an episiotomy
48. How to repair a third-degree tear
49. How to remove the placenta manually
50. How to do cervical cancer screening
51. How to insert long-term contraceptive devices:intrauterine contraceptive devices and hormonal implants
52. How to do a minilaparotomy tubal ligation
53. How to do a laparoscopic tubal ligation
54. How to do a medical termination of pregnancy
55. How to do a manual vacuum aspiration
56. How to do a laparotomy for ectopic pregnancy
57. How to do culdocentesis
58. How to treat a Bartholin’s cyst or abscess
59. How to do an endometrial biopsy
60. How to do a paracervical block and remove a cervical polyp
61. How to take care of a sexually assaulted person
62. How to use and implement ESMOE

SECTION 5: ADULT HEALTH
63. How to perform a lumbar puncture in an adult
64. How to record an electrocardiogram
65. How to interpret an electrocardiogram
66. How to do an exercise electrocardiogram test
67. How to use inhalers and spacers
68. How to do office spirometry
69. How to use a peak expiratory flow meter
70. How to read a chest radiograph
71. How to do a pleural tap
72. How to nebulise a patient
73. How to take blood samples in adults
74. How to give an injection
75. How to interpret a barium swallow

SECTION 6: MENTAL HEALTH
76. How to manage a mental health care user in terms of the Mental Health Care Act
77. How to do a mini mental-state examination
78. How to screen for mental problems
79. How to screen for an alcohol drinking problem

SECTION 7: ENT, EYES AND SKIN
80. How to examine the eye
81. How to treat the eye
82. How to remove a foreign body from the nose
83. How to remove a foreign body from the ear canal
84. How to examine and treat the ear
85. How to examine the mouth and throat, and collect oral and nasal specimens
86. How to do a tonsillectomy
87. How to drain a peritonsillar abscess
88. How to manage epistaxis
89. How to evaluate nasal trauma
90. How to conduct skin prick testing
91. How to do a skin biopsy, cryotherapy and electrotherapy
92. How to excise a sebaceous cyst
93. How to apply a compression bandage for chronic venous ulcers
94. How to partially remove a nail to manage an ingrowing toenail
95. How to treat warts
96. How to approach the care of acute and chronic wounds

SECTION 8: ORTHOPAEDICS
97. How to examine for and inject a painful shoulder
98. How to examine for and inject tennis elbow and golfer’s elbow
99. How to examine for and inject De Quervain’s tenosynovitis
100. How to examine for and inject carpal tunnel syndrome
101. How to measure shortening of the legs
102. How to diagnose and inject trochanteric bursitis
103. How to examine, aspirate and inject an inflamed knee
104. How to assess acute ankle injury
105. How to interpret radiographs of arthritic joints
106. How to apply plaster casts and splints
107. How to apply traction
108. How to do closed reduction of common limb fractures
109. How to reduce dislocations of the shoulder, elbow and hip
110. How to aspirate or excise ganglia
111. How to apply a clubfoot cast
112. How to perform an emergency fasciotomy

SECTION 9: SURGERY
113. How to do a vasectomy
114. How to do a circumcision
115. How to manage haemorrhoids and perianal haematomas
116. How to read an abdominal radiograph
117. How to do fine-needle aspiration biopsy, a core needle biopsy and excision biopsy
118. How to insert a urinary catheter
119. How to do proctoscopy and sigmoidoscopy
120. How to reduce a paraphimosis
121. How to perform a ring block of the penis
122. How to incise and drain an abscess
123. How to drain or remove a hydrocoele
124. How to interpret an intravenous pyelogram
125. How to perform a lower extremity amputation
126. How to perform an appendectomy

SECTION 10: ANAESTHETICS
127. How to do a pre-anaesthetic assessment
128. How to administer oxygen
129. How to check the anaesthetic machine
130. How to administer general anaesthesia
131. How to provide inhalational induction of anaesthesia
132. How to monitor a patient during anaesthesia
133. How to monitor a patient recovering from anaesthesia
134. How to administer and reverse muscle relaxants
135. How to administer regional anaesthesia and local blocks
136. How to administer a spinal anaesthetic
137. How to administer procedural sedation and analgesia
138. How to perform ketamine anaesthesia
139. How to decontaminate anaesthetic equipment

SECTION 11: EMERGENCIES
140. Algorithms for emergencies
141. How to intubate a patient and manage the airway
142. How to do a cricothyroidotomy
143. How to insert an intercostal drain
144. How to relieve a tension pneumothorax
145. How to insert a central venous line
146. How to relieve a cardiac tamponade
147. Transcutaneous cardiac pacing
148. How to do a primary survey
149. How to do a secondary survey
150. How to obtain an arterial blood sample
151. How to do a point of care ultrasound
152. How to insert a nasogastric tube
153. How to give a blood transfusion
154. How to measure the Glasgow Coma Scale
155. How to interpret X-rays in a trauma patient
156. How to calculate the percentage of burn
157. How to manage poisoning or toxic exposure
158. How to restrict spinal motion
159. How to transport a critically ill patient from primary to secondary care
160. How to remove percutaneous foreign bodies
161. How to suture a laceration
162. How to debride a wound

SECTION 12: REHABILITATION
163. Approach to assessing disability and rehabilitation
164. How to assess a patient requesting a disability grant
165. The role of the family physician in the rehabilitation of a stroke patient
166. A structured approach to coordinating the care of people and families with cerebral palsy
167. How to care for a person with spinal cord affliction
168. How to care for amputees

SECTION 13: PALLIATIVE CARE
169. How to care for the dying patient and communicate with the patient and family
170. The use of syringe drivers to deliver continuous subcutaneous infusions in palliative care
171. How to assess pain

SECTION 14: CLINICAL MANAGEMENT AND ADMINISTRATION
172. How to keep a patient’s medical records
173. How to notify a death
174. How to fill in a certificate of illness
175. How to notify a medical condition
176. How to refer and discharge a patient
177. How to assess fitness for driving at work
178. How to claim compensation for work-related injuries or diseases
179. How to complete a J88 form for an assault case and prepare for an appearance in court
180. How to assess drunk driving and the responsibilities of the doctor

SECTION 15: CLINICAL TRAINING AND TEACHING
181. How to establish an effective learning environment
182. How to to use a portfolio of learning
183. How to plan and implement a teaching activity
184. How to have effective learning encounters in the workplace
185. How to facilitate small-group learning
186. How to prepare a presentation
187. How to mentor a colleague
188. How to recognise and help the learner in difficulty

SECTION 16: LEADERSHIP AND CLINICAL GOVERNANCE
189. How to audit and improve the quality of your service
190. How to take on leadership roles and initiate teamwork
191. How to organise and run morbidity and mortality meetings
192. How to deal with a medical mistake
193. How to manage the impaired health practitioner or colleague
194. How to enable resilience and avoid burnout

This review originally appeared in the African Journal of Primary Health Care & Family Medicine

This revised edition of the South African Family Practitioner’s Manual, first published in 1995, is a huge contribution to the field of family practice not only in South Africa but also in many middle-and low-income countries particularly in Africa. The editor Bob Mash has widened his editorial team to manage a remarkable 194 chapters, covering a vast array of practical skills. The range of topics covered by the chapters illustrates the extremely wide scope of practice demanded of generalists, which goes far beyond the manual skills of specific procedures, including: (1) communication, (2) working with interpreters, (3) engaging with communities, (4) teaching and dealing with resilience and (5) burnout, for example. So, as far as comprehensiveness is concerned, the manual is impressive and clearly delineates the role of the generalist practitioner in the South African context.

The list of authors is extremely diverse, with not only family physicians and general practitioners but also specialists from a wide variety of disciplines, including public health, anaesthetics, even plastic surgery and radiation oncology. Many of the emergency skills lie squarely in the domain of the developing specialty of Emergency Medicine, with which Family Medicine has a close relationship in South Africa, and which is fast developing in other countries. While there needs to be overlap, the differentiation of the specialties is important, and this manual helps to specify the skills that are in common as well as those that are more appropriate to generalist practice.

Despite the chapters on family and community engagement, the broad framing of the skills required of the generalist medical practitioner is still too biomedical and curative oriented, with not enough emphasis on health promotion and how to address the social determinants of health that drive the burden of disease. The only issue that, the author feels, does not receive appropriate attention is that of leadership, teamwork and referrals to other levels of care, although it is mentioned as important in several chapters, particularly the community-oriented and rehabilitation chapters. Tackling the social determinants of health demands a structured team approach, and the role of the medical practitioner needs to be negotiated, as it is not necessarily that of the leader, especially at the community level. How best to contribute to the wider systems that concern health, is a high-level skill required of the medical practitioner that possibly requires a separate chapter in the future.

The book is very well laid out, with clear writing and extensive diagrams and images in most chapters. The chapters are succinct and to the point, to the extent of being not detailed enough in some instances, where other resources would need to be consulted before attempting a particular procedure (e.g. Chapter 46 – How to do a Caesarian section). Nevertheless, most chapters offer a good introduction to each procedure, and the bibliography at the end of the book gives some guidance to further reading. This could be enhanced by the inclusion of two or three key references at the end of each chapter, for those interested in taking it further.

The manual deserves to be on the desk of every career generalist practitioner in Africa, from clinical associates or officers, to medical officers, general practitioners and family physicians. Particularly in rural hospitals and health centres, where specialist advice or supervision is not immediately available, the manual fulfils the crucial function of giving practitioners an entry point into the wide range of practical skills demanded of the generalist, which at first appears to be overwhelming to the young community service officer. Having this book at each district hospital in the country should go a long way to mitigating that anxiety.

Reid S. Book Review of South African Family Practice Manual: 4th edition. Afr J Prm Health Care Fam Med. 2023;15(1), a4207. https://doi.org/10.4102/phcfm.v15i1.4207

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