[Health and quality of life among long-term unemployed]

BACKGROUND

Many studies have shown an association between unemployment and poor health.

MATERIAL AND METHODS

This cross-sectional survey from 1993-94 using structured interviews and questionnaires describes health and quality of life among 148 long-term unemployed in Lillesand, Norway.

RESULTS

Compared with the general population, somatoform conditions and anxiety symptoms were twice as common among the unemployed, and depression three times as common. There was a higher frequency of depression among unemployed men than among unemployed women. The unemployed had a lower quality of life score than the general population; the difference was more than twice as large among men as among women. Unemployed aged 30-39 reported the strongest symptoms of anxiety and depression.

INTERPRETATION

The reason why unemployed men are more often stricken by depression and report lower quality of life than women, may be that men experience the job-loss more existentially threatening than do women.

[Courage--the mother of all virtues]

To be a physician requires courage. To engage in the patient as a person calls for social courage. Courage is needed to act rapidly and firmly in unclear clinical situations. The noble art of saying no to patients, bureaucrats and politicians calls upon courageous doctors. To resist follies and fallacies in medicine requires courage. The same virtue is necessary for the brave colleagues who try to diagnose and heal the perils within the medical fraternity. The autonomy, renewal and sustainability of medicine depend on courageous physicians. This article highlights the concept of courage, how this virtue may be promoted in the making of doctors and how courage should be facilitated in our professional culture.

General practitioners' knowledge of their patients' socioeconomic data and their ability to identify vulnerable groups

OBJECTIVE

To explore general practitioners' knowledge of their patients' socioeconomic data and their ability to identify vulnerable groups.

DESIGN

A multipractice survey of consecutive adult patients consulting general practitioners during one regular workday. Doctors and patients independently completed mirrored questionnaires.

SETTING

A geographically defined population of patients and doctors in Buskerud county, Norway.

SUBJECTS

1401 patients attending 89 general practitioners during the last two weeks of March 1995.

MAIN OUTCOME MEASURES

The doctors' ability to state the patients' socioeconomic situation correctly using sensitivity and specificity. Results for patients scarcely and well known to the doctors are compared.

RESULTS

Sensitivity ranged from 0.93 for work as main income source to 0.04 for not having WC/bathroom inside the dwelling. Specificity ranged from 1.00 for several factors to 0.73 for low educational level. Information on household composition and income source was correct for more than half of patients scarcely known to the doctors.

CONCLUSIONS

General practitioners' knowledge of various socioeconomic data of their patients differs substantially and are collected at different stages in the relationship. Among socioeconomic data defining vulnerable groups, the patients' self-perceived work disability is the variable general practitioners are best at evaluating.

[Physicians and other practitioners of acupuncture in Norway--education, theoretical orientation and practice]

We conducted a survey for the purpose of obtaining information on training, theoretical orientation and practice among various categories of practitioners of acupuncture in Norway. Particular attention was paid to physicians, compared with other groups of practitioners. A questionnaire was sent to 161 persons who had attended Norwegian Medical Acupuncture Seminars (Norske legers akupunkturkurs) and to 274 persons found under "Acupuncture" in the Yellow Pages of the telephone directory. The response rate was 80%, questionnaires being returned by 298 practitioners. A significantly higher percentage of physicians, as opposed to other practitioners, had less than 120 hours of acupuncture training. 30% of the physicians, compared to 60% in other groups, had more than 10 acupuncture consultations a week. Physicians performed only a relatively small number of different acupuncture methods. There was a relatively high number of men among the acupuncturists. Hence, acupuncture seems to be a practice with masculine appeal. 67% of the physicians used one or more Chinese medical concepts associated with acupuncture. 45% stated that they found non-scientific explanations for how acupuncture works reliable. We therefore argue that one can identify parallel processes in the development of acupuncture. Some elements of acupuncture have been integrated in a scientifically defined reality. At the same time, this survey indicates another process: it shows that many practitioners use traditional Chinese medical concepts. This may indicate that some practitioners have changed their view on what constitutes a reliable picture of reality.

Influence of social problems on management in general practice: multipractice questionnaire survey

OBJECTIVES

To find how often social problems influence clinical management in general practice, how management is changed, and how the characteristics of patients, doctors, and the doctor-patient relationship influence this management.

DESIGN

Multipractice survey of patients consulting general practitioners. Doctors completed a questionnaire for each patient.

SETTING

General practices in Buskerud county, Norway.

SUBJECTS

1401 consecutive adult patients attending 89 general practitioners.

MAIN OUTCOME MEASURES

How often management of patients was influenced by different types of social problem and main reasons for consultation; frequency and intercorrelation of different types of management applied; odds ratios for social problems' influence on management, controlled for by characteristics of doctors, patients, and their relationship.

RESULTS

In 17% of all consultations the doctors' knowledge of patients' social problems influenced their management, stressful working conditions being the most frequent influencing type of problem. Knowledge of social problems influenced management more often when the doctor knew a patient well, but less often the longer a doctor had worked in a practice. When social problems influenced management, the commonest types of management offered were extra time for consultation (51%), advice (42%), authorisation of sick leave (28%), and prescription of a psychotropic drug (20%), while referral to community services was used in 2.6% of these consultations. Prescription of a psychotropic drug was positively correlated with use of extra time, and was made more often by female doctors.

CONCLUSIONS

Patients' social problems influenced choice of management in at least a sixth of consultations. Prior knowledge of the patient, the doctor's time in present practice, age and sex of the patient, and sex of the doctor significantly influenced management of patients.

Work disability and health-affecting psychosocial problems among patients in general practice

Psychosocial problems are often ignored among patients in general practice. By identifying high risk groups this situation could possibly be altered. This study aimed to explore if patients in general practice perceiving themselves as work-disabled by at least 50% more often have health-affecting psychosocial problems than those not work-disabled. In a geographically defined population, 1,058 consecutive adult patients consulting 89 general practitioners were approached during one regular working day in March 1995. They completed a questionnaire at home, returning it directly to the department of general practice. Male patients considered themselves work-disabled more often than female patients. All psychosocial problems except having a demanding caregiving task were more common among the work-disabled. The doctors should bear in mind that work-disabled patients more often than other patients have concomitant health-affecting psychosocial problems. Granting long-term sick leave or a disability pension may not be the only management needed.

Clinical practice: between Aristotle and Cochrane

Health and disease consist of amino acids and self image, cell membranes and human ideals, muscles and politics. Only to a limited extent can clinical practice be based on science. It can never be carried on in isolation from political, and cultural forces that influence patients' health behaviour. Evidence-based medicine is essential but not sufficient. A continuous relationship with patients is a conditio sine qua non for general practice. The general practitioner must be a master of pragmatic medicine. Rationality, the dominant modern trend, may be dangerous for patients and doctors: (1) advances in technology can give patients and doctors the illusion of mastering the universe; (2) patients complain of being treated like biomachines, without human touch. Another symptom of modernity is the decline of religion. But patients and doctors are by no means rational beings. God, destiny and hope are replaced by modern medico-scientific megalomania. Modern medicine is also strongly influenced by commercialization and invasion by bureaucrats. Instead of becoming a biomedical robot, the general practitioner must learn to value the Aristotelian concept of phronesis. It means practical wisdom and can only be gained by personal experience; a form of learning by doing. Good clinical practice cannot come from science alone, or from personal experience alone. It is an amalgam of scientia and phronesis.

Psychosocial problems presented by patients with somatic reasons for encounter: tip of the iceberg?

BACKGROUND

Health-affecting psychosocial problems are inherent in general practice, present among one-third of the patients and constituting between 3 and 13% of reasons for encounter. Such problems are not always presented, and often overlooked by the doctors.

OBJECTIVES

We aimed to describe the frequency of psychosocial problems presented to the doctor by patients with somatic reasons for encounter, as a proportion of the patients' existing health-affecting problems, and to explore whether characteristics of the doctor, the patient, their relationship or reason for encounter influence the presentation of problems.

METHODS

A questionnaire survey of 1401 consecutive patients visiting 89 Norwegian GPs mapped the prevalence of nine commonly occurring psychosocial problems and the frequency by which they were disclosed during the consultation.

RESULTS

From 21% (loneliness) to 59% (occupational stress) of problems were disclosed to the doctors. Reason for encounter was the only factor to influence the disclosure from male patients, while reason for encounter, educational level and income source of the patient, gender of the doctor, and the doctor's previous general knowledge of the patient influenced the disclosure from female patients.

CONCLUSIONS

Less than half of health-affecting psychosocial problems are disclosed to GPs by patients with somatic reasons for encounter. Occupational stress is disclosed more often than other psychosocial problems. Female patients disclose non-occupational problems more often than male patients, especially if they know the doctor or if the doctor is a woman. Symptoms from the musculoskeletal system are the reasons for encounter most often preceding the disclosure of psychosocial problems.

[Norwegian physicians and alternative medicine. Knowledge, attitudes and experiences]

1272 members of the Norwegian Medical Association took part in a survey on knowledge about, attitudes towards and experience of acupuncture, reflexology, healing, homoeopathy and herbalism. The response rate was 91%. Knowledge about these five complementary methods of treatment was poor, particularly in regard to reflexology, healing and herbalism. Four out of five physicians, on the other hand, felt that they needed such knowledge to put them in a position to inform their patients. Furthermore, the physicians' attitudes were also fairly negative, except towards acupuncture. Only 4-11% regarded homoeopathy, reflexology or healing as valuable supplements to scientific medicine. 9% of the physicians had undergone acupuncture, and 4% practised this method. 65% referred their patients to acupuncture. Experience of the other four methods was less common. Poor knowledge and limited experience put Norwegian physicians in a weak position in the debate about complementary methods of treatment.

General practitioners' knowledge of their patients' psychosocial problems: multipractice questionnaire survey

OBJECTIVES

To evaluate general practitioners' knowledge of a range of psychosocial problems among their patients and to explore whether doctors' recognition of psychosocial problems depends on previous general knowledge about the patient or the type of problem or on certain characteristics of the doctor or the patient.

DESIGN

Multipractice survey of consecutive adult patients consulting general practitioners. Doctors and patients answered written questions.

SETTING

Buskerud county, Norway.

SUBJECTS

1401 adults attending 89 general practitioners during one regular working day in March 1995.

MAIN OUTCOME MEASURES

Doctors' knowledge of nine predefined psychosocial problems in patients; these problems were assessed by the patients as affecting their health on the day of consultation; odds ratios for the doctor's recognition of each problem, adjusted for characteristics of patients, doctors, and practices; and the doctor's assessment of previous general knowledge about the patient.

RESULTS

Doctors' knowledge of the problems ranged from 53% (108/203) of "stressful working conditions" to 19% (12/63) of a history of "violence or threats." Good previous knowledge of the patient increased the odds for the doctor's recognition of "sorrow," "violence or threats," "substance misuse in close friend or relative," and "difficult conflict with close friend or relative." Age and sex of doctor and patient, patient's educational level and living situation, and location of practice influenced the doctor's awareness.

CONCLUSIONS

Variation in the patients' communication abilities, the need for confidence in the doctor-patient relationship before revealing intimate problems, and a tendency for the doctors to be entrapped by their expectations may explain these findings.

General practitioners' drug prescribing practice and diagnoses for prescribing: the Møre & Romsdal Prescription Study

We have examined the prescribing patterns among general practitioners (GPs) in a Norwegian county in relation to the patients' age and sex and the diagnosis for prescribing. Altogether 69,843 contacts with patients were recorded during which 56,758 items were prescribed. The average number of items prescribed per patient contact was 0.81 (male 0.76, female 0.83). Diazepam, the compound analgesic of paracetamol (i.e. acetaminophen) and codeine, and triazolam were the three most frequently prescribed drugs for females as compared to phenoxymethylpenicillin, paracetamol/codeine and diazepam for males. Insomnia was the most frequently recorded diagnosis for prescribing. Listed second were upper respiratory tract infections (males) and anxiety (females). Hypertension was the number three diagnosis. The twenty most frequently prescribed items accounted for 48.5% of all drugs prescribed and the twenty most frequently recorded diagnoses for prescribing accounted for 61.7% of all diagnoses. This makes it possible to analyze a substantial part of the GPs' total prescribing by focusing on a few drugs or diagnoses.