Nephrology in general practice

Hints for the practitioner concerning the management of patients with renal disease are presented. Important facts relating to history, physical, laboratory and radiological findings are stressed and diagnostic assessment is briefly described. Although the general practitioner will refer such patients in most instances to a nephrologist, he should know what kind of further examinations and studies are necessary for correct diagnosis and adequate treatment. The present therapeutic possibilities have greatly improved, but one still disappointing aspect is the treatment of certain forms of glomerulonephritis. The cumulative survival rates in patients undergoing hemodialysis and renal transplantation are assessed and compared with the survival rates in patients suffering from myocardial infarct and carcinoma of the breast, colon and the lung. Essential preventive measures are avoidance of toxic substances like analgesics and consistent antihypertensive therapy even in patients with a renal ailment. The dosage of drugs which are mainly eliminated by the kidneys must be adapted to renal function (serum creatinine or clearance of endogenous creatinine).     

Somatization in general practice

Patients with unexplained physical symptoms are very common in primary care. Some patients attribute these symptoms to physical disease (somatizing patients). Somatization can be a symptom of psychiatric disorder, which is found in 1/4 to 1/3 of the patients in a primary care setting. This form of somatization makes diagnosing difficult and is the main reason why psychiatric disorders are underdiagnosed. Simple techniques for diagnosing and treating somatizing patients are available to general practitioners. However, to improve diagnostic sensitivity and treatment, further teaching and development in primary care settings are necessary.     

Psoriasis in general practice

This report, based on a resource pack for primary care nurses, describes the features of psoriasis and reviews current prevention and treatments. The pack emphasises the important role of nurses in helping people to maintain their confidence and independence in the face of this chronic disease.     

Adrenaline degradation in general practice

The general practitioner's (GP's) doctor's bag is exposed to extreme temperatures that may affect the stability of the drugs it contains. Adrenaline (1:1000 solution) is more stable than previous studies would suggest. GPs carry out-of-date drugs despite stating that they regularly check expiry dates.     

Lithium follow-up in general practice

Lithium salts have been used in medicine for over a century and are a widely accepted treatment. Clinical practice in the London borough of Barnet led us to suspect that agreed guidelines were not being followed. We checked them against published guidelines and followed up their implementation. A list of patients on lithium was obtained from the local biochemistry laboratory and a representative sample extracted. We looked at the frequency of laboratory testing and compared it with the guidelines. We found that the standards for lithium therapy follow-up were not being met and that while we awaited the outcome of our consultant psychiatrists' committee deliberations, the recommendations were not being implemented. A lithium register or clinic needs to be established in the area, and there is also a need for more reliable and effective implementation of clinical audit recommendations.     

Endometrial sampling in general practice

Unexpected vaginal bleeding is a common problem in general medical practice and likely to increase as more women use hormone replacement therapies (HRT). This study looks at the successful introduction of a technique for endometrial sampling into general practice, allowing earlier diagnosis of endometrial cancer and reassurance for women without serious pathology.     

Consultation frequencies in general practice

Some models of the process by which individuals seek medical care suggest the negative binomial as the underlying distribution of the frequencies of consultations in a given practice. Data from the 1970-71 National Morbidity Survey of General Practice are used to test these competing models. It is shown that the negative binomial distribution successfully fits consultation frequencies in aggregate and in subdivisions according to age, sex, and duration of registration. In this article is is assumed that the consultation process has two components: the patient's decision to visit his doctor for a new illness and the follow-up visits that results from this new problem. Supplementing previous evidence that the distribution of episodes of new illnesses follows a negative binomial distribution, this article shows that consultation frequencies among individuals presenting with one new illness also follow a negative binomial distribution. A unifying model is required to synthesize these findings.     

Intercultural communication in general practice

What is the reason for possible communication problems between physicians and immigrants from the third world? How is the interaction between the two groups regulated? To answer such questions, 15 doctors and 10 immigrants were interviewed about their experience of the doctor-patient interaction in unstructured open-ended interviews. Culturally based verbal and non-verbal expressions were particularly difficult to interpret, being based on different thought models and language. Owing to the world wide generalisation of the doctor-patient roles the gap between the two "partners" in the communication has been to some extent bridged. Largely independent of the doctors' will, the immigrants assigned considerable authority to the doctors. Thus the power of the doctor is based on the institutionalisation of the more universal doctor-patient role.