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This study deals with a replication of a previous research project on the correlation between medical and behavioural skills of general practitioners. The PREVARA observation schedule was used to assess these skills of 75 general practitioners. Fifteen surgery contacts were tape-recorded for each GP and were rated by trained observers. The study shows that fundamental dimension underlies the surgery behaviour of the GP: the various skills appear to be equally developed. More specifically, a positive correlation was found between performing obligatory physical examination and paying attention to psychosocial aspects. The results are discussed in the context of the evaluation of the vocational training and medical audit of GPs.

A diabetes protocol characterized by self-monitoring of blood glucose was introduced in four general practices with the aim of making the frequency of consultations dependent on the metabolic regulation and emphasizing body weight reduction. The feasibility of the programme was investigated and the results after 1 year were compared with those of conventional care in four control practices. In the experimental practices, 13 patients switched from a medical specialist's to a general practitioner's supervision, 20 remained under supervision of their GP and 33 started self-monitoring. The self-monitoring rate, the consultation frequency according to protocol, the low number of dropouts and inadequate referrals and adherence to the therapeutic scheme showed that the protocol was feasible for both the GPs and the patients. At the initial assessment, the regulation of the diabetes was worse in patients of the experimental group, compared with those of the control group (mean HbA1 9.7% vs 8.9%; p less than 0.05). On average, patients in the experimental group (n = 56) lost 0.4 kg of body weight, whereas those in the control group (n = 73) gained 0.1 kg (n.s.). The mean change in HbA1, adjusted for the initial value, was -0.4% in the experimental and +0.5% in the control group (p less than 0.05). The results of the protocol can be attributed to a combination of greater participation of the patient, the individualized consultation frequency and the prescription of oral hypoglycaemic agents according to body weight development.

This investigation focuses on the effect of the death of a family member on the number and type of diagnosed illnesses of the remaining members. The data on mortality and morbidity were obtained from a continuous morbidity register. A total of 225 cases of death were selected, involving 313 family members. A control group of 4909 people who had not been confronted with a death of a family member were selected. A comparison of morbidity rates for the two groups showed that morbidity rates, both for minor and serious illnesses, were affected by the death of a family member. Increases in minor illnesses occurred more often when people had been confronted with death after a chronic illness; increases in serious illnesses were mainly found among people confronted with sudden death. Surprisingly, people with nervous disorders in their medical history showed fewer diagnoses for minor illnesses after a sudden death of a family member. An explanation may be found in the basic principles of family medicine.

The emotional reactions of 57 general practitioners to three aspects of work was assessed by means of questionnaires. The quality of patient care was assessed by means of observations of general practice consultations, assessment of audiotaped consulting hour contacts and an analysis of the referral and prescription figures. A distinction was made between the degree of positive and the degree of negative feelings general practitioners have about their work. Many positive feelings (satisfaction, feeling at ease) correlated with more openness to patients, more attention to psychosocial aspects of the complaints but also with a higher rate of referral to medical specialists. On the other hand, many negative feelings (frustration, tension, lack of time) correlated with a high prescription rate and with giving little explanation to patients. To some extent the way that work is experienced by general practitioners correlated with the quality of care for the patients, but what constitutes cause and effect requires further study. A reflection of a doctor's own feelings about work should become part of training, continuing education and medical audit programmes.

A project of group-based peer review by general practitioners is described. Attention is given to the motivation of general practitioners to participate in audits, to the threat posed by peer review and to the use of criteria. The recruitment and motivation were successful. A total of 253 general practitioners took part, divided into 23 groups. This represented approximately 30% of all general practitioners in the area and 72% of all general practitioners specifically approached by us. The threat posed by audit disappears rapidly for most physicians once they have started auditing. The use of predefined criteria developed by 'experts', representing an optimal way of work for the general practitioner, appeared to be quite feasible in this project. From the results several conclusions are drawn as regards the planning and implementation of peer review under general practitioners.