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Background Lung cancer is a common cancer disease: nevertheless, in Denmark a GP only sees one new case of lung cancer per year. The core symptoms of lung cancer, cough and dyspnoea, are on the other hand very common in general practice. This represents a challenge to the diagnostic process and increases the risk of diagnostic delay. Aim To explore diagnostic delay in primary health care among patients with lung cancer. Design of study A population based observational case series of 84 lung cancer patients' delay. Setting The County of Aarhus, Denmark. Method From county-based registers of all histological and cytological tests we identified all patients in the County of Aarhus with lung cancer diagnosed during a 6 month period in 2003. Inclusion was verified by contacting the departments involved in the treatment of lung cancer. Data were based on telephone interviews with patients' GPs. A review of delay was made starting with the first symptom until referral to secondary care. Results The overall median delay in primary health care was 32.5 days (interquartile interval (IQI) = 12-68 days). One-third of the patients were referred to the diagnostic investigation after their first consultation. Important reasons for delay in primary care were: symptoms not related to the lungs, chest X-ray without suspicion of cancer, comorbidity, waiting times for investigations and lack of explicit follow-up appointment. Prolonged delay was often due to a combination of these factors. Conclusion When diagnosing lung cancer, it is important that GPs are aware of the low sensitivity of chest X-ray. Shorter waiting times for investigations could reduce delay considerably. [ABSTRACT FROM AUTHOR]

Background Urogenital Chlamydia trachomatis infections are widespread, and each year many tests are performed in general practice. Aim First, to quantify the magnitude of stigmatisation, problems related to partner, and anxiety of infertility among men and women tested for C. trachomatis in general practice. Second, to investigate the effect of a C. trachomatis test result on planned future condom use. Design of study Comparative cross-sectional study. Setting General practices in Aarhus County, Denmark. Method Men and women tested for C. trachomatis in general practice were given a questionnaire about feelings of stigmatisation, fear of partner's reaction, fear of future infertility and other psychosocial side effects related to being infected or not infected with C. trachomatis. Results A total of 277 participated in the study. The response rates were 61% (82/135) and 54% (195/365) among infected and non-infected individuals, respectively. Among the infected individuals 32% (9/28) of the men's partners and 35% (19/54) of the women's partners were upset about the test result, 9% (5/54) of the women and 11% (3/28) of the men split with their partner, 59% (32/54) of the women and 54% (15/28) of the men expressed nervousness about infertility, and 91% (19/21) of the women but only 56% (5/9) of the men said that they would use a condom more often in the future. All these figures were significantly lower for both men and women having C. trachomatis negative test results. Conclusion A chlamydia test affects the individual in terms of sexuality, relation to partner, reproduction, and future contraceptive strategy. The influence is highest among women and individuals with a positive test result. These findings should be taken into account in screening programmes targeting young women and men. [ABSTRACT FROM AUTHOR]

The author focuses on the context of placebo therapy in general practice field. Also discussed is the study conducted by researcher K. B. Thomas which reveals the impact of the placebo effect in medical consultation. The implication of context-modulated symptoms on various clinical research is explored.

Several letters to the editor are presented in response to the paper by P. Vedsted and F. Olesen on the question of whether serious problems in cancer survival are partly rooted in gatekeeper principles.

A letter to the editor is presented in response to a study that mental health screening may prove effective in primary care.

Background: A lack of social support is associated with increased morbidity and mortality and a decreased effect of prevention. Frequent attenders to primary care are characterised by poorer social conditions than other patients in general practice, but we do not know whether this is due to social inequalities in health or whether social factors in themselves determine the use of general practice., Aim: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables., Design of Study: Population-based cross-sectional survey., Setting: Two hundred and twenty GPs in 132 practices in the county of Aarhus, Denmark, and the listed adult population (aged 20-64 years)., Method: A sample of frequent attenders and infrequent attenders was drawn. The study included only those resident in the county and who had consulted a GP during the period November 1997-October 1998. A questionnaire about physical, psychological and social factors was sent to the patients. The associations between social factors and frequent attendance were adjusted for physical and psychological health and tendency towards somatisation., Results: A total of 1423 (73.7%) frequent attenders and 1103 (74.9%) infrequent attenders responded. Male frequent attendance was associated, with statistical significance, with living alone and being without work or on a disability pension. Among women, lack of professional education or being without work tended to increase the likelihood of frequent attendance., Conclusion: This study shows that for men, social factors may in themselves determine the use of general practice. None of the investigated social factors seemed to restrict the use of general practice.

Background: Somatisation is highly prevalent in primary care (present in 25% of visiting patients) but often goes unrecognised. Non-recognition may lead to ineffective treatment, risk of iatrogenic harm, and excessive use of healthcare services., Aim: To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners (GPs)., Design of Study: Cluster randomised controlled trial, with practices as the randomisation unit., Setting: Twenty-seven general practices (with a total of 43 GPs) in Vejle County, Denmark., Method: Intervention consisted of a multifaceted training programme (the TERM [The Extended Reattribution and Management] model). Patients were enrolled consecutively over a period of 13 working days. Psychiatric morbidity was assessed by means of a screening questionnaire. GPs categorised their diagnoses in another questionnaire. The primary outcome was GP diagnosis of somatisation and agreement with the screening questionnaire., Results: GPs diagnosed somatisation less frequently than had previously been observed, but there was substantial variation between GPs. The difference between groups in the number of diagnoses of somatisation failed to reach the 5% significance (P = 0.094). However, the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group (7.7% and 3.9%, respectively, P = 0.007). Examination of the agreement between GPs' diagnoses and the screening questionnaire revealed no significant difference between groups., Conclusion: Brief training increased GPs' awareness of medically unexplained physical symptoms. Diagnostic accuracy according to a screening questionnaire remained unaffected but was difficult to evaluate, as there is no agreement on a gold standard for somatisation in general practice.

Background: Research on questionnaires as screening tools for psychiatric disorders has yielded conflicting results., Aim: To examine the effect of a routinely administered questionnaire on recognition of common psychiatric disorders in general practice., Design of Study: Randomised controlled trial., Setting: Twenty-eight general practices in Aarhus County, Denmark., Method: Thirty-eight general practitioners (GPs) and 1785 consecutive patients, aged 18-65 years old, presenting with a new health problem, participated. Before consultation, patients were screened using a brief screening questionnaire (SQ) including somatisation, anxiety, depression, and alcohol abuse scales. Patients were randomised to one of two groups: 900 questionnaires were disclosed and scored by the GPs, 885 were blinded. A stratified subsample of 701 patients was interviewed after the consultation using a standardised psychiatric research interview (SCAN)., Results: Overall the GPs' recognition rates were 14% (95% confidence interval [CI] = -2 to 30) better for depression and 35% (95% CI = 2 to 68) better for alcohol problems when SQs were disclosed. Recognition rates for anxiety improved 8% (95% CI = -9 to 26) overall. In the case of somatoform disorders, disclosure showed no effect overall. Among those with high SQ scores, however, disclosure increased recognition rates on any mental disorder evaluated., Conclusion: This study demonstrated limited usefulness for routine screening for common psychiatric disorders. However, findings suggest that the SQ may be useful for case-finding among a subgroup of patients with high SQ scores.