Common Dilemmas in Family Medicine

1. Front Matter

   Pages i-xiv

   PDF

2. Mild-to-moderate hypertension — to treat or not to treat?

   • Daniel M. Barr, Eric Gambrill, John Fry, John P. Geyman

   Pages 1-22

3. Psychotropic pills or psychotherapy?

   • Paul Freeling, Stanley Levenstein

   Pages 23-38

4. Alcoholism — disease or self-inflicted vice?

   • John Fry, Benno Pollak, Ken Young, W. E. Fabb

   Pages 39-52

5. Acute myocardial infarction — home or hospital care?

   • Brian R. McAvoy, Joseph H. Levenstein

   Pages 53-68

6. Is obesity worth treating?

   • Robert B. Taylor, Denis Craddock

   Pages 69-87

7. Diabetes: strict control or flexibility in management?

   • Robert G. Russell, Douglas G. Garvie, A. I. M. Bartelds

   Pages 89-107

8. Antibiotics for acute otitis media and sore throat?

   • Niels Nørrelund, Michael J. Whitfield

   Pages 109-121

9. Premenstrual tension and the menopausal syndrome — specific treatment?

   • Gillian Strube, K. Gill, Alistair Moulds

   Pages 123-137

10. Acute backache — active or passive treatment?

    • Peter B. Martin, Jack Froom

    Pages 139-152

11. Terminal care — at home or in the hospital or hospice?

    • M. Keith Thompson, Bridget Matthews, A. G. O. Crowther

    Pages 153-170

12. Compulsory immunization, or not?

    • W. O. Williams, Tommy Bouchier Hayes

    Pages 171-184

13. House calls — more or less?

    • John Grabinar, George Davie, William Stewart, Andrew Fraser

    Pages 185-201

14. Teamwork — delegated or shared?

    • John D. Williamson, John Smith, David Brooks

    Pages 203-227

15. Patient participation — more or less?

    • Alfred O. Berg, Patrick Kerrigan, Peter Pritchard, G. J. Pistorius, Keith W. Sehnert

    Pages 229-269

16. Telling the patient the truth, the whole truth and nothing but the truth?

    • Axel Engberg Pallesen, Robin Steel

    Pages 271-291

17. How many patients — more or less?

    • Stan Schuman, Derek A. Coffman, Eric Gambrill

    Pages 293-310

18. Medical check-up — useful or useless?

    • E. C. Gawthorn, Nils Andersen, Michael D’Souza

    Pages 311-336

19. Solo practice or group practice?

    • Susi Rottenberg, Roger A. Rosenblatt

    Pages 337-348

20. Vocational training for family medicine — useful or useless?

    • K. H. M. Young, John Fry, W. E. Fabb

    Pages 349-359

One of the eXCltmg challenges of medicine has been the reaching of decisions based on less than complete evidence. As undergraduates in teaching hospitals future physicians are taught to think in clear and absolute black and white terms. Diagnoses in teaching hospitals all are based on supportive positive findings of in­ vestigations. Treatment follows logically on precise diagnosis. When patients die the causes of death are confirmed at autopsy. How very different is real life in clinical practice, and particularly in family medicine. By the very nature of the common conditions that present diagnoses tend to be imprecise and based on clinical assessment and interpretation. Much of the management and treatment of patients is based on opinions of individual physicians based on their personal expenences. Because of the relative professional isolation offamily physicians within their own practices, not unexpectedly divergent views and opinions are formed. There is nothing wrong in such divergencies because there are no clear absolute black and white decisions. General family practice functions in grey areas of medicine where it is possible and quite correct to hold polarized distinct opinions. The essence of good care must be eternal flexibility and readiness to change long-held cherished opinions. To demonstrate that with many issues in family medicine it is possible to have more than one view I selected 10 clinical and II non -clinical topics and invited colleagues and fellow-practitioners to enter into a debate-in-print.

• family medicine
• medicine

• Beckenham, Kent, England

  John Fry

Policies and ethics