The Journal of the Royal College of General Practitioners最新文献

To identify factors associated with the decision to consult with dyspepsia, patients with dyspepsia were identified from a postal survey in the community. A random sample of 69 patients who had consulted their general practitioner and 66 patients with dyspepsia who had not consulted were interviewed in their homes. Differences in consultation behaviour were not explained by differences in self-reported severity or frequency of symptoms or by the presence of associated symptoms. The most striking difference between the two groups was concern among the consulters about the possible seriousness of symptoms. Consulters were also more likely to be worried about cancer and heart disease and to have experienced more disruptive or threatening life events than the non-consulters. These results emphasize the importance of looking beyond the presentation of common symptoms in general practice to patients' fears about the significance of the symptoms and to non-physical determinants of consultation behaviour.

This paper reports the incidence of dyspepsia in general practice, the characteristics of patients, the types of complaints presented and the management of the dyspeptic patient by general practitioners. Fourteen general practitioners in the Maastricht region of the Netherlands studied 318 consecutive patients presenting with dyspepsia. Two questionnaires were used: one filled in by the patient (82% response), the other by the physician (100% response). The diagnostic conclusions which were established after three months of follow-up were compared with the diagnostic hypotheses at the initial consultation. The annual consultation rate for dyspepsia was calculated as 27 per 1000 registered subjects. One third of the patients had an earlier history of dyspepsia. Almost all patients (95%) complained of pain, and 37% had been suffering from pain for more than three months before consulting the general practitioner. The general practitioner prescribed medication in 70% of cases; less commonly the patient was referred for x-ray (14%), endoscopy (13%) or to a specialist (11%). A higher age was associated with a higher probability of referral, and with the finding of organic disease. A history of ulcer disease was strongly correlated with the diagnosis of an ulcer during the current episode. The overall concordance between the general practitioner's diagnostic hypothesis at the initial consultation and the diagnostic conclusion after three months of follow-up was 78%; it was highest when minor pathology was suspected. We conclude that dyspepsia is managed well in general practice and is only rarely associated with major lesions. Dyspeptic patients referred to a specialist therefore constitute a highly selected population.

An analysis of 7218 consultations showed that homeopathic medicines are being used to treat a wide range of morbidity in the United Kingdom. The data were derived from all consecutive consultations during one week by 73 doctors who used homeopathic medicine. Of these consultations 88% were conducted as part of the National Health Service (the majority in general practice). Thirty five per cent overall and 25% of general practice consultations were managed using homeopathic medicines, and these were combined with conventional drugs in 8.5% of the prescriptions.

Most psychiatrists who visit health centres use the shifted outpatient clinic model, the main aim of which is to improve secondary care by providing it in the primary care setting. For five years we have employed a liaison-attachment scheme in which support and advice from the psychiatrist enables general practitioners to improve their care of patients with psychiatric and psychological problems. One of the advantages of the latter model is that the psychiatrist can contribute to the care of patients not seen by the specialist psychiatric service and also to the development of the primary care team. The scheme is cost effective as psychiatrists can advise on the care of far more patients than they could see in formal referrals, fewer patients are taken on for a course of psychiatric treatment that could be provided by general practitioners and the skills of general practitioners and their trainees are enhanced. It is hoped that more general practitioners will adopt this pattern of working so that it can be fully developed and evaluated.