Primary medical care can be provided either by a bureaucratic hierarchical organization or alternatively by independent contractors. Most members of the caring professions in medicine, nursing, and social work are employed in bureaucracies, whereas general medical practitioners, general dental practitioners, opticians, and pharmacists are independent contractors.The independent contractor status has recently been heavily attacked from within the medical and nursing professions, and also from outside. It has been suggested that contracting for services is an inappropriate and anomalous way of arranging medical care, which should now be stopped. However, this process of contracting for services can be analysed, using perspectives from some of the behavioural sciences, to reveal hidden depths in the independent contractor status which suggest that the provision of primary medical care is best carried out by independent contractors.

Contract Services↗

PubMed1977

A system of training for general practice.

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Educational Measurement↗

PubMed1975

Maximal aerobic capacity at different levels of carboxyhemoglobin.

Previous studies had indicated that maximum aerobic power (VO2 max) would be seriously impaired when HbCO levels were above 7% but was not altered if HbCO was around 2.7%. The present studies indicated that the critical level at which HbCO influenced VO2 max was approximately 4.3%. This was accompanied as in the above-noted studied with a reduction in total work time to the attainment of VO2 max. Two procedures to raise HbCO to appropriate levels were employed, i.e., a buildup wherin HbCO was incrementally increased by breathing ambient air containing 75 or 100 ppm CO and a bolus plus maintenance procedure. In the latter, HbCO was raised to the level attained in the buildup test by giving a "bolus" of CO followed by the continued inhalation of CO at a level to just maintain this level of HbCO regardless of the magnitude of the ventilation. Regardless of the mode of presentation, the decrement in VO2 max occurred at the same level of HbCO. These observations are of considerable significance, since it indicated that even low ambient levels of CO (23.7 ppm) would result in lowering maximum aerobic power if the individual had been previously exposed to CO such that the level was raised to this critical point.

Adult↗

PubMed1975

Technique for accurately producing desired carboxyhemoglobin levels during rest and exercise.

A method is described for accurately adjusting a subject's blood carboxyhemoglobin (HbCO) level and then maintaining this level during either rest or exercise. The data presented describe the constancy with which HbCO levels (between 3 and 5% HbCO)were maintained despite varying the inspired ventilatory volumes from 5 to 120 1/min (BTPS). After an initial bolus inhalation of CO to bring the blood HbCO to a desired level, the concentration of CO in the inspired air to maintain this level of HbCO can be predicted from the following equation: COI (ppm) = desired %HbCO divided by 0.180.

Body Burden↗

PubMed1974