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Biomedical subjects

D H Metcalfe

Publications and source records attributed to D H Metcalfe.

16 recordsLinked to original sources
PubMed1989

The meaning of information on GP referral rates to hospitals.

Research shows consistently wide variations in all aspects of general medical practice. Extreme variations in rates of referral to hospital have recently been highlighted, but remain largely unexplained. New information systems now make it possible to identify GPs with very high or very low rates of referral so that their behaviour can be reviewed. Before using this information politicians, managers and doctors should give careful thought to what it means and its limitations. The rate of referral provides no indication of the appropriateness of referrals. Any intervention designed to improve the referral mechanism should aim to increase the proportion of people who are appropriately referred to hospital and to reduce the proportion who are inappropriately referred. This is unlikely to be achieved by focusing attention on GPs with high or low rates regardless of how they are made up.

Behavior↗
PubMed1985

Seasonal variations in the process of care in urban general practice.

Using data collected for a study of the process of care in a large urban area, the opportunity was taken to examine seasonal variations in consultation patterns. While overall numbers of consultations varied month by month, no seasonal pattern was found. The ratio between patient and doctor-initiated contacts remained stable throughout the year, as did the age, sex and social class of patients consulting. The proportion of consultations that took place in the home increased during the winter months. As expected, seasonal fluctuations in morbidity were most apparent in respiratory disorders, though a small number of non-respiratory problems showed similar variations. There was no discernible seasonal pattern to investigation, referral, and prescribing rates, though wide variation existed between individual general practitioners. The implications of these findings for the design of future studies are discussed.

England↗
PubMed1979

How much do patients know? A multiple choice question paper for patients in the waiting room.

A questionnaire about knowledge of personal preventive medicine, treatment, and the appropriate use of health services was put to a population of patients attending their doctors' surgeries. The population was probably biased toward the younger and those willing to fill in such a questionnaire. The results showed a social class gradient in knowledge and a distressing degree of ignorance on some topics. Suggestions are made for using the method in a positive educational way in practices, and for further studies with improved methods.

Adult↗
PubMed1978

Febrile convulsions--what do parents do?

To find out about the medical and parental management of children having their first febrile convulsion a hospital-based questionnaire study was carried out in which parents were asked what they did at the time. Fifty-four out of 89 parents brought their child directly to hospital while the remainder attempted to contact their general practitioner, usually successfully, and were then referred to hospital. Whichever course of action the parents chose the outcome was satisfactory. Eighty-seven per cent of convulsions lasted for less than 15 minutes and in only two instances did they last longer than 30 minutes. One child who had convulsions for an hour was given intramuscular phenobarbitone at home without success, and the fit was finally terminated with intravenous diazepam. Parental management of the fit was often widly inappropriate. Only a few parents laid the child on his side and waited for the fit to stop. The parents were bewildered and frightened--30% thought their child was dying or dead. Education of patents of young children is needed. Simply written instructions on how to reduce the temperature of a febrile child and manage a convulsion might help.

Attitude↗
PubMed1978

Doctors' attitudes to information systems: a survey of Derbyshire general practitioners.

This paper describes the results of a survey of all 365 general practitioners in Derbyshire. It deals in particular with their attitudes to information systems and the factors which affect them. The results show that there is much more interest in continuous data collection from primary care than is often supposed. This is particularly so among younger general practitioners. The survey thus describes the possible interest in information recording amongst a typical population of general practitioners.

Adult↗
PubMed1976

The teaching of medical ethics.

The subject of medical ethics is intended to run like a thread throughout the whole undergraduate period at the Nottingham Medical School which was established in 1970, the first such foundation in Britain this century. Dr J S P Jones, who is the Clinical Subdean, and Dr D H H Metcalfe,of the Department of Community Health, describe the plan of the course leading to qualifying, and how the thread of medical ethics has been woven into that fabric. The final objective of the course is to train men and women to become technologically capable and at the same time alive to the human needs of their patients. The authors define the two crucial characteristics of the fully trained professional as a person - self regulating and self policing - who advises and does not command those who come to him as patients.

Codes of Ethics↗