Young General Practitioners Research Articles

Stroke prevention and atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study.

The aim of the Stroke and Atrial Fibrillation Ensemble (SAFE) II study was to identify the reasons underlying the under-utilization of oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (NVAF). We investigated from all available sources the reasons why patients hospitalized for a stroke, who had a previously known NVAF, were not receiving OAC beforehand. We interviewed general practitioners (GPs) and cardiologists with a structured questionnaire, to identify the reasons for their therapeutic choice. Of 370 patients, 257 were theoretically eligible for OAC according to guidelines and the presence of contra-indications, but only 82 (22.2%) of them had actually received OAC before. We found that factors independently associated with the prescription of OAC were being followed-up by a cardiologist and having a younger GP. The leading reason evoked by GPs or cardiologists to explain why patients were not treated with OAC was the presence of a 'potential contra-indication', which was often inappropriate, followed by 'there was no indication', 'low compliance' and 'fear of bleeding'. An important reason for not prescribing OAC was the lack of knowledge about trials and guidelines. Medical education about OAC in NVAF should therefore be improved.

Understanding William Farr's 1838 article "On prognosis": comment.

In 1838, when William Farr published the accompanying article, he was a young general practitioner struggling to establish a practice near the bottom of London’s highly stratified medical profession (Eyler, 1979, pp. 1–6; Peterson, 1978, pp. 5–39). To supplement his income Farr took in lodgers and gave lectures in his own home, and he turned to medical journalism. Beginning in 1835 he helped edit the British Medical Almanack, an annual review of the profession and its institutions and the journal that published his article “On prognosis.” He also founded and edited his own journal the British Annals of Medicine, Pharmacy, Vital Statistics, and General Science, a weekly publication that ran from only January to August 1837. He wrote pro-lifically in these years in part to fill the pages of his journal. His vitriolic editorials in these years demonstrate his sympathy for radical reform of his profession. However, it was his articles on vital statistics had something novel to say, and in these early articles we can find the germ of ideas and methods he would develop during his long and productive career.

Improving local services for women with breast cancer: interviews with general practitioners in central Sydney.

We conducted interviews with 85 randomly selected general practitioners (GPs) in Central Sydney to examine patterns of referral of women with breast cancer, satisfaction with local services, awareness of evidence-based guidelines and suggestions for local support. Previous experience was the most frequently cited factor influencing choice of specialist (n = 80, 94%) followed by personal knowledge of the consultant's expertise (n = 72, 85%). Only one third of respondents agreed women wanted to be more involved in choosing the specialist (n = 28, 33%). Of 79 women recently diagnosed with breast cancer, the majority (96%) had been referred to a male surgeon (n = 71, 96%). While only 35% of the GPs rated the care received by women with breast cancer in local facilities as 'excellent', significantly fewer rated communication between GPs and specialists as 'excellent' (35% v 19%, p < 0.01). Younger GPs were less likely to rate communication as 'excellent' compared with GPs aged 55 years or older (p = 0.01). Only 18% of GPs considered their patients as having been 'very well informed' about their treatment choices. Younger GPs were more likely than older GPs to recall all available breast cancer guidelines (p = 0.02). Significantly more GPs (68%) requested seminars with experts than any other types of educational support (p < 0.001). To improve outcomes for women with breast cancer, mechanisms to support communication between GPs and specialists are recommended. Seminars for GPs with experts who emphasize evidence-based guidelines should be funded and evaluated, especially for impact in meeting the needs of older GPs.

Home visits by general practitioners

EDITOR, - Linda Beecham reports on the current state of negotiations about the reorganisation of out of hours emergency services by general practitioners.1 The accompanying photograph of a young general practitioner visiting an elderly woman at home is ironic, because those who argue in favour of …

Research training for general practitioners: an experiment in The Netherlands.

One of the great problems in the field of primary health care research is the lack of qualified general practice researchers. The same is true for General Practitioners working in the University Departments of General Practice. Therefore the Department of General Practice at the University of Limburg in Maastricht in the Netherlands, developed a one-year research training programme for young General Practitioners. The aim was to provide a sufficient number of trained and qualified staff members in primary health care research for the various University Departments of General Practice. This article describes the main ideas behind this training course, as well as its contents and characteristics.

Doctors' perceptions of pressure from patients for referral.

To assess the effect of pressure from patients on patterns of general practitioners' outpatient referrals. Survey of general practitioners' referrals to hospital outpatient departments during one week. One health district. All (160) general practitioners in the health district. Specialty of the referral, the reason for it, and its status (NHS or private) and the general practitioner's assessment of the degree of pressure exerted by the patient for the referral (much, little, or none). 122 (76%) general practitioners completed the survey. Younger general practitioners (aged less than or equal to 45) and those qualifying in the United Kingdom and Republic of Ireland reported greater pressure from patients to refer (p less than 0.03, p less than 0.001 respectively). Pressure was also greater for patients referred privately (p less than 0.001), for those referred for reassurance (p less than 0.05), and for those referred to clinics in psychiatry, rheumatology, dermatology, and orthopaedics. General practitioners with a higher referral rate (with total consultations in the week as the denominator) were more likely to report pressure (p less than 0.01). The pressure from patients to refer reported by general practitioners is related both to general practitioners' characteristics and to the nature of the referral. Pressure to refer seems to explain some of the variation in referral rates among general practitioners.

Belgian General Practitioners on their Vocational Training: A Postal Inquiry

Vocational training of general practitioners in Belgium consists--among others--of 34 seminars to be followed in small groups during a period of two years. The purpose of this study was to develop an instrument for continuing evaluation of this system, and to gather evaluative data. 58% of 177 young general practitioners responded to our postal inquiry, in which ten open-ended questions were put, and 50 statements were to be rated on a six-point-scale. The inquiry revealed that the Belgian vocational training has a large influence on the evolution from inexperienced young doctor to self-confident general practitioner. Factor analysis on the scores of the 50 statements uncovered three dimensions: (1) working climate, (2) learning results, and (3) identification. The reliability of the scales, constructed for each of these factors, was between 0.80 and .86 (Cronbach's alpha). Mean scores on these scales were all high. The Belgian vocational training seems to be accepted and appreciated by the young GPs, but improvements might be suggested.

Satisfaction and job stress in general practice.

This paper investigates sources of job satisfaction and dissatisfaction in general practice and identifies pressures and difficulties experienced by general practitioners in their work. The study revealed widespread job satisfaction based on three separate (but independent) aspects of general practice: clinical, psychosocial or managerial. Despite this, significant pressures were experienced and, in common with previous studies over the last 20 years, this research found continuing problems affecting young general practitioners in particular. The main pressures currently experienced were uncertainty and insecurity about work, isolation, poor relationships with other doctors, disillusion with the role of the general practitioner, and an awareness of changing demands. These pressures were related to experience in general practice, amount of study leave and practice organization. Like previous studies, it also appears from this research that continuing education could play an important role in attenuating these difficulties. It is argued that the emphasis should be on developing support, confidence and better contacts between general practitioners, as well as teaching knowledge and skills.

General practitioner obstetrics in the Northern region in 1983.

In late 1983 a four page questionnaire on general practitioner obstetrics was sent to a 50% random sample of general practitioners in the Northern region of England; 84% responded. Half of them said that they had access to general practitioner facilities for delivery, and half of these used them. A quarter of all respondents had provided intranatal care previously but had given it up, most of them during the late 1970s. Younger general practitioners were more highly qualified in obstetrics than older ones but did not do more intranatal work. Isolated general practitioner maternity units were much more likely to be used than those that were alongside consultant units or integrated with them. Ninety per cent of respondents provided antenatal care, 77% of these at special clinics and 88% with midwives in attendance. Teamwork, however, was not well developed. Increasing general practitioner participation in obstetric care seems feasible but depends heavily on more appropriate training and intranatal facilities being provided for general practitioners in association with specialist units.

Predictors of dentists' level of knowledge regarding the recommended prophylactic regimen for patients with rheumatic heart disease

Maintaining knowledge of clinical practices, confirming to the latest scientific information, is a major challenge for health professionals. The study aims were (1) to measure clinicians' knowledge and (2) to determine what social factors could best explain and predict those dental clinicians who are most knowledgeable about current expert recommendations for the use of appropriate antibiotic regimens for patients at risk for bacterial endocarditis. Telephone interviews were conducted with 322 New York State dentists, assigned to the study by a computer-generated randomization procedure from lists of oral surgeons, urban general practitioners and rural general practitioners. Data demonstrated extraordinary differences in level of knowledge between oral surgeons and general practitioners, while the level of knowledge between urban and rural general practice groups was quite similar. General Linear Model (GLM)-based analyses indicated that practice size, rationalization of practice, and practice setting and affiliations contributed to the explanation of knowledge level among general practitioners, when adjusted for age. R 2s for each of those variables and age, ranged from a low of 0.132 to a high of 0.334. Age made a significant contribution to the explanation of knowledge level in all of the models presented, while the explanatory power of the practice structure variables varied according to respondent's locale (urban vs rural) and age (younger vs older). In order to assess the impact of these structural variables, they were dichotomized (high-low) and entered into a GLM program which accounted for age and locale. Differences in excess of 20 points (on a 0–100 knowledge scale) were sometimes noted. The findings demonstrate the importance of specifying variable relationships in explaining level of knowledge and also suggest, albeit indirectly, differences in the processes by which urban and rural and young and old general practitioners come to know.

A Review of Ethics, Legal Medicine and Forensic Pathology

Abstract Ethics, Legal Medicine and Forensic Pathology is as its inclusive title indicates an attempt to incorporate in one small volume of 279 pages all that most any physician would want to know about medical jurisprudence and forensic pathology in the Common Law countries, particularly Australia. The author has taken his lectures from medical school and woven them together in a relatively inclusive text which should be of great value to senior medical students, house officers, and young general practitioners.

Teaching psychosomatic medicine to young general practitioners.

Teaching psychosomatic medicine to young general practitioners.

Interesting Opportunity in Burma

An excellent opportunity exists for a young American general practitioner with an interest in surgery, to work with the Burma Surgeon, Dr. Gordon S. Seagrave, at his 250-bed hospital in Namkham, Burma. Minimum appointment is for 2 years. With satisfaction, an extended tenure would be encouraged. The candidate should be an American citizen of any race or religion, but his age should not exceed 40 years. He may be married or single. If he is married to a trained nurse, there would be an important place for her in the nurses training program; or to a teacher, an opportunity to teach in the secondary school on the hospital compound. Extensive experience is not a requirement, but graduation from an "A" class medical school is. Professional practice at the Namkham Hospital is intensive, widely varied, and often rare to Western medical experience. The candidate must be prepared to leave for Burma not later than the Spring of 1963, or sooner, if possible (depending upon issuance of his visa), so that his appointment can overlap that of the American physician now serving the program. This appointment offers a modest salary per annum. Travel expenses and Western style housing will be provided. Anyone interested should write to John F. Rich, Executive Vice-chairman, American Medical Center for Burma, Inc., 6 Penn Center Plaza, Philadelphia 3, Pennsylvania, including a statement of qualifications.

The modern family physician.

America needs more young general practitioners, yet the decline in medical students planning general practice is alarming. A physician, by acquiring through medical-school training the essential skills of the profession and by devoting these skills to his patients' welfare, can in truth become the family doctor—the key man of the medical profession. If there are fewer family doctors using their abilities and influence in the broad area of citizenship, in improving public relations, and in humanizing and personalizing medicine, the profession will lose its influence. Cooperation of the American Medical Association, the Council on Medical Education and Hospitals, the American Academy of General Practice, and the Advisory Board on Medical Specialties is needed to encourage formation of a Board of General Practice, thereby giving incentive to young men to enter general practice.

THE GENERAL PRACTITIONER AND THE PSYCHIATRIST

1. Sixty percent of 416 general practitioner respondents felt that their psychiatric training was reasonably adequate. A desire for more presentations and informal discussions of office-type cases was expressed. 2. Generalists are in need of more instruction in counseling techniques. 3. Twenty-four percent of general practice was considered to be primarily psychiatric in nature. The respondents estimated that they could take care of 78% of their psychiatric patients themselves. The main complaint about psychiatric patients was that they take too much time and are often difficult to help. 4. The main difficulties with referring patients to a psychiatrist were the expense to the patient (72%), resistance on the part of the patient (43%) and lack of available psychiatrists (32%). 5. The main complaints of these generalists about psychiatrists were their lack of availability and the inadequate nature of psychiatric reports to the referring doctor. 6. That progress is being made was indicated by the fact that the younger general practitioners were better satisfied with their psychiatric training, and felt that they could and wished to take care of more of their psychiatric patients as compared to the older practitioners. Some suggestions are made for improving the help that the psychiatrist can give to the generalist in this important area of medical practice.

Atlas clinique d'ophthalmoscopie photographique.

As photography of the eyeground has made great advances, the authors believe that an atlas of photographic pictures of the fundus oculi would be suitable for young ophthalmologists and general practitioners to learn that the elementary lesions in pathologic conditions of the fundus are comparatively simple and conform to similar changes encountered in general pathologic conditions. The apparatus used is the well known Nordenson camera. The great advantage of photography of the fundus, as has been stated before, is that successive pictures will describe the course of a lesion and at the same time give exact measurements of the lesion, while the drawings in color of the older atlases lack the exactness of a good photograph. The photographs were obtained during ten years' attendance at the clinic of Dr. Bailliart at the Quinze-Vingt, and a number of others have been added through the courtesy of Amsler, Bailliart, Diaz-Caneja, Laignier, Mawas,