Procedures for Primary Care Handbook 2026: Evidence-Based Principles of Dermatologic, Musculoskeletal, and Gynecologic Office Technique for Family Medicine Physicians

Built for the family medicine and internal medicine physician who performs procedures inconsistently — comfortable with some, avoidant of others, too often referring out work they are already credentialed to do — this handbook connects anatomic landmarking, sterile technique, and point-of-care ultrasound guidance to the decisions that determine whether a procedure belongs in the exam room or on a specialist's schedule. It moves system by system — dermatologic, musculoskeletal, reproductive, genitourinary, eye and airway, vascular and wound, cardiopulmonary — before closing with pediatric-specific modifications and the practice systems that sustain the work.

Every procedure runs through a five-part readiness check — setup, sequence, the pitfall a competent clinician still misses, the factor that stops the procedure, and confirmation it was done right — consolidated into one indexed atlas for the clinical day.

• Select the correct skin biopsy technique — matching shave, punch, or excisional depth to melanoma suspicion before the blade touches the lesion.

• Target the joint, not the guess — landmark and ultrasound-guided aspiration and injection across the upper extremity, lower extremity, and spine.

• Place and troubleshoot an IUD with confidence — sounding, insertion, and the non-visible-string workup that resolves most cases without referral.

• Recognize the office emergency hiding in a routine visit — testicular torsion, epiglottitis, and ocular perforation signs that demand immediate action.

• Repair the wound completely — irrigation, layered closure, and the tendon and nerve assessment a rushed exam misses.

• Read the ECG and the flow-volume loop correctly — lead-placement artifact and QTc red flags that change management the same visit.

• Adapt every technique to a developing patient — from newborn circumcision to age-matched comfort strategies that make pediatric procedures succeed.

• Build the practice infrastructure that sustains it — coding, credentialing, and complication tracking that convert skill into durable capability.

Bring the procedure back into the visit where it belongs — open this handbook before the next patient who needs it.