General Internal Medicine

Steven A. Schroeder, MD
JAMA. 1986;256(15):2062-2064. doi:10.1001/jama.1986.03380150072014.
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Recently, -1- Vecently, internists have embraced decision analysis as a means of more efficient use of diagnostic tests.1 Members of the internal medicine community have also become increasingly concerned about maintaining the specialty's leadership role in primary care.2,3 This review, however, will summarize some of the more specific developments in two areas of great importance: prevention of disease and management of chronic illness.

Cigarette smoking remains the single most important cause of preventable morbidity and premature death. Smokers die five to eight years earlier than nonsmokers and have twice the risk of fatal heart disease, ten times the risk of lung cancer, several times the risk of cancers of the mouth, throat, esophagus, pancreas, kidney, bladder, and cervix, a twofold to threefold greater incidence of peptic ulcers (which heal less well in smokers), and about a twofold to fourfold greater risk of fractures of the hip, wrist, and


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