Decision-Making in General Practice by Michael Sheldon, John Brooke, Alan Rector

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By Michael Sheldon, John Brooke, Alan Rector

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J ~ IJ... 0 5 0~ o I ][ m:& Jz: ARMED SOCIAL CLASS SERVICE Figure 2 Gynaecological symptoms by social dass. Each column expressed as a percentage of all symptoms presented in each social dass. (From an analysis of 5904 new presenting symptoms in general practice) There is another phenomenon which we have aH noticed and that is that patients who see us about one, perhaps fairly insignificant symptom, may fai! to mention the serious symptom that coexists. In other words, they are at the same time in both boxes (b) and (d) but with regard to different symptoms.

A baby was admitted to hospital because of failure to thrive and repeated infections. There was evidence of maternal deprivation and the provisional diagnosis was maternal deprivation with malnutrition and secondary immuno-deficiency. One course of action would have been to start management based on this diagnosis and treat the infant with "tender loving care", and antibiotics when required for the infections. In fact, the infant was subjected to a prolonged series of tests aimed at ruling out other causes of immuno-deficiency and identifying infecting organisms.

When I booked into a workshop on decision-making in general practice I thought I would be coming to a pragmatic discussion which would give me some insights into the day to day working of general practice. I do not use the word pragmatic in any derogatory sense. As a social scientist concerned with health and health care I go to many academic conferences where there are presentations of models and variously shaped diagrams relating to patients, their families, their illnesses and their doctors are often displayed.

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