Bent Guttorm Bentsen

Fundamentals of General Medical Practice

In many countries there is a recognized specialist education for general practice, corresponding to those offered for organ specialties. Why, then, is general practice not recognized everywhere as a full specialty? It has been suggested that general practice is characterized by an easily available, continuous, personal, binding and comprehensive care. However, there are also other aspects which characterize this discipline. Firstly it is based on an overall view of health and disease, in which physical, mental, and social factors must be taken into account simultaneously. Secondly the epidemiological world, as seen by the primary physician, is different from those of all traditional specialties. This gives rise to considerable consequences in diagnostic and therapeutic work, as reflected in the predictive values of tests and for symptoms in general practice, when contrasted with specialist practice. Thirdly, the approach to problem solving is also very different. In general practice, it is characterized by thinking in terms of possibility or probability, whereas in specialist practice the reductionistic method is used. A fourth factor can also be pin-pointed. Although the primary physician is responsible for the greater part of diagnosis and treatment of illness in the population, he also co-ordinates the patients contact with the second and third line services in the hospital and in specialized medicine. Therefore, general practice is an independent medical discipline, which demands its own specialist education.

Record Keeping in Norwegian General Practice

Routines of medical record keeping were studied in a random sample of 50 out of 228 general practitioners in two counties, Möre & Romsdal and Sör-Tröndelag. One doctor refused to participate and one had retired. The 48 physicians were interviewed and a questionnaire was completed with details about their record keeping. The standard of the records was assessed according to legibility, quality of notes, past history and tidiness using a score system. All general practitioners had records for every patient, but the quality of the records varied considerably. More than 50 per cent used handwriting in progress notes, which varied from diagnostic labels to extended reports. Few records contained accessible background information about the patient concerned, and many records contained large amounts of old and irrelevant papers. The record-scores varied from 3 to maximum 10 with an average of 6.7. Higher Standards of recording in general practice are called for, since the quality of records does not only affect the individual patient, but, in the end, the quality of medical care in general.