Women's experiences of general practitioner management of miscarriage.

A study of 67 women one month after miscarriage identified significant levels of dissatisfaction with their medical care. There are particular problems in managing miscarriage which is very distressing for many women but a common clinical presentation for doctors. The reasons for women's dissatisfaction with their management are explained. Greater understanding of the experience of miscarriage should lead to better management and suggestions are made for better care for this common distressing experience.     

Women''s experiences of general practitioner management of their vaginal symptoms.

BACKGROUND: Little is known about the management of vaginal symptoms despite their frequency. Most vaginal symptoms in non-menopausal women are managed as thrush, although bacterial vaginosis is commoner. AIM: The aim of this study was to measure the experiences of women attending their general practitioner with vaginal symptoms including self-reporting of symptoms, duration and severity, informal support, over-the-counter remedies, sources of information, gender of doctor, expected and actual vaginal examination, and explanations and knowledge of common vaginal infections. METHOD: A postal questionnaire survey was conducted of 490 patients presenting with vaginal symptoms aged between 18 and 48 years who had attended 10 general practices within the previous 3 months in the East Midlands of England. RESULTS: A total of 85% of patients had suffered a previous episode, with 39% having had three or more infections in the previous year. Overall, 68% consult with each episode, and most consult within 7 days of onset of symptoms (median = 4 days). In all, 68% discussed their symptoms with partners, families or friends, but 32% relied solely on their doctor. Some 33% bought over-the-counter remedies. A total of 65% informed themselves further from encyclopaedias, leaflets and women's magazines, but there was a strong request for more information. Out of those questioned, 75% expected a vaginal examination, whereas 57% had such an examination performed. Most were told their symptoms were caused by thrush (78%), but patients' ideas on causation were varied. Most believed sexual transmission played a role in transmission of symptoms. Women were socially embarrassed by their symptoms, with 46% admitting to having the condition on their minds all or most of the time. Twenty-eight per cent of women wished to see a female doctor, with gender being unimportant to the remainder. CONCLUSIONS: Vaginal symptoms were commonly recurrent, socially embarrassing and managed as candidiasis. Just over half the patients had a vaginal examination. There is a shortage of suitable information on vaginal infections available to patients, many of whom used over-the-counter medications.     

Working out of hours: the experiences and training needs of general practitioner registrars.

Out-of-hours work has been identified as a major concern for registrars, and as contributing to the steady decline both in the number of applicants to vocational training schemes and in those practising as principals on completion of their training. Until now, little has been known about registrars' views about their experience of working out of hours and how this might be improved. The present study describes general practitioner (GP) registrars' current patterns of out-of-hours working and their perceptions about training needs.     

Quality of general practitioner referrals to outpatient departments: assessment by specialists and a general practitioner.

Thirty eight specialists in one district health authority were asked to take part in a questionnaire survey to assess the appropriateness of referral and the quality of the referral letter for 20 consecutive new patients each. A total of 705 new patient referrals to 13 specialties were included in the study. Twelve of the 38 specialists were randomly selected and their 234 new patient referral letters were independently assessed by a general practitioner for the appropriateness of the referral decision. The study revealed errors and omissions in between 5% and 28% of referral letters according to the category of information. Thirteen per cent of the new patient referrals were assessed by specialists to be inappropriate and 4% of patients had been referred to an inappropriate specialty. Significantly more of the referrals to medical specialties were inappropriate (20%) than to surgical specialties (9%) (P < 0.01). There were more than three times the number of errors and omissions in the referral letters of referrals assessed as inappropriate than in the referral letters of referrals assessed as appropriate (P < 0.01). The referral letters of referrals assessed as inappropriate were more than nine times as likely to omit the reasons for or objectives of the referral compared with letters for those referrals assessed as appropriate (P < 0.01). There was a good overall agreement between the specialists and general practitioner in their assessment of the appropriateness of the clinical referrals (kappa = 0.614, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Patients' experiences and expectations of general practice: a questionnaire study of differences by ethnic group

BACKGROUND: Research has highlighted variations in morbidity, mortality and health needs by ethnic group, and suggests that some ethnic groups may receive a poorer service. AIM: To explore the impact of ethnic group on patients' experiences and expectations of their general practice consultation. DESIGN OF STUDY: Cross-sectional survey. SETTING: One general practice in a multicultural area of London. METHOD: A total of 604 consecutive patients attending their general practice (response rate = 60.4%) who described their ethnic group as white British, black African, black African Caribbean or Vietnamese completed a measure relating to their experiences and their expectations of the general practice consultation in terms of treatment, communication, patients' agenda, patients' choice and doctor consistency. RESULTS: No differences were found for the black African or black African Caribbean patients. The Vietnamese patients reported better experiences of communication, more focus on their agenda and more attention to their choices than the white British patients. However, they also reported expecting lower levels of communication, less focus on their own agenda and reported wanting less GP consistency than the other ethnic groups. CONCLUSION: Vietnamese patients state that they are receiving better standards of care in general practice than other ethnic groups. However, they also state that they expect less. This may illustrate a problem with assessing experiences of primary care. Higher scores of experience may not illustrate better consultations as such, but only better when compared with a lower level of initial expectation. A lower expectation is easier to fulfil.     

Estimates of general practitioner workload: a review.

This paper reviews four studies sponsored by the Department of Health which have attempted to measure workload in general practice and compares these with data from the general household survey. Despite the considerable differences in the objectives and methods employed by the four studies, they were found to contain remarkably consistent measurements of general practitioner workload. In a 'normal working week' general practitioners spend 38 hours on general medical service duties (including 24 hours of patient contact and five hours of travel to home visits), they see 150 patients or their representatives in surgery, and make 26 home visits. In an 'annual average week', taking into account holidays and sick leave, general practitioners undertake 90% of this workload. The studies show consistently large variations in the workload of general practitioners measured in this way, but fail to identify the key determinants of such variations. The reasons underlying the variation in general practitioner workload will remain unclear until we can distinguish between the expected, measurable variation and the residual, unexplained variation which may be due to the personal preferences of general practitioners.     

Experiences in a general practitioner workshop

The organization and working of a general practitioner workshop are described, with analyses of subjects, participants, and group dynamics. An unusual form of peer group has arisen, with trainees, trainers, and principals all contributing on an equal basis. The workshop group is suggested as a useful method of continuing education for general practitioners, using existing postgraduate facilities, with minimal financial outlay.     

Comparison of the work of a nurse practitioner with that of a general practitioner

The work of a nurse practitioner was compared with that of a general practitioner. Both were equally available to the same patient population over the same period. The nurse practitioner saw a similar age and sex distribution of patients to the doctor but saw different types of problems. More of the patients she saw were for followup of chronic diseases, health advice and screening measures while fewer were acutely ill. The doctor dealt with four times as many patients. The nurse practitioner managed 78% of her consultations without referral to a doctor, and 89% without resorting to prescribed drugs. There was a high level of patient satisfaction with her work and 97% of the patients who saw the nurse would choose to consult her again. The role of the nurse practitioner in our practice has developed differently from a similar post in another setting, thus emphasizing the need for flexibility when defining the role.

Nurse practitioners are a valuable extra resource for the development of new areas of care, rather than a cheaper substitute for a general practitioner.

     

Acute medicine in a general practitioner hospital

Admissions during 1980 to a hospital staffed by general practitioners are analysed. Almost all (94 per cent) were acute admissions. The mean length of stay was 11.7 days and the mean age of the patients 63.3 years, with 40 per cent of them under 65 years of age. Two thirds of the patients were discharged to their homes and only 7 per cent of patients spent more than four weeks in hospital. General practitioner hospitals have medical, social and economic advantages over large district hospitals for certain acutely ill patients and have an important role in primary medical care.     

Service families: a new perspective for the general practitioner.

The psychological problems among the dependents of armed servicemen presenting to general practitioners are discussed, with particular emphasis on how the peculiarities of service life contribute to their aetiology and presentation. Within the UK, primary health care for service dependents is increasingly being provided by National Health Service general practitioners who have no knowledge of service life. An understanding of this minority group with its different lifestyle and subculture is important for management of these disorders.