PubMed · 10730106
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R Fleetcroft. 1998. The general physician--extinction or evolution?. https://doi.org/10.1177/014107689809101201
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OBJECTIVE: To compare the effects of regular referral by general practitioners to the Rheumatology outpatients' clinic with that of joint consultations by general practitioners (GPs) and rheumatologists, and to compare the subsequent treatment policy followed. DESIGN: Randomised. METHOD: In 1999 and 2000 all rheumatological patients who, according to the 17 participating GPs in the Maastricht region had an indication for referral, were referred to the outpatients' clinic or seen during a joint consultation where three GPs and one rheumatologist decided on a treatment policy in the presence of the patient. Agreement about diagnosis and diagnostic and therapeutic approaches between the rheumatologists and GPs was determined using questionnaires. The patient's state of health was assessed using the 'EuroQol health-related quality of life questionnaire' (EuroQol) and their satisfaction was determined by means of questionnaires. RESULTS: One hundred and sixty-six patients were included: 45 (27%) men and 121 (73%) women, with an average age of 53.7 years (SD: 14). The rheumatologists and the GPs differed in opinion on the diagnosis in 64% of the patients. Agreement on diagnosis resulted in greater agreement on the treatment policy than when there were discrepancies about the diagnosis. The rheumatologist used additional diagnostic tools and follow-up consultations at the outpatient clinic (78% and 65%) more frequently than during the joint consultation (44% and 15%). Patient satisfaction and general state of health were comparable in both groups.
In two studies about medical errors, family physicians reported health, time, and financial consequences in nearly 85 percent of their error reports. Health consequences occurred when the error caused pain, extended or created illness, or placed patients, their families, and others at greater risk of harm. Care consequences included delayed diagnosis and treatment (sometimes of serious health conditions such as cancer), and disruptions to care that sometimes even resulted in patients needing care in a hospital. Other important consequences were financial and time costs to patients, health care providers, and the health system generally. However, sometimes no consequence was apparent.
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