General Practice Observed: Survey of General Practice Records

A study of a sample of records from eight general practices showed that 10% of patients'' ages were not recorded, that 99% of males had no indication of their marital state, and 60% did not have an occupation recorded. In recording of disease episodes a diagnosis was recorded in a little over half of the episodes and was the only recorded item in 10% of records. The recording of the therapeutic agent used was the most frequently recorded item, occurring in 70% of episodes, but the amount prescribed was recorded in only one-quarter of the episodes and the dosage in less than one-fifth. Less than half of the episodes had any symptoms recorded and only one-third had a physical sign recorded.     

Classification of Disease in General Practice: A Comparative Study

A comparison is made between the International Classification of Diseases (Eighth Revision) and the classification of the British College of General Practitioners (1963 Revision), with particular reference to their application to the diagnostic data from a family practice in Canada over a period of one year. The International Classification proves superior but would require modification to be ideal for use in recording morbidity from general practice. A plan for such a modification is outlined.     

Contemporary Themes: Congenital Malformations and the Problem of their Control

The possibility of preventing or reducing the prevalence of human congenital malformations is discussed in the light of current knowledge about their aetiology. The original data presented are derived from an epidemiological study of all the infants (92,982) born in the three years 1964-6 to women resident in a defined area of South Wales and all the congenital malformations (3,242) discovered in those infants by the second anniversary of their birth.     

Natural History of Patients with X-ray-negative Dyspepsia in General Practice

When 102 patients with dyspepsia who had normal findings on barium-meal examination in 1964 were interviewed in 1970, 85 of them (76%) were symptomatically improved, and only three were later shown to have a peptic ulcer. This suggests that “x-ray-negative dyspepsia” has a good prognosis in a general practice setting.     

Anglo-Canadian Exchange in General Practice: British View of Canadian General Practice

The Canadian general practitioner is remunerated by an item-of-service system of payment which encourages servicing demands rather than needs, discourages delegation of work to paramedical workers, and involves his staff in a massive amount of paper work. He has an excellent hospital attachment, which unfortunately is overdone. His community facilities are piecemeal and his office organization is rudimentary. There are few incentives for good general practice in the community. He spends an inordinate amount of time examining well people. The university departments of general practice are extremely good and much should be heard from them very quickly. The patient''s attitude towards his doctor is quite different from the one prevailing currently in Britain.I returned happily to British general practice.     

Anglo-Canadian Exchange in General Practice: Canadian View of British General Practice

Before embarking on this exchange venture in British general practice I had many preconceived impressions of what it might be like to be an English family physician. Early in my five months of group practice it became apparent that many of my attitudes had no real basis and in fact I had to admit many aspects of the British health system were indeed superior. It has been my impression that a group general practice in Great Britain can certainly afford the practising family doctor a stimulating and rewarding professional and social life.     

Risk of Ischaemic Heart Disease in Patients with Inflammatory Bowel Disease: Cohort Study Using the General Practice Research Database

ObjectivePatients with inflammatory bowel disease (IBD) demonstrate an inflammatory response which bears some similarities to that seen in ischaemic heart disease (IHD). The nature of the association of IBD with IHD is uncertain. We aimed to define the extent and direction of that association.DesignThis retrospective cohort study examined records from patients aged ≥ 15 years with IBD from 1987–2009 (n = 19163) who were age and gender matched with patients without IBD (n = 75735) using the General Practice Research Database. The primary outcome was the hazard ratio for IHD.ResultsA higher proportion of IBD patients had a recorded diagnosis of IHD ever, 2220 (11.6%) compared with 6504 (8.6%) of controls. However, the majority (4494, 51.5%) developed IHD prior to IBD diagnosis (1404 (63.2%) of IBD cases and 3090 (47.5%) of controls). There was increased IHD incidence in the first year after IBD diagnosis. Mean age at IHD diagnosis was statistically similar across all IBD groups apart from for those with Ulcerative Colitis (UC) who were slightly younger at diagnosis of angina compared to controls (64.5y vs. 67.0y, p = 0.008) and coronary heart disease (65.7y vs.67.9y, p = 0.015). Of those developing IHD following IBD diagnosis, UC patients were at higher risk of IHD (unadjusted HR 1.3 (95% CI 1.1–1.5), p<0.001) or MI (unadjusted HR 1.4 (95% CI 1.1–1.6), p = 0.004).ConclusionAlthough IHD prevalence was higher in IBD patients, most IHD diagnoses predated the diagnosis of IBD. This implies a more complex relationship than previously proposed between the inflammatory responses associated with IHD and IBD, and alternative models should be considered.