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Letters
to
the
Editor
intelligence,
drive,
and
ability,
this
lesser
system
is
surely
much
more
likely
to
be
of
real
value,
if
only
because
it
stands
a
much
greater
chance
of
being
introduced?
I
submit,
Sir,
that
once
again
Dr
Stevens
(1977)
is
right:
"The
excellent
is
the
major
enemy
of
the
merely
good".
R.
J.
L.
DAVIS
The
Health
Centre
Dover
Kent.
References
Stevens,
J.
(1977).
Quality
of
care
in
general
practice:
can
it
be
assessed?
Butterworth
Gold Medal
Essay
1976.
Journal
of
the
Royal
College
of
General
Practitioners,
27,455-466.
Tait,
I.
G.
(1977).
The
Aldeburgh
System.
BritishMedicalJournal,
27,455-466.
Zander,
L.
I.,
Beresford,
S.
A.
A.
&
Thomas,
P.
(1978).
Medical
records
in
general
practice.
Occasional
Paper
5.
London:
Journal
of
the
Royal
College
of
General
Practitioners.
RUBELLA
SYNDROME
Sir,
I
wonder
if
you
would
be
kind
enough
to
inform
your
readers
that
assistance
can
be
given
to
any
of
their
patients
who
have
a
child
born
handicapped
as
the
result
of
the
rubella
epidemic.
Our
Association
has
information
available
to
assist
with
communication,
education,
and
social
problems.
J.
P.
OWEN
General
Secretary
National
Association
for
Deaf,
Blind
and
Rubella
Handicapped
164
Cromwell
Lane
Coventry
CV4
8AP.
GENERAL
PRACTITIONER
HOSPITALS
Sir,
Council
has
appointed
a
working
party
to
examine
the
present
state
of
general
practitioner
hospitals
and
to
make
recommendations
regarding
their
future.
Much
information
has
been
obtained
from
a
recent
paper
by
Cavenagh
(1978)
but
if
any
doctor
has
further
information
or
comments
about
the
use
of
these
hospitals
and
the
problems
which
they
face,
I
should
be
grateful
if
he
would
write
to
me
at
the
address
given
below.
J.
C.
HASLER
Hon.
Secretary
of
Council
Sonning
Common
Health
Centre
Wood
Lane
Sonning
Common
Reading
RG4
9SW.
Reference
Cavenagh,
A.
J.
M.
(1978).
Contribution
of
general
practitioner
hospitals
in
England
and
Wales.
British
Medical
Journal
2,34-36.
PRIMARY
CARE
IN
BIG
CITIES
Sir,
We
read
with
interest
the
recent
article
"The
family
doctor
in
Central
London"
(October
Journal,
p.606).
In
particular
we
were
interested
in
the
conclusion
that
"60
per
cent
of
people
registered
with
an
NHS
doctor
were
'very'
satisfied
and
a
further
22
per
cent
'fairly'
satisfied".
If
this
picture
is
correct
then
the
NHS
appears
to
be
meeting
most
people's
expectations.
This
conclusion,
however,
conflicts
with
research
we
are
currently
carrying
out
and
may
be
more
a
reflection
of
the
methodology
employed
than
the
reality
explored.
Unlike
the
Community
Health
Council
(CHC)
study
which
used
a
structural
quantitive
questionnaire,
we
have
employed
in-
depth
interviews
using
standard
questions.
This
approach
revealed
that
the
whole
concept
and
meaning
of
'patient
satisfaction'
is
so
complex
that
to
ask
a
patient
"Are
you
satisfied?"
is
for
all
intents
and
purposes
meaningless
and
certainly
the
wrong
question
to
ask.
Like
the
CHC
research
we
have
found
that
a
patient
has
a
"low
expectation
of
the
NHS",
"wishes
that
the
doctor
spent
more
time
with
the
patient"
and
finds
the
relationship
"impersonal
and
hurried".
But
unlike
the
CHC
study
we
believe
that
these
expectations
mirror
the
patient's
perception
of
a
'medical
encounter'
which
is
far
from
being
a
satisfactory
experience.
They
also
point
to
the
existence
of
a
hierarchy
or
a
range
of
experiences
which
each
contribute
to
the
patient's
overall
satisfaction,
rather
than
a
single
level
of
dimension
of
satisfaction.
More
importantly,
they
suggest
that
the
'level
of
satisfaction'
currently
experienced
by
the
NHS
patient
is
very
low.
We
are
now
extending
our
research
study
with
a
grant
from
the
King's
Fund,
but
we
already
have
sufficient
evidence
available
to
indicate
that
'patient
satisfaction'
is
a
concept
which
needs
to
be
unravelled.
The
phenomenology
of
the
medical
encounter
is
very
complex
and
it
would
be
unwise
for
anyone
concerned
with
the
NHS
to
become
complacent
about
levels
of
satisfaction
which
seem
more
apparent
than
real.
DONALD
W.
GAU
Senior
Lecturer
JAMES
MAXIN
Department
of
Community
Medicine
Middlesex
Hospital
Medical
School
Horace
Joules
Hall
Central
Middlesex
Hospital
London
NW1O
7NS.
INFORMATION
SYSTEMS
Sir,
As
a
corollary
to
the
report
by
Dr
Madeley
and
Dr
Metcalfe
on
records
in
Derbyshire
(November
Journal,
p.654)
I
thought
that
the
results
of
a
simple
study
which
I
did
recently
might
be
of
interest
to
readers.
I
wanted
to
see
if
general
practitioners
were
satisfied
with
their
records
or
would
be
prepared
to
contribute
towards
the
cost
of
a
new
system
(such
as
a
computer).
The
results
were
as
follows:
One
hundred
and
four
general
prac-
titioners
within
20
miles
of
Exeter
were
circulated
with
an
anonymous
short
questionnaire,
of
whom
88
replied.
Of
this
number:
52
felt
that
their
records
were
inadequate;
43
used
some
form
of
record
summary;
80
said
that
they
would
be
interested
in
a
new
form
of
record
system;
22
were
prepared
to
contribute
towards
this
(£300
was
men-
tioned)
and
a
further
14
gave
equivocal
answers-usually
a
qualified
"yes".
I
feel
that
general
practitioners
are
more
interested
in
a
satisfactory
record
system
than
some
authorities
would
have
us
believe.
K.
J.
BOLDEN
Senior
Lecturer
Department
of
General
Practice
Barrack
Road
Exeter
EX2
5DW.
A
DIPLOMA
IN
GENERAL
PRACTICE?
Sir,
We
welcome
Dr
S.
Hall's
suggestion
that
the
College
should
institute
a
dip-
loma
examination
for
our
hospital-
based
colleagues
(September
Journal,
p.
572).
Such
a
diploma
would
help
finally
to
dispel
the
last
remaining
vestiges
of
the
psychological
barrier
which
has
its
roots
in
the
awe
with
which
apothecaries
and
barber
surgeons
used
to
look
up
to
physicians.
The
younger
generation
of
general
practi-
tioners
certainly
respect
and
even
admire
technical
skill,
but
early
clinical
diagnosis
is
by
far
the
most
difficult
118
Journal
of
theRoyal
College
of
General
Practitioners,
February
1979
Letters
to
the
Editor
part
of
modern
medicine,
and
they
do
not
therefore
recognize
an
automatic
intellectual
superiority
in
their
specialist
contemporaries.
Income
should
be
based
solely
on
workload
and
level
of
responsibility,
and
not
on
the
expectations
of
a
bygone
era.
Yet
many
consultants
still
object
in
principle
to
the
small
overlap
in
relative
overall
remuneration
compared
with
their
own;
although
they
continue
to
have
misconceptions
and
confuse
general
practitioners'
net
and
gross
income
while
still
sniping
at
tax
ad-
vantages
which
cease
to
exist
only
for
consultants
without
private
practice
(Scurr,
1978).
D.
L.
BEALES
General
Practitioner
Trainer
P.
K.
SCHOTTE
General
Practitioner
Trainee
Phoenix
House
Phoenix
Way
Cirencester
Gloucestershire
GL7
2PJ.
References
Scurr,
C.
G.
(1978).
The
hospital
practitioner
grade.
Anaesthesia,
33,
838.
MIDWIFERY
RESEARCH
PROJECT
Sir,
I
should
like
to
ask
your
readers
for
help
in
a
research
project
which
is
being
undertaken
by
myself
and
colleagues
at
the
Nursing
Education
Research
Unit
of
Chelsea
College.
The
research
is
con-
cerned
with
the
role
and
education
of
the
midwife
and
will
consider
the
relationship
of
the
midwife's
work
with
that
of
other
health
professionals,
in-
cluding
the
general
practitioner.
The
original
initiative
for
the
project
came
from
the
Royal
College
of
Midwives
and
it
is
financed
by
the
Department
of
Health
and
Social
Security.
We
shall,
of
course,
be
studying
the
issues
involved
from
the
midwife's
point
of
view,
through
questionnaires
and
interviews,
but
feel
it
is
also
im-
portant
to
establish
the
views
of
other
health
professionals.
We
are
therefore
planning
to
send
questionnaires
to
a
small
random
sample
of
general
prac-
titioners
in
all
14
regional
health
auth-
orities
and
hope
to
conduct
a
short
interview
with
a
sub-sample
in
three.
We
do
hope
that
general
practitioners
who
are
asked
to
participate
in
the
project
will
feel
able
to
do
so,
as
we
think
it
is
important
for
their
views
on
this
subject
to
be
represented
in
the
project.
SARAH
ROBINSON
Research
Fellow
Nursing
Education
Research
Unit
Chelsea
College
University
of
London
17a
Onslow
Gardens
London
SW7
3AL.
ROLE
OF
ACUPUNCTURE
Sir,
I
am
surprised
at
the
cursory
recogni-
tion
given
in
your
columns
to
the
role
of
acupuncture
therapy
in
successfully
treating
many
conditions
which
fail
to
respond
to
other
forms
of
treatment.
In
my
six
years
of
experience
with
acupuncture,
I
have
found
it
to
be
suc-
cessful
in
treating
pains
in
the
back,
head,
and
neck,
as
well
as
migraine,
neuritis,
some
forms
of
arthritis
and
skin
conditions,
asthma,
alcoholism,
obesity,
and
other
problems.
The
apparent
timorousness
on
the
subject
is
extremely
disappointing.
In
the
rest
of
the
non-British
western
medical
circles
acupuncture
is
growing
with
rapid
acceptance,
especially
in
France,
Germany,
and
other
European
countries,
not
to
mention
its
increasing
acceptance
in
Canada,
the
USA,
and
Australia,
as
a
glance
at
the
past
few
years
of
Index
Medicus
will
attest.
It
is
to
be
hoped
that
acupuncture
will
eventually
be
considered
with
other
medical
sciences,
instead
of
being
rele-
gated,
as
it
is
in
this
country,
to
articles
by
non-medical
people
in
popular
journals
and
the
netherland
of
fringe
medicine.
JOHN
SHEEHAN
186
London
Road
Leicester.
BOOK
REVIEWS
FAMILY
MEDICINE
F.
J.
H.
Huygen
Roya
Vangorcum
Ltd
Netherlands
(1
978)
164
pages.
Price
E9
It
is
a
rare
pleasure
to
read
an
out-
standing
book
which
could
have
been
written
only
by
a
general
practitioner.
We
in
Britain
take
some
pride
in
our
belief
that
we
are
family
doctors
and
we
do
indeed
work
at
the
level
of
the
family
and
the
home.
All
too
few
of
us
take
the
next
step,
that
of
recognizing
our-
selves
as
doctors
of
families.
It
has
taken
a
Dutch
doctor
to
show
us
the
way.
Professor
Huygen
entered
general
practice
in
Nijmegen
during
the
war
and
began,
under
almost
impossible
circumstances,
the
meticulous
docu-
mentation
of
the
patients
he
inherited
from
his
predecessor.
The
difference
was
that
from
the
start
he
quantified
his
evidence
on
diagnoses,
attendance
patterns,
and
referrals
in
family
terms
rather
than
in
relation
to
the
isolated
patient.
Documentation
of
diagnoses
and
management
consistently
over
the
years
is
difficult
enough
but
when
he
reviews
his
notes
on
the
families
he
describes
Professor
Huygen
is
able
to
adduce
those
small
observations
of
behaviour,
character,
living
circumstances,
or
job
which
taken
together
can
be
called
personal
insight.
Not
only
does
he
deal
with
the
evidence
in
a
professional
way:
he
also
shows
the
real
affection
and
regard
that
a
good
family
doctor
has
for
the
patients
whom
he
knows
well.
The
descriptions
of
families
which
exemplify
a
particular
point
come
first.
Reading
them
the
British
doctor
will
recognize
patients
in
his
own
practice
and
find
himself
wishing
that
he
knew
more
about
the
family.
The
story
could
be
set
in
any
country
town
although
the
reader
is
often
reminded
by
delightful
pen
and
ink
sketches
that
the
scene
is
in
fact
set
in
Holland.
He
cannot
forget,
however,
that
patients
are
patients
wherever
they
are
and
have
qualities
that
can
be
consistently
observed
by
good
family
doctors.
The
next
dimension
is
the
application
of
aggregate
analysis
to
100
younger
families,
and
100
older
ones.
Methods
of
quantification
are
described
and
used
which
although
by
no
means
simple
seem
to
work
convincingly.
They
are
based
on
data
collection
methods
which
Journal
of
the
Royal
College
of
General
Practitioners,
February
1979
119
ResearchGate has not been able to resolve any citations for this publication.
Article
A survey of a one-in-seven sample of general practitioner hospitals in England and Wales, performed to determine the contribution they make to overall hospital work load and the attitudes of the general practitioners working in them, showed that 3% of acute hospital beds in England and Wales were in general practitioner hospitals, which provided initial hospital care for up to 20% of the population. Altogether 16% of general practitioners and 22% of consultants were on the staffs, and they coped with more than 13% of all casualties, 6% of operations, and 4% of x-ray examinations. Nearly a million casualties were treated at no cost to the National Health Service. Twenty new district general hospitals would be needed to cope with the work load currently dealt with by general practitioner hospitals. The results of this survey indicate that these smaller hospitals deal efficiently and cheaply with their work load, and that morale is high. General practitioner hospitals could have an important part to play in providing certain types of care, but there are no financial incentives to enable general practitioners to realise this potential fully.