Family practice
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Parents frequently give over-the-counter paracetamol (acetaminophen) during childhood illness. This study aims at exploring parents' use of this medicine in relation to their management of common childhood illnesses and the impact on the family. ⋯ Fever was often judged to cause discomfort and danger. Thus antipyretics like paracetamol were regarded as a medicine counteracting disease. Paracetamol constituted an important tool for parents in managing different upsets during childhood illnesses. Information was not always wanted. Better knowledge about the significance of fever and how to handle children during common illnesses might need to be presented in a context familiar to parents, for instance, in relation to general information on childcare.
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The population of individuals who are ageing with a disability is growing rapidly, yet we know little about their views of their primary care and family physicians. ⋯ A partnership with primary care/family physicians that communicates concern while avoiding stereotyping and recognizing patient expertise is important for many patients ageing with a disability.
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Shared decision-making between patients and health professionals has been promoted as ethically and clinically desirable. Patients vary in their willingness to participate in decision-making, while clinicians identify practical barriers to greater participation, such as time and communication skills. A paternalistic approach to treatment decisions remains common even in an area of clinical uncertainty. The willingness of patients to participate in decision-making varies over time during the course of an illness but patients may not be given the opportunity to revisit clinical decisions with their specialists after the initial consultation. ⋯ The paternalistic decision-making model remains the chosen approach in this situation. The patients' willingness to become actively involved in choosing their care varies over time. Barriers to shared decision-making can be identified both in the nature of the doctor-patient relationship and the structure of the clinical follow-up.
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For a variety of reasons, GPs are working more and more with unfamiliar patients. The proposed new British GP contract stipulates that in future patients will register with a practice, rather than with a named GP and a recent new definition of general practice did not mention continuing care. There has been persistent confusion about the definition of continuity of care. ⋯ The contributions of informational continuity (especially good records) and of excellent consulting skills are put in context. We conclude that further evidence is needed to demonstrate the added value of interpersonal continuity in general practice and that this needs a clear theoretical basis. We propose that such a theory will define the concept of multi-dimensional diagnosis as the key strength of our discipline and that continuity, especially interpersonal continuity, is an important factor in achieving this economically and in a way which satisfies both patients and professionals.
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Schizophrenia affects up to 1% of the population in the UK. People with schizophrenia use the National Health Service frequently and over a long period of time. However, their views on satisfaction with primary care are rarely sought. ⋯ Satisfaction with primary care is multiply mediated. It is also rarely expected or achieved by this group of patients. There is a significant gap between the rhetoric and the reality of user involvement in primary care consultations. Acknowledging the tensions between societal and GP views of schizophrenia as an incurable life sentence and the importance to patients of hope for recovery is likely to lead to greater satisfaction with primary health care for people with schizophrenia.