Journal of the Royal Society of Medicine
-
Biography Historical Article
Classical notes: Beethoven's medical history. Variations on a rheumatological theme.
-
Forty specialists were asked about their management of three theoretical patients with advanced cancer of the head and neck. Reasons for variation were explored by considering the influence of perceived aims of treatment (radical or palliative), together with a number of factors relating to the tumour, the lymph nodes, and the patients' personal circumstances. The perceived aim of treatment was the most important determinant as to treatment modality but, when chances of influencing survival were small, there was disagreement as to the appropriate aim and subjective value judgements became influential. More careful analysis of the initial decision-making process is needed if new clinical trials are to significantly affect clinical practices.
-
In an attempt to establish what the general practitioner expects from an accident and emergency department, and how closely the service provided correlates with that view, a 12-point questionnaire was sent to the general practitioners in the Glasgow Royal Infirmary catchment area. Out of the 61.2% of general practitioners who replied, the majority wish to have responsibility for their own patients for conditions which are neither accidents nor emergencies. There is less agreement as to how much should be done within an accident and emergency department and on the appropriate modes of referral and communication between the general practitioner and the hospital service. Further consultation and cooperation are necessary to interpret and resolve these differences.