Large Meningioma Complicating Pregnancy

EDITORIAL COMMENT: This case report was accepted for publication because of the clinical lesson it delivers, namely that intracranial tumours, although rare in pregnancy, may as the authors state 'produce a wide variety of symptoms that are difficult to distinguish from the more common symptoms of pregnancy, including nausea, vomiting and headache'. This case suggests that examination of the optic fundi is essential in patients with neurological symptoms even when/especially when there is a history of psychiatric illness.     

Rural Obstetrics in NSW

Summary: Rural general practitioners are responsible for providing obstetric services to the majority of women living in rural communities. This paper reports a comparison of 5,950 deliveries conducted by rural GPs in NSW during 1990–1991 with all 88,275 deliveries during the same period in NSW. No evidence that obstetric care in accredited rural GP obstetric units is of less than acceptable standards could be found. There is scope to increase the use of rural obstetric units for the training of future rural GP obstetricians.     

‘Managing patient involvement’: provider perspectives on diabetes decision‐making

Background Most studies of shared decision‐making focus on acute treatment or screening decision‐making encounters, yet a significant proportion of primary care is concerned with managing patients with chronic disease. Aim To investigate provider perspectives on the role of patient involvement in chronic disease decision‐making. Design A qualitative, grounded theory study of patient involvement in diabetes care planning. Setting and participants Interviews were conducted with 29 providers (19 general practitioners, eight allied health providers, and two endocrinologists) who participated in diabetes care planning. Results Providers described a conflict between their responsibilities to deliver evidence‐based diabetes care and to respect patients’ rights to make decisions. While all were concerned with providing best possible diabetes care, they differed in the emphasis they placed on ‘treating to target’ or practicing ‘personalized care’. Those preferring to ‘treat to target’ were more assertive, while ‘personalized care’ meant being more accepting of the patient’s priorities. Providers sought to manage patient involvement in decision‐making according to their objectives. ‘Treating to target’ meant involving patients where necessary to tailor care to their needs and abilities, but limiting patient involvement in decisions about the overall agenda. ‘Personalized care’ meant involving patients to tailor care to patient preference. Discussion and conclusions Respecting a patient’s autonomy and delivering high‐quality diabetes care are important to providers. At times it may not be possible to do both, so a careful balance is required. Involving patients in decision‐making may be a means to this end, rather than an end in itself.