Biomedical subjects
Publications and source records attributed to P M Tombleson.
There is considerable interest in general practice assessment both as a means of monitoring vocational training and as a form of self audit for the general practitioner. Basic principles involved in the selection and design of assessment procedures are reviewed and their application discussed.
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The results of a study of repeat prescriptions in a semi-rural general practice of 2715 patients showed that 97 people had not attended for review of their drug treatment for over 12 months. Nearly 60 patients seemed to elude contact; the motivation for this behaviour was divided between pride and fear. A psychological study showed pronounced phobic features in the group that was most closely aligned to the patients having repeat prescriptions described by the Balint group.
We hope that general practitioners will consider counselling their dying patients more actively, including those in hospital where terminal care may be poorly handled psychologically. This entails a major change in training which we hope is taking place through vocational training schemes. We feel a change in attitude to be necessary by many general practitioners who often deal with death by evasion and untruth.
Some conclusions are reported from a series of seminars involving several experienced general practitioners over a period of three years. The aim was to examine first consultations in general practice.We found that these were often handled superficially and that both doctors and patients seemed hesitant in their new relationship. We believe that the loss of a trusted family doctor can create a bereavement reaction in patients, especially where the relationship has been long and when the doctor leaves or dies suddenly.We are investigating the possibility that the death rate is increased among patients who have recently lost their general practitioner suddenly.