Building bridges over changing times.
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Biomedical subjects
Publications and source records attributed to M Rennert.
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Hypertension is a major risk factor for cerebral and coronary disease and its early detection is very important for the family physician. We checked the implications of a hypertension survey in the community (from the age of 10 years) on the attitude of the primary care team. We found that although the medical team was aware of the significance of early detection and treatment of hypertension, according to the "law of halves" half the hypertensives were in treatment and of them half had normal blood pressure. This fact is probably not related to the quality of medical care. High risk groups identified were hypertensive patients who smoked, Jewish men of western origin, and Jewish women of Asian-African origin (who had a high rate of strokes). These groups were targeted for active intervention by the primary care team. This survey is part of planned community-intervention by the primary care team in the field of hypertension.
Physicians in general are at risk for the development of stress, drug and alcohol abuse, as well as for suicide. Furthermore, the treatment of the sick physician is more difficult than that of a 'regular' patient. These difficulties may cause the postponement of diagnosis and treatment to critical stages of the disease. This paper presents a study of self-rated health and health-seeking behaviour of Israeli family physicians and their families. Our major finding is that two-thirds of the physicians do not have a regular family physician, and physicians who suffer from chronic diseases are even less likely to be treated than the 'healthy' ones. Twenty eight per cent of the physicians did not use any kind of medical consultation. However, each physician's family did receive some form of medical consultation, although in some cases this was not the usual form of medical care. The physicians who treated themselves tended to treat their own families and vice versa. Eighty-eight per cent of the physicians reported stress owing to their work (work overload, poor relationships with the medical team or with the patients), and 20% said that their work as physicians negatively affected their marital life. The relationship between the help-seeking behaviour of the family physician and the quality of care they give is as yet unclear. Various alternatives are raised for changing family physicians' behaviour as well as the primary care health system in order to possibly provide better care for the physicians and their families.
As part of an ongoing quality-control program, a retrospective survey of all rigid rectoscopies performed by a family physician as a diagnostic procedure in 1985-1986 was undertaken. 35 men and 27 women were examined after an average wait of 2.5 days. Most were referred because of rectal bleeding. 3 malignant and 4 benign rectal tumors were diagnosed. In cases with no pathological finding, a subsequent barium enema and/or colonoscopy resulted in the diagnosis of 2 more proximal cancers. This frequency of tumors is relatively high compared with other series, in which there had not been systematic screening for early detection of colonic cancer. There were no complications of the rectoscopies. This survey strengthens our impression that rectoscopy can be carried out effectively by the family physician in the clinic.
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