General practitioners and the pull of prevention

Sociologists have often criticised notions of preventive health work advocated by doctors. This work has yielded important insights into victim-blaming and into ways the economic and political causes of ill-health have been mystified or denied. While this analytical strategy remains an important one, it needs extending in at least three directions. First, we must appreciate changes over time in the forms of arguments about preventive work; secondly, we must situate the argument both in terms of developments within the medical profession and in terms of the relationship of the medical profession to the wider society; finally, we need to make sense of the doctors' claims that these ideas are radical/progressive. The paper is based on a recent series of reports on prevention by the Royal College of General Practitioners, and focusses in particular on the one dealing with preventive care for children.     

Health promotion and disease prevention beliefs and behaviors of dietetic practitioners

Fifty-three percent of a random sample of 500 members of the Texas Dietetic Association responded to a survey designed to determine their personal health behavior, beliefs, and patient counseling practices related to health promotion and disease prevention. This article reports the responses of the 180 practitioners involved in direct patient care in order to depict the health promotion/disease prevention beliefs and behaviors of that particular group. Health habits (e.g., smoking, physical activity, and dietary patterns) of dietetic practitioners were better than those of the general female population. Personal health habits related to not smoking and to getting regular exercise were significantly associated with belief in the importance of that behavior for others. Although most of the dietetic practitioners indicated that the identified health behaviors were important to the health of the average person, only a few practitioners gave them routine attention in their practice. Respondents generally expressed a lack of confidence in their ability to educate clients about specified health behaviors, with the exception of weight control, high-fat diets, elevated blood pressure, and exercise patterns. The practitioners' confidence in their counseling skills was significantly correlated with intensity of counseling (p less than or equal to .001) and the likelihood of client compliance, except in the area of weight control. The majority of the dietitians strongly agreed that health promotion will be more important in the future.     

General practitioners at the crossroads

As practices take on fund-holding status, GPs are thrown into a new management role/ According to Ross Hamilton and Fiona Shepherd, there is some doubt whether current medical training provides the skills for this.     

General practitioners and mental disorders

This article presents the results of a mail survey about mental illness in general practice carried out in France in 1981 on a sample of 353 general practitioners. The research had two main objectives: The first was to understand the general practitioners perceptions of the manner in which they dealt with their patients suffering from psychiatric or psychologic disorders. The second was to test several hypothesis concerning the relationship between the frequency of diagnoses of mental disorders by the general practitioner and her or his links with the field of psychopathology and with the mental patients. The findings of the survey confirm the main hypothesis: the way general practitioners diagnose mental illness is significantly related to their interest in the subject of psychopathology and in their mental patients. Moreover, these results show how general practitioners claim that psychological problems are part of their field and that they do not feel at all uneasy when confronted with patients suffering from mental disorders. They frequently deal with these patients with mental disorders and believe that they are qualified to practice psychotherapy.     

General practitioners and public health

Family Health Service Authorities (FHSAs), since 1st April 1991, have been both 'managed', by the Regional Health Authority, and 'managing', their contractor services. Both situations are relatively new to them, their Region and the contractors. We examine the opportunities and potential problems of this major strategic change. These relate to: (1) the establishment of effective coordination between providers of primary care services; (2) the establishment of minimum basic standards of care and administration for GPs (based on those set for training practices by the Regional Advisors in General Practice); (3) the development and validation of a data collection system from General Practice which could be used to establish a morbidity database from general practice as a means of health needs assessment as well as for performance review.     

General practitioners with special interests: evolution and evaluation

General practitioners with special interests (GPSIs) have emerged in the UK as a government initiative aimed at improving access in specialities that traditionally have long waiting times for investigations and treatment. This represents, to some extent, a formalisation of existing working practices of general practitioners who had obtained specialist experience during hospital training. GPSIs are working in a wide range of clinical areas including coronary heart disease, drug abuse, echocardiography and sexual health. Similar changes at the primary-secondary care interface are taking place in other European health systems. Key issues in the development of these services include the assurance of high-quality health care, clinical governance and risk management, cost-effectiveness and impact on outpatient care, and the work and role of specialists. It is possible that these new opportunities for general practitioners and other health care professions will aid recruitment and retention of staff in primary care, enhance education and encourage commissioners of services to look carefully at unmet needs in their health economies. Further challenges include the need to train a cadre of practitioners and to provide the research evidence on which to base continued investment in this promising initiative.     

General practitioners and the geriatric day hospital.

All patients referred by general practitioners (GPs) over a year period to a geriatric day hospital were assessed at home. Sixty-one patients were referred and 33 (54%) were accepted for day hospital attendance, Alternatives were found for the remaining 28 (46%). Day hospitals are underused by GPs and there is confusion between the different functions of day hospitals and social service day centres. Guidelines to assist in patient selection are provided.     

General anaesthesia in the accident and emergency department

This paper describes the results of a survey in 1990 which examined the practice of general anaesthesia in Accident and Emergency Departments. Data were obtained concerning the anaesthetics induced during the previous year, specifically the number of procedures undertaken, the equipment, the facilities and the personnel involved, including any complications. These findings are discussed in relation to recommendations for minimum standards in anaesthetic practice.