General practitioners and opiate-abusing patients

General practitioners' involvement with patients who abuse opiates has increased in recent years but little is known about the difficulties they may encounter in working with such patients. This study examined a series of general practitioner consultations with patients who were abusing heroin and describes the problems that arose. Manipulative behaviour, lying about symptoms and a lack of motivation to give up drug use were common among drug abusers; by such behaviour, the patients failed to satisfy the underlying assumptions on which the doctor-patient relationship ordinarily depends. There is a need to evolve alternative approaches for the care of this group of patients which will help general practitioners to establish more effective relationships with them.     

General practitioners and their staff

We describe the practices and staff of a random sample of 158 doctors. There has been a significant increase in ancillary staff since the Doctors' Charter of 1966. The study showed that there was no economy in staff as the number of doctors in a practice increased. In the selection of receptionists, doctors preferred married women over 35 with children, and were in favour of good personal qualities rather than good academic attainments. However, a high standard of work is important as well as a good understanding of human behaviour.     

General practitioners and learning by audit

The ways in which `medical audit' can be used in the continuing education of general practitioners are examined, and certain rules for the conduct of such education in small groups of peers are put forward. However, it proved impossible to evaluate the outcome of the educational exercise because those taking part refused to audit twice any single aspect of their daily work.     

General practitioners and social help for the handicapped

A study was undertaken by the Greater London Association for the Disabled in consultation with the Royal College of General Practitioners, to explore the depth of knowledge of the Chronically Sick and Disabled Persons Act and statutory and voluntary social provision, of 22 general practitioners in 16 practices served by one area social services office in a London borough.

The doctors were mainly middle-aged, of British or Irish birth and training and had no language barrier. The majority lived in or near their practices. Half the practices were groups or partnerships, half were singlehanded. Only in three groups was there any attached district nursing staff and in only one was there an attached health visitor. More than half the general practitioners had reception staff only during surgery hours. Four practices had no reception staff during National Health Service surgery hours, two of which had no reception staff at all. In no practice was there any privately employed nursing staff. All the practices had private patients.

Nine of the 22 doctors in the study had never heard of the Chronically Sick and Disabled Persons Act, and a further five had not mentioned the Act to their patients. Fifty per cent had no knowledge of the extent of functional disability in their practice. More than half the doctors knew no more of the social services than that home helps and meals-on-wheels were available, while six doctors knew of no provision at all. Knowledge and use of the voluntary services was almost non-existent. No meetings with team members were held, other than in the group practices with attached staff, and the team members were largely unknown to most of the doctors.

Attempts were made through various channels to extend the knowledge of the general practitioners of the services provided by both statutory and voluntary agencies, and to introduce them and their receptionists to their team, but little use was made of the opportunity.

     

General practitioners and occupational health services.

BACKGROUND: Occupational physicians and general practitioners often appear to differ in their attitudes to the provision of health screening, health promotion and vaccination in the workplace. AIM: This study aimed to explore the attitudes of occupational physicians and general practitioners to particular aspects of workplace health services. METHOD: Anonymous piloted postal questionnaires were sent to 400 UK general practitioners and 300 occupational physicians. RESULTS: Questionnaires were returned by 260 general practitioners (65%) and 223 occupational physicians (74%). There are differences between the specialties in attitude to specific health screening and vaccination at work, and to the role of occupational health services in helping the disabled, but greater agreement on the usefulness of workplace health promotion. CONCLUSION: General practitioners may misunderstand the role, responsibilities and priorities of occupational health services. Further educational work needs to be done to overcome communication difficulties between the specialties.     

General practitioners and work in the Third World.

In recent years the number of general practitioners who have worked in the third world before entering general practice has fallen. The reasons for this are not clear but may include worries about future career prospects. Ninety four doctors who had entered general practice since 1984, after previously working in the third world, completed a questionnaire about their career experience and views about the value of such work. They were generally widely experienced and well-qualified and work abroad had not apparently harmed their careers, rather, many believed it had enhanced it. Work in the usually arduous conditions of poor countries was often considered by the respondents to lead to a wider perspective, increased maturity, confidence, self-reliance, adaptability and initiative. Doctors who are interested and suitable for work in the third world prior to entering general practice should be encouraged to pursue this possibility.