Cooperation between hospital and general practice in multipractice studies. Personal experiences from a study on early diagnosis for gastric cancer

In this study close cooperation between general practice and out patient clinic made it possible to establish earlier diagnosis of serious disease using advanced diagnostic methods on patients seen only in general practice. However, the cooperation established in an attempt to diagnose gastric cancer at an early stage using endoscopic technique revealed major practical problems. It was difficult to make exact calculations of the background population because of the degree of the patients' right to choose a general practitioner. Furthermore, referral of all patients wanted for investigation proved a major obstacle, because of differences in workload and lack of understanding of scientific principles among the participating general practitioners. The desired cooperation between general practice and out patient clinics cannot easily be established in a way which gives us exact and scientifically reliable data, and such cooperation-for scientific purposes--can only involve smaller groups of doctors. However, the education of general practitioners in scientific methods and understanding, and hospital doctors in knowledge about the consequences of working conditions in general practice should be considerably improved.