OBJECTIVES: (a) To investigate defensive medical practices among general practitioners; (b) to compare any such practices with general practitioners' understanding of certain aspects of the terms of service and medical negligence and practitioners' concerns about the risk of being sued or having a complaint lodged. DESIGN: Postal questionnaire survey. Each questionnaire was followed by a reminder. SUBJECTS: 500 systematically selected general practitioners on the membership list of the Medical Defence Union. MAIN OUTCOME MEASURES: Answers to questions on defensive medical practices, understanding of certain aspects of the terms of service and medical negligence, and concerns about the risk of being sued or having a complaint lodged. RESULTS: 300 general practitioners returned the questionnaire (response rate 60%). 294 (98%) claimed to have made some practice changes as a result of the possibility of a patient complaining. Of the defensive medical practices adopted, the most common (over half of doctors stating likely or very likely) seemed to be increased diagnostic testing, increased referrals, increased follow up, and more detailed patient explanations and note taking. Respondents practised defensive medicine as a possible consequence of concerns about the risks of being sued or having a complaint lodged. This association was particularly strong for negative defensive practices. Defensive medical practice did not correlate with any misunderstanding about the law of negligence or the general practitioners' terms of service. CONCLUSIONS: General practitioners are practising defensive medicine. Some defensive practices such as increased patient explanations or more detailed note taking are clearly beneficial. However, implementing the findings of the Wilson report may increase negative defensive medical practices.

Adult↗

PubMed1995

The use of desk-top cholesterol analysers in general practice.

An examination of the use of desk-top cholesterol analysers was performed within 10 practices in Kirklees, West Yorkshire. The survey entailed a questionnaire survey of the principal users of desk-top cholesterol analysers and the analysis of two laboratory quality control samples. The majority of practices used Boehringer Lipotrend, with frequency of use varying from < 5 tests/week to a maximum of 20/week. Training by manufacturers was absent in four practices. The maintenance of analysers was inadequate in seven practices as was quality control in five practices. Analysis of laboratory quality control samples showed about 50% of results within 0.5 mmol/l of mean, but 20.6% differed from mean by > 1 mmol/l. The coefficients of variation were 18% and 20% respectively. The use of desk-top cholesterol analysers is increasing in general practice, but improvements in training and quality control are necessary to ensure precise and accurate results with near-patient testing.

Bias↗

PubMed1995

Primary care and the public health: general practitioners and health protection.

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Adult↗

PubMed1994

Local notification of infectious diseases--a neglected tool.

A country-wide survey of consultants in communicable disease control (CCDCs) was conducted to assess the use of Section 16 of the Public Health (Control of Disease) Act, 1984 for the local notification of infectious diseases. A response rate of 84% was achieved. The results indicate that, although the power is generally little used, 24 local authorities have locally notifiable diseases and at least eight CCDCs are actively considering the use of Section 16. The power may be particularly valuable as an additional tool in the surveillance of 'clinically diagnosed' and locally troublesome infections such as scabies.

Communicable Disease Control↗