The Journal of the Royal College of General Practitioners

Publications
In response to an invitation sent to women who had complained previously of regular incontinence, 65 women with regular incontinence were seen by their general practitioner. A diagnosis was made using a personally administered questionnaire and appropriate examination. Patients were placed in one of three diagnostic/management categories--stress, urge or stress/urge incontinence--and were given an appropriate treatment programme. Fifty six women were recruited as matched controls from non-responders while attending the surgery for other reasons. They underwent identical entry procedures but were not offered a treatment programme. All the patients were reassessed after 12 weeks at which time significant improvement in incontinence was reported by the treated women in the stress and urge categories compared with the controls. There was no significant difference in reported efficacy of treatment between age groups and treatment was shown to be effective irrespective of the duration of incontinence. This study shows that for the majority of women reporting incontinence the condition can be diagnosed by a general practitioner and significantly improved by appropriate intervention.
 
The side-effects encountered by 1,090 patients taking the oral contraceptive pill were reviewed. The main side-effects were migraine, headaches, weight gain, depression, and irregular bleeding. Reasons for changing the Pill are discussed, and recommendations are suggested for a way of monitoring patients taking the Pill. Analysis of the results show that 50 per cent of patients are happy with their first Pill, and that the 30 microgram pill produces fewer side-effects.
 
One thousand final-year medical students were asked to record what they had learned during a three-and-a-half week attachment to a general practice, under the headings of diagnosis, treatment, prevention, workload, use of medical care; they were also invited to criticize the teaching programme. It is suggested that this clinical education and vocational experience should now be made available earlier in the undergraduate course.
 
Post-marketing surveillance in general practice represents an important part of the monitoring of adverse events associated with newly introduced drugs. Such a study of the angiotensin-converting enzyme inhibitor enalapril maleate has been undertaken in 11 710 patients with essential hypertension. Serious adverse events occurred in 1.7% of patients, though most of these were not thought to be related to the treatment. The incidence rates of death (0.09%), stroke (0.11%) and myocardial infarction (0.15%) were compatible with rates predicted from age, sex and blood pressure considerations. Other events reported were hypotension (0.3%), angioneurotic oedema (0.03%), rash (0.5%), taste disturbance (0.2%) and cough (1.0%). The degree of blood pressure reduction attained was similar to that previously reported from pre-marketing development studies, as was the overall nature and frequency of both serious and non-serious adverse events. The most frequently reported event during enalapril therapy was of an improvement in well-being (19.8%).
 
Communication between medical and dental practitioners about patients they have in common enhances total patient care, but such communication rarely occurs. This may be due to lack of appreciation by doctors of the medical risks to certain patients undergoing dental treatment. To ascertain a relevant medical history, prospective medical screening was performed on 1500 new patients attending a general dental practice using a standard health questionnaire followed by an interview between the patient and dentist. There were 382 (25.5%) patients with a current or past medical history of relevance to dentistry, 90 (6.0%) were taking medication of potential importance and 105 (7.0%) considered they had an intolerance to certain drugs. The screening provided a patient data base for medical and medico-legal purposes. A total of 376 (25.1%) questionnaires were filled out incorrectly and 63 of these (16.8%) had major misinformation about medical history. A small but important group deliberately misled the dentist either from fear of refusal of treatment or embarrassment about their medical history. Therefore interviews are an essential adjunct to written health questionnaires in eliciting accurate information. Formal screening of new patients is essential in general dental practice. Furthermore, general medical practitioners need to become aware of the common risks to patients undergoing dentistry. Better formal and informal communication between general medical and dental practitioners is recommended for the benefit of their mutual patients.
 
A review of all the cases of the coroner's court for the Liberty of Ripon and Kirkby Malzeard in Yorkshire from 1855 to 1926, and those of 1981-83, showed that the number of deaths from acute coronary artery disease was very low in Victorian times, suddenly increased in the period 1906-10, and was very high in 1981-83. The population of the area was stable throughout the period at around 22 000. The number of postmortems for myocardial infarctions carried out in London hospitals was very low between 1907 and 1914, but greatly increased between 1917 and 1923. A study of autopsies in the City of London showed that the increase in the number of deaths from coronary artery disease began in 1909/10.
 
John Peacock MD was in practice in Darlington when he published his Practical Hints on the Treatment of Several Diseases in 1834. It is suggested that his cases described therein of ;scirrhous pylorus' are adult hypertrophic pyloric stenosis. If authenticated, his work would predate the earliest description of this condition by the French pathologist, Professor Jean Cruveilhier in 1835.
 
PIP The history of the family planning movement in England in the 1920s is traced. The movement actually began with the establishment by Andrew Carnegie of maternity and child welfare clinics on an experimental basis. The government extended such clinics by legislation. The radical element within the birth control movement recognized these clinics as the perfect environment for dissemination of birth control information and supplies. In 1926 Ernest Thurtle moved in Parliament that local authorities be given authorization to provide birth control methods to married women through the clinics. His bill was permissive, allowing but not compelling the clinics to participate in family planning. He aimed at removing 1 of the disabilities of poverty and at equalizing the sexes. The issue was controversial within Parliament. Finally, the Ministry of Health issued a directive allowing birth control information and supplies to be disseminated through the clinics, thus taking the issue out of the political and legislative realm. By the early 1930s, voluntary clinics, the forerunners of today's Family Planning Association affiliates, were being set up to implement the Ministry of Health directive.
 
Annual patient consultation rates have been recorded continuously for 36 years in a stable National Health Service practice in a south-east London suburb. Four phases in consultation rates were noted: rising rates from 1950 to 1956; peak rates from 1957 to 1963; falling rates from 1964 to 1970 and low stable rates from 1971 to 1985. Thus workload fell by almost 50%, from a peak of 3.81 to a low of 1.93 consultations per patient per year. The reduction of 91% in home visits was much greater than the 43% reduction in surgery (office) consultations.CERTAIN QUESTIONS ARE RAISED BY THE STUDY: why are the consultation rates of this practice so low (one half the national rates); why have consultation rates in the practice fallen; and how many general practitioners are needed by the NHS? More studies are needed which compare practices, their processes and outcomes, and which analyse cost benefits in the health service.
 
The results are reported of a study of casualty and surgical services in five general practitioner hospitals in Perthshire - Aberfeldy, Auchterarder, Blairgowrie, Crieff and Pitlochry. Details of the total workload, the nature of the conditions treated and the referral rate to major hospitals are given. Figures for the Royal Infirmary, Perth, the main referral hospital for the county, are also given for comparison. The surgical service at one of the rural hospitals is described.Experience has demonstrated the usefulness of these hospitals in providing casualty and surgical services to both the local population and to visitors, and their superiority in providing these services over health centres because staff and beds are available 24 hours a day.Rural general practitioner hospitals merit a continuing share of resources and bed allocation as they spare major hospitals surgical and medical work. The general practitioners serving the hospitals studied here undertook almost 40% of the total accident and emergency workload in the Perth and Kinross area of Scotland.
 
This study describes the changing patterns of adult self-poisoning in East Cheshire between 1970 and 1975. Six hundred and ninety episodes were analysed. It was found that the percentage of acute medical admissions due to self-poisoning increased during the five years: it doubled for females and trebled for males.The average annual incidence of self-poisoning was one per 600 of the population, a rate lower than that in the cities. It was most common in females under 25 years of age, the divorced and single, the unemployed, urban dwellers, previous self-poisoners, and social classes 4 and 5. In a third of the patients it followed a quarrel with a sexual partner. The risk of unconsciousness increased with age and occurred in over half the patients aged between 65 and 74 years. The mortality rate was almost the same for repeaters as non-repeaters - seven per cent overall. Half of the patients presented at the accident and emergency department within two hours of taking the poison.It is recommended that the medical records of patients with multiple self-poisoning risk factors be identified with temporary stickers.
 
In the 10 years from 1970 to 1979 there were 224 known episodes of parasuicide involving 158 patients (71 per cent women) registered with doctors in a group practice in a health centre in South East London. Nearly 40 per cent of patients were known to have repeated parasuicide at least once. Self-poisoning by drugs was the commonest method. Nearly three quarters of the drugs used had been prescribed by doctors and just under 60 per cent of the study patients had consulted their doctor within the 28 days preceding parasuicide. Personality disorder was the most frequent psychiatric diagnosis and was often associated with depression. There was no past or present evidence of psychiatric abnormality in 22 per cent. The most frequent precipitating cause of parasuicide was a breakdown in personal relationships. The annual total of episodes fell in the last two years of the study, but it is not yet clear whether this marks a significant development. Six of the patients died from suicide during the study period.
 
We describe the changing pattern of general practitioner prescribing in the National Health Service in England between 1970 and 1975.The percentage increase in items of prescriptions had increased 10 times as much as the percentage increase in the population in the same period. One of the reasons given is that there may be a growing tendency to give a prescription when it would be better to give advice.The evidence seems to support other findings that the profession responds much more widely to reports on the good effects of a drug than it does to its adverse effects.
 
I report here on an audit of the work of a general practitioner maternity unit situated in the same building as a consultant obstetric unit. Between 1970 and 1979, 10,588 patients were admitted under the care of general practitioner obstetricians. The perinatal mortality rate averaged 6.9. I show in the report how an audit of such a unit can be carried out, and demonstrate that general practitioner obstetricians still have a valid and useful place in a district obstetric service.
 
During the 1970s and 1980s, vocational training for general practice developed from experimental beginnings to become established nationwide. Committees were set up nationally and regionally and methods devised for the approval of training practices. Important publications related to the discipline of general practice and to educational methodology appeared. The problems that remain include the absence of a compulsory assessment prior to entering general practice and the low remuneration for course organizers.
 
Nine cases of hand, foot and mouth disease were found in a small area within a month. The condition is benign, commonest in small children, and the infectivity is low. It is suggested a fuller investigation be considered in 1976.
 
Top-cited authors
Stephen Patrick McKenna
  • Galen Research Ltd
Denis Pereira Gray
  • University of Exeter; UK; St Leonard's Reseach General Practice, Exeter, UK
ProfessorPhilip Ley
  • The University of Sydney
Peter William Bradshaw
  • Khon Kaen University
Martin Wilkinson
  • University of Birmingham