Family practice
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Advocacy of communication skills training in medical curricula is common, but this paper highlights some paradoxes which become apparent when such training is instituted. Fourth-year medical students completed a standardized questionnaire measure of empathy, before and after intensive training in counselling and communication in general practice. Low rates of empathetic responding were shown, and no increase occurred after training. The results are discussed in terms of an emerging dilemma within medical education and practice, namely the conflict between the traditional view of the doctor as problem-solver and recent evidence of the health benefits of a more patient-centred style of medical practice.
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The cost of a consultation with a general practitioner forms an integral part of many economic evaluations. If resources are to be allocated efficiently it is necessary to provide accurate costings. Despite this, the research literature lacks any established method for costing consultations. This paper reviews some of the approaches used in previous studies, considers some of the issues involved in costing consultations, and provides some guidelines to follow when costing general practitioner consultations.
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Serum total cholesterol and lipoprotein analysis was performed on the same blood samples of 139 asymptomatic Chinese subjects aged 40-60 years. There was a highly significant correlation between serum total cholesterol and low density lipoproteins (correlation coefficient = 0.8376, p less than 0.001) in Chinese, which means that total cholesterol can be used as the initial screening to identify individuals who may need lipoprotein analysis. ⋯ Thirty to forty per cent of the lipoprotein analyses recommended by the ANCEP guidelines were not necessary. There was no significant age or sex influence on the degree of correlation between serum total cholesterol and LDL.
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The present population-based study comprises 84% of all known diabetics cared for at a rural primary health care centre. Patient education has been given high priority as an integral part of the treatment provided by a specially trained nurse and dietician under the supervision of the general practitioners. Most of the patients were under good metabolic control, as reflected by HbA1 (diet-treated, n = 119, 7.3 +/- 1.3%; oral agent-treated, n = 127, 7.8% +/- 1.3%; insulin-treated, n = 110, 8.0 +/- 1.3%; reference range 5.3-7.3%). Obvious reasons for any high HbA1 values were found.
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An analysis is made of the pattern of presenting premenstrual symptoms in randomly selected general practice patients from the Wellington region, New Zealand. Participants, 1826 healthy women 16-54 years old whose characteristics were reasonably representative of the adult female population, were asked about their general, obstetrical and gynaecological health. For the 1456 women who had menstruated within the last month or so, detailed questions were asked about the last menstrual cycle. ⋯ The last group contains a large number of women with miscellaneous symptoms. Characteristics of these groups are outlined. The study highlights the importance of distinguishing among premenstrual syndromes as this can foster more effective clinical management.