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3.  Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters. 
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.
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PMCID: PMC1712216  PMID: 2558204
5.  Mathematical relationship between waiting times and appointment interval for doctor and patients. 
Appointment systems try to achieve a balance between the time the doctor waits for patients to arrive and the time patients spend waiting to be seen. Mathematical analysis reveals that the time a patient can expect to wait increases exponentially as the appointment interval is reduced. An appointment interval that is less than the median consultation length can result in long waits for patients with no saving of time for the doctor. More frequent, shorter surgeries can save time for patients with no increase in the doctor's waiting time. Methods of improving the efficiency of use of surgery time are discussed.
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PMCID: PMC1712214  PMID: 2558203
7.  Estimates of general practitioner workload: a review. 
This paper reviews four studies sponsored by the Department of Health which have attempted to measure workload in general practice and compares these with data from the general household survey. Despite the considerable differences in the objectives and methods employed by the four studies, they were found to contain remarkably consistent measurements of general practitioner workload. In a 'normal working week' general practitioners spend 38 hours on general medical service duties (including 24 hours of patient contact and five hours of travel to home visits), they see 150 patients or their representatives in surgery, and make 26 home visits. In an 'annual average week', taking into account holidays and sick leave, general practitioners undertake 90% of this workload. The studies show consistently large variations in the workload of general practitioners measured in this way, but fail to identify the key determinants of such variations. The reasons underlying the variation in general practitioner workload will remain unclear until we can distinguish between the expected, measurable variation and the residual, unexplained variation which may be due to the personal preferences of general practitioners.
PMCID: PMC1712212  PMID: 2558208
10.  A diagnostic centre for general practitioners: results of individual feedback on diagnostic actions. 
A diagnostic centre, managing diagnostic tests for general practice, can improve the service provided by primary health care and the communication between general practitioners and specialists. In addition, it can evaluate the use and misuse of tests. This paper describes the work of a diagnostic centre in the Netherlands serving 80 general practitioners. Following the introduction of individual feedback to general practitioners on their use of diagnostic tests there was a decrease in the number of requests for tests.
PMCID: PMC1712209  PMID: 2558207
14.  Study of the effect of time availability on the consultation. 
This study looked at the effect of different appointment time intervals on process and outcome measures in the consultation. Over a five-month period patients attending a two-partner surgery were non-systematically allocated to appointments at five, 10 or 15 minute intervals. Consultations were audiotaped and analysed. When appointments were scheduled at longer intervals, doctors asked significantly more questions and made significantly more statements explaining the problem and its management, while patients asked significantly more questions and made significantly more statements of their own ideas about the problem. In consultations booked at shorter intervals patients were significantly more likely to report in satisfaction questionnaires that they had little or far too little time available. The implications of the results for future planning are discussed.
PMCID: PMC1712205  PMID: 2558202
17.  New contract. 
PMCID: PMC1712202  PMID: 2558219
20.  Torture of prisoners. 
PMCID: PMC1712198  PMID: 2558218
21.  Survey of the use of homeopathic medicine in the UK health system. 
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.
PMCID: PMC1712197  PMID: 2558206
22.  Treatment of asthma. 
PMCID: PMC1712196  PMID: 2558213
24.  How well do general practitioners manage dyspepsia? 
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.
PMCID: PMC1712194  PMID: 2558205

Results 1-25 (7690)