The Journal of the Royal College of General Practitioners. Occasional paper

Published by Royal College of General Practitioners
Publications
Primary health care can be regarded as the boundary between society as a whole and the medical system. Many of the problems patients bring to doctors in primary care are concerned with their personalities and life situation, and can be considered together as problems of human behaviour.On being questioned in a waiting room, 15 per cent of patients considered their problem "psychosocial only", and an additional 13 to 14 per cent "both somatic and psychosocial".I believe that the concept of the primary health care team is particularly valuable in managing problems of behaviour, and nondoctor members of the team play a crucial role.In my opinion it is questionable whether people's life problems should be channelled through primary health care, but in the meanwhile it seems clear that in most western societies the fact is they are.
 
The health problems of the elderly can be analysed. General practitioners care for about 90 per cent of the aged population. The number of disorders increases with age and social factors are increasingly important. Doctors need to take the initiative, seeking opportunities to look beyond the actual complaint. Clinical and human wisdom are more important than technical skills. The characteristics of a health care system needed by the aged are listed.
 
This research was conducted to investigate patterns of attendance at continuing education meetings and examine which factors encourage or inhibit attendance by comparing the characteristics of general practitioners who attend regularly with those who attend occasionally or not at all. The findings provide course organizers with a detailed insight into the attitudes and perceptions of frequent and infrequent attenders. The research identifies a need for greater personal contact in changing attitudes to continuing education and bringing about greater involvement. It is concluded that the role of general practitioner tutor should be enhanced to provide more direct contact and influence with small groups of doctors.
 
In August/September 1984 a survey of the 267 course organizers in post in England and Wales was carried out. Eighty-two per cent replied to a questionnaire asking for details about their work and personal status. All 16 regions in England and Wales completed a questionnaire about levels of staffing and remuneration of those involved in general practice postgraduate education. The results show that there are considerable variations between regions in the role and responsibilities of course organizers, in their training, and in the facilities that are provided for them. The majority of course organizers reported a workload greater than the number of sessions for which they were remunerated. The effects of these factors on recruitment, tenure of post, and job satisfaction are discussed. Recommendations are made for improving the situation, including the removal of course organizer pay from the scale of trainers' pay, so that there can be flexibility in the number of sessions which can be held, improvement in training and certain facilities, and the implementation of national and local job descriptions.
 
The way in which general practitioners think during consultations can be analysed. There are two broad processes: generalizations (placing the patient's problems in a diagnostic category) and individualization (assessing the patient and his behaviour). Ten ways in which clinical decisions taken in general practice differ from hospital practice are listed.
 
Since 1964 there have been many changes in the organisation of general practice and its links with other parts of the National Health Service. This study aims to document the effects of these changes for patients and doctors, to ascertain the reactions of both these groups to these changes and to consider the implications for future developments.
 
We describe a survey of general practitioners in the Northern Region which was carried out during the summer of 1977 as the result of a commission from the Education Committee of the North of England Faculty of the Royal College of General Practitioners. Seventy-five per cent of a one in two random sample of general practitioner principals returned a postal questionnaire in which their perceptions of postgraduate education were sought and their behaviour measured by the number of sessions they attended during the previous year at their 'usual' and other postgraduate centres. Almost half the respondents had more than a basic qualification and all but three per cent had held full-time hospital appointments, two thirds of them at the level of senior house officer or above. Their experience as general practitioner principals averaged 15 years and 57 per cent held part-time appointments outside their practices. Only four per cent had not attended any postgraduate events during the previous year but the remaining respondents had attended eight sessions on average, six of which were at their usual centres. Those attending more than the average number of sessions tended to have registered between 1950 and 1969, to work in larger practices, to hold additional appointments, or to be trainers or College tutors. Most of the respondents were conservative in their perceptions of teaching methods, the topics discussed at meetings, and the contributors to postgraduate education but the younger general practitioners and a group of established general practitioners affiliated to the Royal College of General Practitioners held more radical views. They agreed about the primacy of traditional clinical topics but were sceptical of the value of ward rounds and formal lectures and favoured the seminar and clinical attachments. They saw a need for more material about practice management and wanted experienced general practitioners and community paramedical staff as teachers in addition to hospital consultants. Most of the respondents believed that their usual centres were well organized and managed but failed to cater for the special requirements of general practitioners in non-clinical aspects of practice. Lunchtime and evenings were seen as the most convenient for weekday meetings and Sunday as the most convenient day of the week. A majority of respondents believed that post-graduate education had altered their practice of clinical medicine but only 15 per cent believed it had caused changes in their practice organization.
 
This project was concerned with the clinical knowledge reported by general practitioners in relation to the diagnosis and management of seven common clinical conditions: acute otitis media, jaundice, iron-deficiency anaemia, transient cerebral vascular insufficiency, infectious mononucleosis, pulmonary infarction, and carcinoma of the prostate. Postal questionnaires were sent to three groups of doctors: a constant group of experienced general practitioners who were or had been trainers, randomly selected groups of 200 general practitioners, and small groups of consultants who were specialists in each condition. The last two groups were changed for each of the chosen clinical conditions; the constant group remained the same throughout. The study was not concerned with the attitudes and skills of general practitioners or consultants, and no attempt has been made to analyse the process of clinical problem-solving. The differences between the constant group and random group of general practitioners were minor. Consultants received questionnaires identical to those sent to general practitioners and were asked to answer them as they would expect a competent general practitioner to do; their answers suggested a more direct approach to the problem concerned than those given by general practitioners. The information obtained has implications for education for general practice and educational audit programmes. Areas for further research are suggested.
 
Top-cited authors
John Fry
Phoenix White
  • Dalian University of Technology
Denis Pereira Gray
  • University of Exeter; UK; St Leonard's Reseach General Practice, Exeter, UK
Barbara A Gregson
  • Newcastle University
David Goldberg
  • King's College London