[Guideline on responsible teamwork: don't let it become a manacle].

The recently published guideline entitled 'Division of responsibility in teamwork within the care sector' was developed on the request of the Dutch Health Care Inspectorate. Its aim is to ensure that in a teamwork situation in the care sector proper agreements are made concerning the responsibilities of the care providers who work together. The intention is good, but the execution is open to criticism.

Starting learning in medical practice: an evaluation of a new Introductory Clerkship.

The transition from undergraduate medical education to learning in clinical clerkships can be difficult for students. Learning in clinical practice requires awareness of learning opportunities and goals, active elaboration and reflection. Staff should provide students with guidance to learn from their experiences.

A new course in age-based medicine at the University Medical Center of Nijmegen.

In 1995 the Medical Faculty of the University Medical Center of Nijmegen revised its curriculum to be more problem-oriented and student-centered. Each of the first four years now consists of ten four-week courses constructed around specific learning objectives. For the new curriculum the authors developed a fourth-year course on age-related health problems in which selected issues of pediatrics, general practice, and geriatrics are integrated.

[Decision support in primary care--a vertical second opinion].

This comment concerns a specific second opinion practice in Amsterdam. In this practice a physician limits her consultations by optimally preparing patients for their subsequent encounter with the responsible clinician. It is argued that this type of practice must be discouraged, as due to its limited goal, lack of personal responsibility and subordination of 'confidence' in doctor-patient relationships, it constitutes a strongly deviant form of clinical practice.

[Comments on separate consultations for second opinions].

Second opinion consultations are an accepted phenomenon in daily clinical practice. In well defined situations such a consultation may be welcomed as a mean to obtain proper medical counselling and advice. However, to preserve a good doctor-patient relationship it is of utmost importance for what reason and by whom such a consultation is initiated.