Of 850 consultant gynaecologists in Great Britain who were asked about their preferred method of pelvic examination, 777 (91%) replied including 87 women. Of these, 574 (74%) regularly choose the dorsal position both for bimanual and speculum examination although 227 of this group use the lateral position in some circumstances. ...

The lack of evidence to support formal annual screening of all older people does not weaken arguments for a preventive and anticipatory component to primary care. A number of short screening schedules for use by nurses or volunteers or for self-completion by patients have been developed. Patients 'failing' the screening ...

To define the process of outpatient consultation, the authors conducted a prospective study of 716 consecutive outpatient consultations in a university-based primary care internal medicine practice. The overall consultation rate was 11.9 per 100 patient visits, with 78% of the referrals to other physicians and 22% to non-physician specialists. Consultation ...

It is commonly believed that longer consultations are essential to better care and that this can only be achieved by lowering list sizes. The results of a survey of general practitioner trainers show that, on average, the time given to each patient was longer when general practitioners had lower list ...

For a general medicine consultation service to be effective, compliance with recommendations is essential, as is an understanding of the factors that improve compliance. Residents in a general medicine consultation service attempted prospectively to improve their skills as consultants and to enhance compliance by implementing the following steps, reported to ...

Fractionated external beam photon radiotherapy is an important component of the clinical management of malignant disease of the central nervous system. The practicing neurologist or neurosurgeon frequently relies on the consultative and treatment skills of a radiotherapist. This article provides a review for the nonradiotherapist of the place of conventional ...

Practitioners of complementary medicine took part in a questionnaire-based survey in 1980-81. Compliance was almost 100% in Oxfordshire and the Cambridge area but much less in five other areas of the UK. There were about 12 practitioners per 100 000 population, including all therapeutic specialties. Half the practitioners had had ...

Different denominators for morbidity studies were compared from two large studies in Britain. From the second national morbidity survey, data from 24 single-handed doctors showed a close correlation between the denominators 'persons consulting' and 'list size' (r greater than 0.9) in both years of the survey, but a weaker correlation ...

Between 1 May and 30 September 1983 a practice of three doctors in the centre of Scarborough conducted 1772 consultations with 1472 temporary residents, 967 (55%) of which were during July and August. The pattern of illness differed considerably from that usually found in general practice, with an excess of ...

In June 1982 an outside consulting firm utilized management engineering techniques to analyze productivity levels of the Radiology Department at the Medical University of South Carolina Hospital. Identical methods were utilized for a follow-up study conducted in January 1984. Strategies for productivity improvement were assessed as measured by number of ...

The author, a consultation/liaison psychiatrist, reviews five important questions about liaison work which are pressing, but remain unanswered. With some trepidation, he seeks to temper the enthusiasm of his colleagues who, by prematurely promising more than can ever be delivered in the name of "holistic" and "biopsychosocial" medicine, may lead ...

Two group general practices were located which, while similar in a number of important respects, differed in the number of appointment consultations arranged per hour, and data was collected to see if corresponding differences in consultation outcome could be found. Information on all appointment consultations offered during a four-week period ...

Of all the relationships that executives enter into with outsiders, perhaps none is so tainted by misunderstanding as the engagement of management consultants. To executives, consultants may seem concerned mainly with prolonging their assignments and unable to appreciate the practicalities of managerial issues. Conversely, consultants may see their clients as ...

Consultations by patients requesting influenza vaccinations were monitored in nine group practices before and after a radio broadcast encouraging patients at risk to seek vaccination. In a population of over 88,000 patients 88 consulted about influenza vaccination prior to the broadcast and 52 after. Not one consulted for vaccination as ...

All the patients (348) seen in one week in a training practice in Exeter were asked to complete a pair of questionnaires, one before and one after consulting, about the content of that consultation. Seventy-one per cent responded. Ninety-two per cent of respondents expected to be told what was wrong ...

Analysis of nationally representative surveys of adults and older teenagers has identified a small but steady decrease in consultation rates following the transient increase which occurred after the introduction of the National Health Service. Visiting rates decreased substantially after 1950 but no trend has been identified in attendance rates. However, ...

Many women who can climax easily with their partner to direct clitoral stimulation are unable to reach orgasm during intercourse unless they receive supplementary manual clitoral stimulation. Such women frequently consult their physician for advice. This two-part article aims to provide clear practical guidelines to the management of this situation.

Ten general practitioners in a study of general practice consultations were shown to differ significantly in the time they spent in their consultations. Patient demographic characteristics contributed little to differences in consultation time. Consultations in which (a) there was a diagnosis of psychological disorder, (b) the practitioner and the patients ...

A simple questionnaire was completed by a group of young consultants and the results compared with the views of a group of general practitioners. Many significant differences were noted which suggest that recently appointed consultants have a limited knowledge of the work of general practitioners.

Three hundred and forty-two general practitioners in Scotland presented their views on content and training in relation to consulting with patients. Differences in responses from trainers, non-trainers, and trainees are examined and possible reasons for the divergences are discussed.

With the increasing use of consultants to facilitate organizational change, managers need to be better informed about the range of available consulting services. In an effort to help managers better understand the various consulting approaches, Kleiner describes five techniques: "socio-technical systems;" "contingency;" "MAPS;" "Michigan survey feedback," and "process consultation." The ...

General-practitioner trainers in Scotland responded to a questionnaire on difficulties in consultation significantly more readily than did non-trainers. Their answers to some questions were significantly different.Trainer and trainee views of difficulties in communication with different types of patients and situations are broadly similar. Because of this similarity of views, the ...

Consultation-referral is a part of everyday family practice. Although the process is taken for granted, it is a complex phenomenon. Neither the practice nor the process always meet the expectations of the referring physician or the consultant, and the patient may be the worse because of this discrepany. Studies of ...

The use of consultations in family medicine has often been misunderstood by both the persons seeking the consultations and the persons acting as consultants. A policy regarding the use of consultants has been written by the Department of Family Medicine and Practice at the Center for Health Sciences, University of ...

FOUR CHARACTERISTICS OF PATIENTS WHICH MIGHT AFFECT THE LENGTH OF TIME SPENT IN CONSULTATIONS IN GENERAL PRACTICE WERE STUDIED: the sex, diagnosis, age, and social class of the patient. The sex of the patient was not shown to be significantly associated with any difference. The diagnosis of ;psychoneurotic' conditions was ...

The change in the practice of psychiatry has been sufficiently marked and sufficiently recent to generate uncertainty as to the psychiatrist's function, and particularly how he might best be used by other doctors. This article examines some issues relevant to the psychiatrist's function as a clinical consultant, as a contributor ...

A study from the Oxford Community Health Project is reported on the effects on consultation rates in general practice of patients' age, sex, date of registration, address, and usual doctor. The impact on consultation rates of accessibility of surgeries and availability of doctors is examined when the variables are controlled, ...

Twenty general practitioners co-operated in a study of the decision-making process in general practice respiratory illness. Ten simulated standard-patient consultations were used, each being included twice, once to make a decision on diagnosis and once to make a decision on management.Comparison of simulated behaviour with previous studies of observed and ...

As part of a larger study of serial complement profiles in glomerulonephritis plasma C3 and C4 concentrations were measured using commercially available immunodiffusion plates. A total of 303 samples were obtained from 128 patients suffering from forms of nephritis associated with hypocomplementaemia-namely, lupus nephritis, mesangiocapillary glomerulonephritis (M.C.G.N.), and acute glomerulonephritis.These ...

Report by Bernard Foëx, Consultant in Emergency Medicine and Critical Care 
Checked by Lee Wallis, Consultant in Emergency Medicine

The UKCC is currently consulting on its proposals to recognize and regulate a higher level of practice (UKCC, 1998a). These proposals follow the work undertaken by the UKCC from 1996-1998 on advanced and specialist practice and seek to build on the current postregistration education and practice (PREP) framework (UKCC, 1994). ...

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined ...

OBJECTIVE: To trace the movement from psychosomatic medicine to consultation-liaison psychiatry, the forces at work in shaping the change, and the extent to which the change is reflected in the latest revisions of the International classification of diseases (ICD-10) and the Diagnostic and statistical manual of mental disorders, third revision ...