Suchergebnisse

Family doctors have been presented with changes in government policies and incentives in a recent white paper on primary care. Little work has been done, however, to find out how general practitioners respond to such measures. The response of general practitioners to professional and economic incentives was examined in relation to the location of the practice and the characteristics of the practitioners in seven different areas of England. The areas represented urban, rural, affluent, and deprived communities. The overall response rate was 74%, but the response varied among the areas, being poorest (64%) in an inner city area. Practices were subdivided as innovative, traditional, or intermediate, according to whether they employed a nurse and participated in the cost rent scheme and the vocational training scheme. Innovative practices were defined as fulfilling two of these criteria and traditional practices as fulfilling none; the remainder were classed as intermediate. The results showed that these three types of practice had distinct strategies that were related to financial constraints and the local population. Innovative practices had more partners and were often located in rural or affluent suburban areas; traditional practices had fewer partners and were more common in urban and working class areas. Innovative practices seemed to be in the best position to increase their services, and hence their incomes, in response to the recent proposals in the white paper. Practices in areas of developmental difficulty (predominantly urban but not necessarily inner city areas) had been less able to respond to existing incentives and had a smaller margin available for developing their services.

The aim of this study was to compare general practitioners/family doctors in different European countries to assess the psychosocial and work-related factors possibly contributing to burnout. The survey included questions on demographic-, work- and lifestyle-related job satisfaction
(Yaman & Ungan, 2002a; Yayli, Yaman, & Yaman, 2003) and the Maslach Burnout Inventory (Maslach & Jackson, 1986). Surveys were conducted in 13 European countries (Yaman & Soler, 2002b) with a response rate of 33%. The 1,503 respondents (833 males, 55.4%) had an
average age of 45.6 (22–74) years. 44% scored high for emotional exhaustion, 37% for depersonalization, 31% for low personal accomplishment, with 12% scoring high for all three. High burnout in one or more dimensions was best predicted by a multivariate model
including income, intention to change job (yes 1.89, no 0.82), satisfaction (0.58), increasing alcohol consumption (3.93), and use of psychotropic medication (2.08). High burnout in all dimensions was best predicted by a multivariate model including working weekends (1.77), job satisfaction
(0.38), increasing smoking (2.38) and psychotropic medication use (2.23). Burnout seems to be a common problem in European general practitioners and family doctors. Future research is needed to develop models to describe the phenomenon and to identify causative factors and effective intervention
strategies.

A large study of general practitioners in Manchester showed that women doctors were younger than men doctors, and few were single handed or worked in deprived inner city areas. They had closely similar patterns of care to their male colleagues, and although they worked slightly fewer hours in surgery, they had almost identical consultation times per patient. Women general practitioners were less active in politics and education than men.

'General practice/family medicine is an academic and scientific discipline and a clinical speciality with its own educational content, research, evidence-base and clinical activity, oriented to primary care.' This is the 2002 European definition issued by the World Organisation of Family Doctors (WONCA). Across Europe, Family Medicine is establishing itself ever more strongly as a recognised speciality requiring specific training. In Malta too, Family Medicine is about to undergo significant changes in the way it is to be perceived and practised. The EU accession process that Malta has been involved in has entailed familiarisation with European Union legislation regarding the Medical profession, the so-called Doctors' Directives. Furthermore, a number of provisions in these directives have been entrenched in the drafting of the new Health Care Professions Act even before Malta's final position with regards to full membership was decided. The issues regarding the EU Doctors' Directives and their relevance to Family Medicine in Malta were the subject of last February's winter CPD meeting organised by the Malta College of Family Doctors (jointly with the Medical Association of Malta). A review of the relevant issues is being reproduced hereunder. ; N/A

Primary health care is important item of political agendas since Alma Ata conference in 1978. West Balkans share common history in development of primary care since 1920' when Andrija Stampar introduced social and community based primary care concepts. The first known specialist training in general practice in the world started in former Yugoslavia in the early 1960'. Since then, much has been done in the field of general practice and family medicine and this is reflected in The European Academy of Teachers in General Practice and Family Medicine (EURACT), which is a network organisation within World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Region Europe (WONCA Europe). Its aim is to foster and maintain high standards of care in European general practice by promoting general practice as a discipline by learning and teaching. EURACT developed several documents and teachers' courses which can serve the development of family medicine curricula in new established departments of medical schools. This is also the case at Maribor Medical School, where learning outcomes and teaching methods are in concordance with EURACT teaching agenda, but also some innovative approaches are used, such as art and e-learning environment as teaching methods.

English
Under the UK Conservative government, GP fundholding represented a major increase in the involvement of primary care doctors in the management of local service provision. The Labour government's proposals for Primary Care Groups extends and develops this role. This article examines the experiences of fundholding of a group of general practices which participated in an external evaluation of their work. Opinions about the merits of fundholding were varied. Doctors and managers expressed concern about the administrative burden and questionable clinical value of the scheme. Uncertainties about the overall impact upon professional autonomy were also raised. These reservations are consistent with discussions elsewhere questioning the role of doctors as managers within health care systems.

Do the many targets, guidelines and governance inherent in modern general practice mean the specialty is becoming increasingly impersonal and mechanised? Is this an advantage or a disadvantage? This book explores this idea, looking at implications for both staff and members of the public.

This paper looks at the emergence in Russia of a strategy for delivering primary health care which differs radically from the specialist-based system of the former Soviet Union. Drawing on Russian language sources, the paper outlines previous training arrangements, the limited role of 'sector' doctors and the reasons for official endorsement of general practice during the years of perestroika. It reports that the Health Ministry asked all the country's regions to make a gradual transition to general practice in 1992, and that legislation made the choice of family doctor a universal right in 1993. The conclusion refers to factors which are likely to determine whether that right will become a reality.

Discusses involvement of primary care doctors in the management of local service provision; based on experiences of doctors and managers in one total purchasing project; Great Britain. Summaries in French and Spanish.

Doctors are among the healthiest segments of the population in western countries. Nevertheless, they complain strongly of stress and burnout. Their own explanation is deprofessionalisation: The honourable art of doctoring has been replaced by standardised interventions and production lines; professional autonomy has withered. This view is shared by many medical sociologists who have identified a "golden age of medicine," or "golden age of doctoring," starting after World War II and declining around 1970. This article looks at some of the central sociological literature on deprofessionalisation, particularly in a perspective of countervailing powers. It also looks into another rise-and-fall model, proposed by the medical profession itself, where the fall in professional power was generated by the notion that there are no more white spots to explore on the map of medicine. Contemporary doctoring is a case of cognitive dissonance, where the traditional doctor role seems incompatible with modern health care.
Keywords: deprofessionalisation, professional autonomy, cognitive dissonance, golden age of doctoring