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Outlines the efforts of the Department of General Practice to develop a clear educational philosophy on which to build its curriculum. Also illustrates the application of this philosophy in developing a community-based early clinical contact course for first-year students. The philosophy was constructed from the basis of whole-person medicine and a conceptual model of knowledge. Contains 22 references. (Author/PVD)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0277-9536(96)00050-0 Byline: Jon S. Dowell (1), David Snadden (1), James A. Dunbar (2) Abstract: The cost of prescribed medication is an increasing burden on health care systems. British general practitioners have been encouraged to reduce their prescribing costs through financial incentives within the fundholding scheme. This study reports on one general practice which reduced prescribing expenditure as part of the move to fundholding. Interviews performed with practice staff and patients were analysed and combined with prescribing statistics and questionnaire data to give a picture of the balance between the experience of patients and practitioners. Fifty-three interviews with 17 patients revealed that most were willing to try cheaper treatments and that dissatisfaction was primarily with the communication they received rather than the change itself. Each patient had to decide how to respond to the change in their medication. The decision-making process and the main factors involved are described and discussed. The experience of having long-standing treatment changed can have an impact on the doctor-patient relationship. This was not found to be a large problem and, it is suggested, can be guarded against. Large-scale economies in prescribing are feasible for some practices, and patients will tolerate such changes if attention is paid to sensitive communication. Author Affiliation: (a) Tayside Centre for General Practice, University of Dundee, Dundee, DD2 4AD, Scotland (b) Downfield Surgery, 325 Strathmartine Road, Dundee, DD3 8NE, Scotland

A group of seven asthmatics were identified from family practice, following administration of a questionnaire, as expressing feelings of stigma or pessimism concerning their condition. They were interviewed in depth, using interpretive research methods, concerning their experience of asthma. Interpretive research uses qualitative methods to explore the emotions, feelings and meaning of the event of interest. All the interviews were transcribed verbatim by the principal researcher and analyzed by the technique of immersion and crystallization. The picture of asthma that emerged for the participants in this study gave rise to the concept of a dynamic model to illustrate their asthma experience. The model showed asthma as a continuum from diagnosis to final acceptance. The transition phase included a nee to integrate knowledge, experience and self-awareness before progressing to acceptance and control. mentoring relationship greatly facilitated resolution of the transition phase. Progress along the continuum was accompanied by diminishing fear. Another important theme to emerge was the fact that tiredness and physical limitations were common feelings, irrespective of the severity of the asthma in medical terms. The implications of this research for health workers is that they have much to contribute in assisting asthmatics to gain control over their condition, particularly in respect to understanding what knowledge concerning their condition is relevant to asthmatics and in understanding the potential benefit to asthmatics of a mentoring relationship.