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We administered a questionnaire to 995 people selected randomly from the electoral roll in one coastal region of subtropical Australia. Three-quarters (739) indicated their skin was checked by a physician, by themselves, or both. Among the 15% who were taught to check their skin, 59% learned to do so from physicians. A family physician would be consulted immediately by 40% who found something suspicious, and by 58% after a period of delay. Several factors associated with other indicators of health-seeking behavior, including being told by a physician that there was a special risk of skin cancer, were related to an increased proportion of respondents who were checked by their physicians as well as themselves. In addition to being the main focus of help should a suspicious lesion be found, physicians may have an important role in introducing the public to the process of early detection of skin cancer as well as providing an important function in its actual conduct.

Before designing an intervention aimed at improving the quality of after-hour general practice services to the residents of a relatively isolated outer suburb of Brisbane, a survey of 247 residents was conducted to assess the provisions of after-hours care. The results of the survey were presented to the suburb's general practitioners (GPs). Meetings with the GPs led to attempts at improved communication, using patient-held Health Summary Cards and doctor-to-doctor clinical feedback forms. Forty-four per cent of the 27 GPs participated in the co-operative scheme. One year later the community was resurveyed to assess the impact of the changes in medical services. There was a small but insignificant increase in satisfaction with the provision of after-hours care from 45% to 48%.

We undertook a prospective randomised intervention study of the proportions of women with abnormal cytology results who were lost to follow-up in 42 general practices in urban and rural Queensland over 26 weeks. Practices in the intervention group were provided with a redesigned cervical smear request form that allowed patients to provide an address for direct notification from the laboratory by mail. Satisfaction questionnaires sent to the general practitioners in the intervention group showed that most made at least some use of direct notification, and most felt it was worthwhile. For women with an initial result of cervical intraepithelial neoplasia (CIN), there was a loss to follow-up of 23 per cent (95 per cent confidence interval (CI) 11 to 39) among the control group compared to none in the intervention group (upper CI 7 per cent), a highly significant difference (P < 0.001). Mailing cervical screening results to women may reduce the loss to follow-up of those with CIN findings.

Objective: To evaluate an intervention designed to reduce the number of benign melanocytic lesions excised from the skin., Design: A randomised controlled field trial based in the medical practices of two cities. Examination of histopathological reports of 5823 melanocytic skin lesions excised over the intervention period and in the preceding six months., Intervention: Medical practitioners were offered an algorithm and use of an instant developing camera., Setting and Subjects: Over 50 medical practitioners, mostly in general practice, in each of two cities in tropical Queensland, Australia., Main Outcome Measures: Percentages of benign (neither malignant nor potentially malignant) melanocytic lesions excised during the two year intervention period., Results: There were no significant differences in the percentages of benign lesions reported in the intervention and control cities before the intervention started (93.6% and 94.0%, respectively), but there was a significant difference afterwards (88.8% and 93.8%, P < 0.001). There was no difference in the percentage of invasive melanomas excised per month in the intervention city (3.4%) compared with control city (3.4%)., Conclusion: Clinical diagnostic accuracy may be enhanced by offering to clinicians managing suspicious melanocytic skin lesions a simple algorithm and a camera with which to record the appearance of lesions objectively.

Six hundred women aged between 45 and 54 were randomly selected from the electoral roll in Brisbane, Australia. A questionnaire addressing their symptoms, hormone status and psycho-social factors was successfully administered to 381 women (64% of the original sample; 83% of those contactable). Although cardiovascular symptoms were experienced by 25% of the sample, the most common (hot flushes) ranked only tenth on a list of recently experienced symptoms. The association of hormone status with symptoms was weak in comparison with other factors. Most symptoms were reported by women who were perimenopausal, had undergone a hysterectomy, or were currently using hormone replacement therapy. A poor mental health index was strongly associated with all groups reporting symptoms. It is concluded that clinicians responding to symptoms from middle-aged women should continue to address psychosocial factors just as vigorously as those related to their hormone status.

Objective: To describe the response of general practitioners (GPs) and patients during the 1991 National Skin Cancer Awareness Week media campaign., Design: Skin examinations in general practices in three representative regional towns in Queensland were monitored for five weeks around the time of the campaign and participating GPs were personally interviewed., Outcome Measures: Number and type of consultations in which the skin was examined for cancer before, during and after the campaign, and GPs' attitudes and beliefs about skin checks., Results: The 46 GPs (47%) who participated, representing 60% of the practices, conducted 1805 consultations in which the skin was examined for cancer. The number of consultations in which skin examinations were conducted by each GP increased by 56% during the campaign. Skin checks were nearly always initiated by the patient (90%), and in only half of all cases was the examination given as the primary reason for the consultation. Sixty-two per cent of lesions were considered to be clinically benign., Conclusion: Public education programs may have an impact on the level of skin examinations requested in general practice consultations. Currently, patients are the principal initiators of such examinations during consultations--there is potential to increase the active role played by GPs in support of patient requests for the early detection of skin cancer.

Evidence of deficiencies in communication skills in general practice abound, despite the importance with which such skills are regarded both within the profession and outside it. A qualitative assessment of associated literature over a 35-year period showed that good communication skills are associated with markers of better care and even of better health. Teaching communication skills to students is regarded as important, but it is not clear what form of education leads to better communication. Sufficient time is one of the most important elements; appropriate attitudes on the part of the clinician are probably important too. General practitioners can improve their care of patients by paying more attention to good communication and to understanding the consultation process.

A cross-sectional study of the sun-related attitudes and beliefs of 3,655 children in Grades 7 to 11 attending 55 representative Queensland schools was undertaken using a structured questionnaire administered at school. Factors derived from a series of focus groups were incorporated into the questionnaire. Knowledge about risk factors in the aetiology of skin cancer and the role of protective measures was high. Several potential barriers to the use of sun protection were identified, including the desire to be tanned, the perceived attitudes of the peer group to sun protection, and difficulties with the use of specific sun protection measures. In general, these barriers were significantly more prominent among boys and children from older grades than other students. These data will be used to design school-based sun protection interventions which are sensitive to these age and sex differences.