PURLs of Wisdom

By Matt Wood

Family medicine physicians try to stay current in their fields by reading the latest medical journals and research literature, but the volume of new research can be overwhelming. To deal with this flood of information, the Family Physicians Inquiries Network created a system called Priority Updates from the Research Literature, or PURLs, in 2007 that is published in the Journal of Family Practice.

The PURLs series has covered a broad range of topics, such as when to expose children to radiation by CT examination after a fall, what medications can treat an infection in a pregnant woman without increasing the risk of birth defects and how best to control atrial fibrillation to prevent a stroke. Each month a network of physicians surveys the relevant literature for articles that might be useful in the typical family medicine setting. An editor then assigns a physician to write an article for the journal that puts the new research into context and examines its impact for family practitioners.

bulbsyringeNina Rogers, MD, and clinical assistant professor in the University of Chicago Department of Family Medicine, participates in this program and has written articles spanning a range of maladies, from appropriate treatment for persistent asthma to, more recently, a home remedy for a common problem that could save time and money for both patients and physicians: removing excess ear wax.

Rogers and a colleague from the University of Missouri wrote about a study published in the Annals of Family Medicine in which physicians from England found that patients can safely and effectively remove excess ear wax on their own. Patients who were given ear drops, a bulb syringe and instructions had on average 50 percent fewer office visits to remove ear wax than patients who were not encouraged to do it at home.

The relative success of home remedies like removing ear wax with a bulb syringe or treating athlete’s foot with corn starch depends on what Rogers calls “patient buy-in.” This is where close relationships earned by treating multiple generations in a family medicine practice comes in handy.

“There’s the component of physician-patient relationship, how much they trust you and how much they’ll take your advice,” Rogers said. “A lot of it is knowing your patients, what’s going to help them. Sometimes saying ‘studies show that this is beneficial’ is good, whereas to others you say, ‘I recommend this to a lot of patients.’ Knowing how to present information to them definitely helps buy-in.”

Research on home remedies might seem mundane, but fewer office visits for procedures that patients can perform safely on their own can save time and money for both patients and community facilities that are often strapped for resources.

“We have barriers to how much patients can spend for medicine, so sometimes we have to come up with creative or inexpensive ways to treat an ailment,” Rogers said. “The exciting feature about this study is that there is now an evidence-based non-pharmacologic treatment we can recommend confidently.”

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Rogers N, & Stevermer JJ (2011). PURLs: Ear wax removal: help patients help themselves. The Journal of family practice, 60 (11), 671-3 PMID: 22049350

About Matt Wood (515 Articles)

Matt Wood is a senior science writer at the University of Chicago Medicine and nonfiction editor for Another Chicago Magazine.

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