Abstract:
:Objective: Investigating the state of generalism in medicine from the outlook of general practice. Line of argument: General practice developed when its pioneers, in continuing relationships, learnt to know their patients through the variety of medical situations. From the 50s, there is an increasing literature on the virtues and challenges of relationship based general practice, and register-based research indicate its benefits. Generalist perspectives and person-centeredness are implemented in specialised care and medical education but need to be complemented by an input from relationship based general practice. The politically defined aim of primary care is not to balance the draw-backs of specialisation, but to provide medicine at the primary care level. In Sweden, and increasingly even in traditional strongholds of general practice, team-based primary care is thought to respond to increasing demands, filtering out non- and minor disease through triage, practicing task distribution, and moving the GP to a secondary level working with the 'really sick', in all a decline in direct contact between patient and GP. Conclusions: When this happens, clinical medicine as a whole becomes drained of the practice of its human dimension. The lack of absolute proof of medical benefits cannot justify a disregard of the value of mutual knowledge and trust in the relationship, but still, in several countries, relationshipbased general practice will be hard to achieve for GPs planning their career. If the political winds should change, a sustaining profession of GPs preserving their relational ethos inside the team model, may be prepared to reform primary care. KEY POINTS Proclaiming both biomedical breadth and the trustful relationship between doctor and patient, as a specialty, general practice embodies medical generalism. A direct input from the patient's personal GP is necessary to make specialised care become more comprehensive and individualised. In reality, the team, practicing triage and task distribution, is increasingly replacing the doctor-patient relationship as working mode in primary care When the disease rather than the doctor-patient relationship, becomes the organising principle of primary care, medicine as a whole will be drained of the practice of its human dimension.
journal_name
Scand J Prim Health Carejournal_title
Scandinavian journal of primary health careauthors
Rudebeck CEdoi
10.1080/02813432.2019.1639909subject
Has Abstractpub_date
2019-09-01 00:00:00pages
335-344issue
3eissn
0281-3432issn
1502-7724pii
10.1080/02813432.2019.1639909journal_volume
37pub_type
杂志文章abstract::Ten study populations sampled from a total of 86 communities in a rural Ethiopian area, have been registered and followed for a period of four years. A baseline census revealed a median age of 15 years, a literacy rate of 24%, poor housing and environmental conditions, and low utilization of the existing health care f...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439209014061
更新日期:1992-09-01 00:00:00
abstract:OBJECTIVE:To examine if abstention from smoking in pregnancy increases with opportunities to limit workload. DESIGN:Cross-sectional study based on self-administered questionnaires to women post partum. SETTING:All maternity wards in Norway, 16 October-26 November 1989. SUBJECTS:5 438 women, or 87.2% of all parturien...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439608997064
更新日期:1996-03-01 00:00:00
abstract::The study describes health, social situation, and contact with general practitioners in a random sample of non-institutionalized persons 70-95 years old in Denmark. There was a strong correlation between health and contact with general practitioners. A small group, 3% of the respondents, had no health problems, but ha...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439109018528
更新日期:1991-12-01 00:00:00
abstract:OBJECTIVE:To explore the medically unexplained disorders by examining endpoints of irresolute diagnostic strategies. DESIGN:Qualitative observational study based on audio-taped general practice consultations, editing analysis style inspired by Giorgi's phenomenological approach. SETTING:Primary health care. SUBJECTS...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134302760234582
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVE:To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care. DESIGN:A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2017.1397253
更新日期:2017-12-01 00:00:00
abstract::A group of 235 persons (180 adults and 55 children 0-15 years old) recorded symptoms of upper respiratory tract infection daily during two three-month periods (autumn 1986 and spring 1987). Samples for culture were taken from the nasopharynx and throat once during each period. Fifteen per cent of asymptomatic subjects...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438909088665
更新日期:1989-12-01 00:00:00
abstract:OBJECTIVE:To examine whether vaginal application of Lactobacillus casei v. rhamnosus reduces the reinfection rate in cystitis-prone women. DESIGN:A controlled, randomized, double-blind clinical trial. SETTING:Division for General Practice, University of Bergen, Norway. INTERVENTION:Vaginal application of lactobacill...
journal_title:Scandinavian journal of primary health care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.3109/02813439409029247
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre. DESIGN:Randomized controlled trial. SETTING:Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章,随机对照试验
doi:10.3109/02813432.2013.811943
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:To study associations between dairy fat intake and development of central obesity. DESIGN:A prospective population-based cohort study with two surveys 12 years apart. SETTING:Nine municipalities selected from different parts of Sweden representing the rural areas in the country. SUBJECTS:1782 men (farmers ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813432.2012.757070
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To evaluate barriers to adherence to hypertension guidelines among publicly employed general practitioners (GPs). DESIGN:Questionnaire-based survey distributed to GPs in 24 randomly selected primary care centres in the Region of Skåne in southern Sweden. SUBJECTS:A total of 109 GPs received a self-administe...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813430802202111
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). DESIGN:An observational and quasi-experimental study based on b...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813432.2015.1041825
更新日期:2015-06-01 00:00:00
abstract::The Swedish trial in old patients with hypertension was initiated by the Swedish League against Hypertension. It will be conducted as a prospective multicentre study in Swedish primary health care, and will comprise approximately 2 000 patients on active treatment and 2 000 on placebo to be studied for three years. Th...
journal_title:Scandinavian journal of primary health care
pub_type: 临床试验,杂志文章
doi:10.3109/02813438609014824
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:To study the distribution of prenatal and postnatal risk factors for sudden infant death syndrome (SIDS). DESIGN:A questionnaire-based survey for SIDS risk factors; family interviews were performed among the parents of SIDS victims and symptom-free infants. SETTING:The survey was conducted in paediatric pri...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134301316982414
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVE:To describe medical and odontological aspects of patients who believed their illness was caused by mercury in dental fillings. DESIGN:Comparison of self-reported and assessed medical and odontological variables. SETTING:The School of Dentistry, Karolinska Institute. SUBJECTS:Sixty-seven patients, referred ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134398750003043
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:To increase our knowledge about the diagnostic process in physiotherapy and to identify possible differential frames of reference. DESIGN:Video-recordings and semi-structured interviews of the participants. SETTING:Natural working settings, i.e. private institutes and patients' homes. PARTICIPANTS:Manual, ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439408997056
更新日期:1994-03-01 00:00:00
abstract::Ninety-three percent of all problems and complaints reported by patients aged 21 and older to their family physician dealt with somatic disorders, and only 7% with psychosocial problems. Psychological complaints were evenly distributed among major age groups, and between male and female patients. "Social problems" pea...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438809009294
更新日期:1988-05-01 00:00:00
abstract::In Iceland a problem oriented medical record system for primary health care has been developed. A contact-form is used to record data on all contacts between the inhabitants in a district and the health center. A minicomputer is used for retrieval and analysis. One rural health center using this system has been succes...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438409017714
更新日期:1984-11-01 00:00:00
abstract::This study explores the diagnostic process of general practitioners confronted with ill-defined and ambiguous complaints, which eventually appeared to be caused by a malignancy. Three aspects were rated: (a) the adequacy of the initial problem definition; (b) the carefulness of further diagnostic methods; and (c) how ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438909103670
更新日期:1989-03-01 00:00:00
abstract::Physical work load was assessed by doctors and patients to have contributed to the health problems leading to sickness certification in 48.4% of 1413 patients certified sick by 118 general practitioners in Buskerud county, Norway (1986). Correspondingly, psychological factors were considered contributory in 32.1%. The...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439008994927
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to gain a deeper knowledge and understanding of experiences of antihypertensive drug treatment. DESIGN:Interview study. SETTING:A primary health care centre in western Sweden. METHOD:Qualitative interviews and analyses through systematic text condensation described by Malter...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813432.2014.982365
更新日期:2014-12-01 00:00:00
abstract::Longitudinal analyses of heavy users of prescription drugs were carried out in a geographically defined population in mideastern Sweden. During the period 1976-1983 the individual stability in heavy use of prescription drugs was analysed in heavy users identified in 1975. Mortality of heavy and nonheavy users during t...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438909087232
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:To identify and describe variations in ways of experiencing asthma management among general practitioners (GPs) in Sweden. DESIGN:Descriptive and explorative study using a phenomenographic approach. Semi-structured tape-recorded face-to-face interviews, focusing on the GP's own experiences regarding asthma m...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134399750002458
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:To study changes in Finnish GPs' child-psychiatric networks over a one-year period. DESIGN:Postal questionnaire. SETTING:Health centres in the area of Tampere University Hospital with a catchment population of one million. INTERVENTION:A one-off course in the field of child psychiatry was held 56 times in ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813430510018374
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVE:On the basis of emerging research evidence, this review aims to discuss the importance of the context surrounding the doctor-patient encounter for the success of treatment. DESIGN AND SETTING:Discussion paper based on placebo-nocebo and pain studies conducted in the western world. MAIN OUTCOME MEASURES:Lite...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章,评审
doi:10.1080/02813432.2016.1249065
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To explore the health economic consequences of menstrual disorders in Denmark. DESIGN:Analysis of the total costs of menstrual disorders in women, and a cost effectiveness analysis of menstrual disorders in women. SETTING:The analysis is based on retrospective 1991 data from the Danish National Patient Regi...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439508996752
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVE:To explore depression from a gender perspective, by capturing depressed women's and men's formulations of their experiences and understanding of their situation. DESIGN:Qualitative interview study. SETTING:A healthcare centre in northern Sweden. SUBJECTS:Eighteen patients who had been diagnosed with depres...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813430510031315
更新日期:2005-09-01 00:00:00
abstract::Freshly prepared quality control materials of different kinds were distributed by cars to all the public health centers, sanatoria and mother and child stations in Oslo. The recipients, who were unaware of the correct values, analysed each sample once without delay and reported the results back to our laboratory. A la...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438609014825
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:The objective was to study primary healthcare patients' understanding of their diagnosis of heart failure (HF), using patients treated for diabetes mellitus (DM) as a comparative group. DESIGN:A cross-sectional community based study. SETTING:Karlskrona community situated on the Swedish south-east coast with...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813430500428919
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:To study the prevalence, aetiology and treatment of chronic leg and foot ulcers, and to estimate the nurse's time in wound management. DESIGN:A structured questionnaire with 19 questions about chronic ulcers and wound management was sent to all district and community nurses in the county during 1 week in Mar...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章,多中心研究
doi:10.1080/028134300448788
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:To describe the management of dyslipidaemia in patients with high risk of cardiovascular disease (CVD) and patients with a history of CVD identified by screening for diabetes in general practice in Denmark, concentrating on prescription of lipid-lowering drugs. Moreover, to analyse predicting factors for star...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813430903335216
更新日期:2010-03-01 00:00:00