Case history

The general practitioner

Case history

In 1966, Mrs. Taylor developed pains in her abdomen. The doctor diagnosed gallstones. Mrs. Taylor spent ten days in the hospital while the surgeons removed her gallbladder. The scar, which was 16 cm long, took a month to heal and Mrs. Taylor needed two months off work.

In 1992, Mrs. Taylor’s daughter Louise developed the same symptoms. Louise spent two days in the hospital, where the surgeons removed her gallbladder using a laparoscope. Louise’s scar was only 3 cm long and she was well enough to return to work after only two weeks.

Britain has a two-tier system of medical care. A person who is ill goes first to a primary care physician or general practitioner. The general practitioner treats most problems himself, and refers patients with unusual or serious illnesses to specialists for secondary care.

The two-tier system has several advantages. Primary care is a cheap and accessible way of treating minor illnesses. The patient can consult the same doctor for almost all illnesses. Specialists do not waste their time on simple problems. In serious illness the general practitioner helps the patient find the most appropriate specialist.

General practice is the “gateway” to specialist health care. But it is also becoming a specialty in its own right. In Britain 99 percent of the population is registered with a general practitioner. Two-thirds of the population visits a general practitioner every year and 98 percent do so at least once every five years. The general practitioner can therefore offer preventive medicine and health education to almost every one in the community. In the past the general practitioner dealt only with “presenting complaints,” that is, the symptoms and anxieties which patients brought along to the doctor. This is called reactive medicine, where the doctor does nothing until the patient has noticed that something is wrong. Modern general practice involves pro-active medicine, where the doctor makes contact with healthy people and offers medical care to people who have not asked for it.

Timothy, aged ten, was brought to his general practitioner complaining of severe chest pains. The general practitioner knew the family well. She had cared for Timothy’s father three years ago. The father had had chest pains followed by sudden death from a heart attack. The doctor examined Timothy and found nothing wrong with his heart, but noticed that the boy was unhappy and overweight. Timothy said he was frightened that he too might die of a heart attack. The doctor said that there was nothing physically wrong, and Timothy did not need to see a heart specialist. She asked the boy and his mother to come back for some counselling to talk about the father’s death. A few weeks later Timothy stopped getting chest pains.

Дата добавления: 2014-10-15