Doctors' perceptions of personal boundaries to primary care interactions: a qualitative investigation.

Definitions of professional roles and appropriate care are increasingly inclusive in primary care but many subjective factors influence the care that is actually delivered. One such factor is the boundary a clinician puts on his or her self in interactions with patients. This qualitative study investigated doctors' perceptions of personal boundaries to primary care consultations by exploring two examples: touch and spiritual care.

Pastoral relationships and holding work in primary care: affect, subjectivity and chronicity.

Objectives: To understand family doctors' constructs of long-term therapeutic relationships with patients in primary care.

Methods: Semi-structured interviews were administered to general practitioners with > 5 years of experience (n = 28) working in an English semi-rural district, and the results were subjected to constant comparative qualitative analysis.

Results: Participants identified pastoral relationships as long-standing patterns of doctor-patient interaction aimed at providing reliable supportive care indirectly concerned with clinical medicine.

Failure to act on good intentions.

The GMC's response to rapidly changing attitudes towards the medical profession seems to have been to bury its head in the sand

Mothers' mental health and infant growth: a case-control study from Rawalpindi, Pakistan.

Background: Epidemiological studies in Pakistan show high rates of depression in women, while rates of malnutrition in children are also high. This study aimed to determine whether poor maternal mental health is associated with an increased risk of infant undernutrition.

Methods: Clinic-based case-control study.

What influences elderly peoples' decisions about whether to accept the influenza vaccination? A qualitative study.

Influenza and its related illnesses remain a major cause of preventable morbidity and mortality in the elderly worldwide. The current influenza vaccine campaign in the UK is only a partial success despite annual costly publicity campaigns. The aim of this study was to explore the influences on decision making by elderly people for influenza vaccine uptake.

Finding a vein or obtaining consent: a qualitative study of hepatitis C testing in GP methadone clinics.

Background: Informed consent is a professional norm, but the promotion of testing for infectious disease in organized clinics and the introduction of targets for uptake, such as those for human immunodeficiency virus (HIV) testing in antenatal clinics, might impair truly voluntary consent. Hepatitis C virus (HCV) is highly prevalent among intravenous drug users (IDUs) and the 'offer' of a serological test for HCV antibodies is now seen as a national standard within drug misuse services, including GP methadone clinics. We hoped that GPs' descriptions of the context and offer of HCV testing could provide an exploratory study of consent within primary care clinics.

Can undergraduate education have an effect on the ways in which pre-registration house officers conceptualise communication?

Aims: In 1994 Manchester Medical School introduced a learner-centred course using problem-based learning (PBL), which emphasises effective communication skills. This study explored how 2 cohorts of graduates conceptualised communication within their role as pre-registration house officer (PRHOs).

Methods: Graduates from the last year of the traditional and first year of the new course were interviewed 3 months after starting work.

Qualitative research and the problem of judgement: lessons from interviewing fellow professionals.

Background: Qualitative research methods are recognized increasingly as valuable tools for primary care research, and add an extra dimension to quantitative work.

Objective: The aim of this study was to illustrate the benefits and problems attending the dual role of clinician/qualitative researcher.

Methods: As part of two studies employing semi-structured interviews of GPs in a North-West conurbation, about the topics of consultations on chronic low back pain and drug misuse in primary care, respondents' views on their interaction with a GP researcher were explored.

An analysis of practice-level mortality data to inform a health needs assessment.

Background: The utility of practice death registers has been indicated but, in the wake of the recent Harold Shipman case in the United Kingdom, the value of individual practice-level analysis has been questioned.

Aim: To assess the value of analysing practice-level mortality data to inform health needs assessment.

Design Of Study: Comparative analyses of mortality.

Patient satisfaction with teledermatology is related to perceived quality of life.

Background: There is a lack of good data about patient satisfaction with teledermatology and about its potential interaction with quality-of-life factors.

Objectives: To assess the association between perceived skin-related quality of life and patient satisfaction with a nurse-led teledermatology service.

Methods: In a mobile nurse-led teledermatology clinic located in four inner city general practices in Manchester, the teledermatology service used digital cameras to capture and store images of skin conditions for remote diagnosis by dermatologists.

Determinants of consultation rate in patients with anxiety and depressive disorders in primary care.

Background: Although it is recognized that anxiety and depression are associated with frequent attendance in primary care, not all patients with these disorders attend frequently. The factors associated with general practice consultation in the important group of patients with anxiety and depressive disorders are not clear.

Objectives: Our aim was to determine prospectively the factors which predict consultation rate in a cohort of patients with anxiety and depressive disorders in primary care.

Academic general practice in Manchester under the early National Health Service: a failed experiment in social medicine.

During the Second World War, medical academics hoped to reform medical practice and education in Great Britain, increasing doctors' sensitivity to the social and environmental causes of ill health and orientating them towards prevention. At the start of the National Health Service (NHS), central planning aimed to raise the status of isolated urban general practitioners (GPs) by grouping them in an experimental health centre. This offered a locus for social medicine, encouraging cooperation and research with local authority staff (nurses, midwives, and social workers).

When protocols fail: technical evaluation, biomedical knowledge, and the social production of 'facts' about a telemedicine clinic.

Telecommunications systems seem to offer health care providers, professionals and patients a plethora of opportunities to respond to social and geographical inequalities in health care provision, and a new field of health care endeavor has emerged--'telemedicine'. This paper presents results from a three year ethnographic study of the development and implementation of telemedicine systems in a British region. We explore how attempts to put into service one 'telemedicine' system failed to get beyond the draft of a written protocol.

Resisting and promoting new technologies in clinical practice: the case of telepsychiatry.

New telecommunications technologies promise to profoundly change the spatial and temporal relationship between health professional and patient. This paper reports results from an ethnographic study of the introduction of a videophone or 'telemedicine' system intended to facilitate faster and more convenient referral of patients with anxiety and depression in primary care, to a community mental health team. We explore the reasons for contest over the telemedicine system in practice, contrasting professionals' critique of the technology in play with a more fundamental problem: the extent to which the telecommunications system threatened deeply embedded professional constructs about the nature and practice of therapeutic relationships.