The Journal ofThe Royal College of General Practitioners

The British Journal of General Practice

EditorE. G. Buckley, FRCPE, FRCGPLivingston

Assistant EditorsA. R. Bichard, D.PHILJ. M. Bumstead, BSc

Journal Secretary1. M. Scott, MA

Editorial BoardD. Brooks, FRCGPManchester

A. G. Donald, OBE, FRCPE, FRCGPEdinburgh

R. C. Froggatt, MRCGPCheltenham

D. G. Garvie, FRCGPNewcastle, Staffordshire

D. J. Pereira Gray, OBE, MA, FRCGPExeter

J. S. McCormick, FRCPI, FRCGP,FFCM

Dublin

N. T. A. Oswald, MRCGPCambridge

N. C. Stott, FRCPE, MRCGPCardiff

C. Waine, FRCGPBishop Auckland

Statistical AdviserI. T. Russell, PH.D, FSSNewcastle-upon-Tyne

Published by The Royal College ofGeneral Practitioners, 14 PrincesGate, London SW7 lPU.Editorial Office: 8 Queen Street,Edinburgh EH2 IJE.Printed in Great Britain byThomas Hill Print (1985) Ltd.,Bishop Auckland, Co. DurhamDL14 6JQ.

Volume 36 Number 290 September 1986EditorialsSupporting good practice John Hasler 394Quality in general practice: a focus on inner cities Brian Jarman 395Alcohol - finding solutions Allan Scott 396

WONCA 1986 - Keynote AddressHealth for all, primary health care and general practitionersHannu Vuori 398

Original papersWorkload in a general practice 1950-85John Fry and John B. Dillane 403How bad are medical records? A review of the notes received bya practice Brian G. Mansfield 405Assessment of drinking patterns in general practiceSimon M. Wiseman, Susan N. McCarthy and Martin C. Mitcheson 407Use of the Michigan alcoholism screening test in general practiceE. Fiona Nicol and M. J. Ford 409Treatment for hypertension interrupted by placebo: the response ofpatients with high and low general health questionnaire scoresAlbert Jacob 411The outcome of hidden neurotic illness treated in general practiceAlan Johnstone and Margaret Shepley 413

Case reportOnce in a lifetime: a case of a pineal tumour Peter D. Perkins 416

Review articleReye's syndrome and aspirin Ronald D. Mann 418

For debateA model to describe social performance levels in elderly peopleE. Idris Williams 422Marriage guidance counselling in general practiceRoslyn H. Corney 424

Letters 427

News and reports 434

Primary care bookshelf 438

Classified advertisements and notices 440

B.G. Mansfield Original papers

for women) are fairly similar to the results found here, and cer-tainly this study shows no detectable improvement in the levelof recording.

Moulds5 also reported that the notes received by his practicewere in an 'abysmal state'; he found summary cards in only 15out of 1000 notes and a separate record for repeat medicationin only eight. The gradual introduction of summary cards forboth history and continued medication is the latest recommen-dation from the Joint Committee on Postgraduate Training forGeneral Practice for the improvement of record-keeping in train-ing practices. Of the 155 records reviewed here 36 contained sum-maries of the patient's history and 23 summaries of continuingmedication. This gives a measure of the workload facing thispractice in keeping all of its records summarized. The usefulnessof summaries is widely recognized, particularly when a patientis seen by more than one doctor or is transferring to the careof another doctor, during out-of-hours visits and in the prepara-tion of insurance reports. Stuart6 suggested the inclusion of asummary as a possible objective for record improvement. In-deed, the What sort of doctor? report3 emphasized that entriesshould be retrievable and suggested a completed summary sheet(in addition to the date of birth, marital status, occupation anda record of continued medication) as a guide to the quality ofrecord-keeping in a practice.

In the area of preventive care What sort of doctor? suggeststhat doctors should 'Consistently give evidence of a willingnessand ability to give both opportunistic and anticipatory care' Inthis study there was no record of any immunizations in 61/oof records. It is also disappointing that less than 50% of womenaged over 16 years had had a cervical smear performed in thepreceeding five years.

For any record to be of value it must be both legible and ac-cessible. It was reassuring to find that 86.207o of the entries ex-amined were totally legible. However, there is still some roomfor improvement. The long delays involved in the transfer ofrecords are worrying. This study does not attempt to identifythe source of the delay, but it is of note that 51 of the 53 notesfrom other practices in Devon, an area served by a family prac-titioner committee which is computerized, arrived in less than10 weeks.

Taylor7 asserted that 'Doctors who claim that they can carryin their heads all the information needed to deal with each oftheir patients usually have low standards of both need and per-formance' It can be concluded that either doctors do not knowtheir patients as they should or they attempt to carry too muchinformation about patients in their heads.

References1. Royal College of General Practitioners. Evidence to the Royal

Commission on the National Health Service. Policy statement1. London: RCGP, 1985.

2. Royal College of General Practitioners. Quality in generalpractice. Policy statement 2. London: RCGP, 1985.

3. Royal College of General Practitioners. What sort of doctor?Report from general practice 23. London: RCGP, 1985.

4. Dawes KS. Survey of general practice records. Br Med J 1972;3: 219-223.

5. Moulds AJ. Achieving better records. Update 1985; 30:545-549.

6. Stuart D. Practical problems of improving records. Br Med J1981; 282: 783-784.

7. Taylor S. Good general practice. London: Oxford UniversityPress, 1954.

AcknowledgementsThe author acknowledges help given to him by his tutors and colleaguesduring his training periods in Exeter, and in particular the help of DrK.J. Bolden.

Address for correspondenceDr B.G. Mansfield, 9 Greenacres, Wrefords Lane, Exeter EX4 5BS.

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Any doctor who is registered or provisionally registeredwith the General Medical Council may become anAssociate of the College without having to pass anexamination. Associates may take part in all Collegeactivities but are not able to describe themselves asMRCGP or to vote at general meetings. Together withMembers and Fellows they undertake to uphold and pro-mote the aims of the College to the best of their abilityand, while in active practice, to continue as far as prac-ticable approved postgraduate study.

The benefits of Associateship include:1. A sense of belonging to an organization dedicated

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ticipation in its activities including education andresearch.

3. Access to the services of the College library. This isprobably the most extensive library of general prac-tice in the world and is staffed by librarians used tohandling enquiries from general practitioners. Newreading for general practitioners is produced quarterlyfor those who wish to keep up to date with the grow-ing literature of general practice.

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406 Journal of the Royal College of General Practitioners, September 1986

R.D. Mann Review article

Paediatric paracetamol elixir has for some time been consideredpreferable to aspirin for infants and the present action, in ef-fect, extends this statement throughout the whole period ofchildhood. The disadvantage of substituting paracetamol foraspirin is that overdosage with paracetamol is particularlydangerous as it may cause hepatic damage which is sometimesnot apparent for four to six days. Doctors should therefore con-sider coupling their advice regarding the use of aspirin in childrenunder 12 year of age with warnings that the conventional dosesof paracetamol should in no case be exceeded. The Committeeon Safety of Medicines and its Secretariat have made carefularrangements to monitor the number of reported cases ofparacetamol overdose.

ConclusionAssessment of the effects of the present action to restrict theuse of aspirin in children aged under 12 years is clearly of crucialimportance. Doctors are asked to be particularly diligent inreporting suspect adverse reactions to paracetamol by means ofthe yellow card scheme and, while it is perhaps appropriate thatdoctors should be on their guard against being influenced indiagnosing Reye's syndrome by their knowledge of whether ornot aspirin has been given, it is of special importance that suspectcases of Reye's syndrome should be reported to the British Reye'sSyndrome Register (telephone 01-200 6868).

It is possible that the number of cases of Reye's syndromesuspected may now increase (rather than diminish) owing to theincreased awareness of the profession. Thus care must be exer-cised in interpreting future statistics on the apparent incidenceof the condition.

It is hoped that the advice of the Committee on Safety ofMedicines on restricting the use of aspirin in children under 12years of age will reduce the levels of mortality and morbiditycaused by Reye's syndrome in the UK. However, the final out-come depends on doctors and pharmacists bringing the messagehome to parents and to their children.

References1. Mowat AP. Reye's syndrome: 20 years on. Br Med J 1983; 286:

1999-2001.2. Glasgow JFT. Clinical features and prognosis of Reye's syndrome.

Arch Dis Child 1984; 59: 230-235.3. Reye RDK, Morgan G, Baral J. Encephalopathy and fatty

degeneration of the viscera: a disease entity in childhood. Lancet1963; 2: 749-752.

4. Starko KM, Ray CG, Dominguez LB, et aL Reye's Syndrome andsalicylate use. Pediatrics 1980; 66: 859-864.

5. Waldman RJ, Hall WN, McGee H, Van Amburg G. Aspirin as arisk factor in Reye's Syndrome. JAMA 1982; 247: 3089-3094.

6. Halpin TJ, Holtzhauer FJ, Campbell RJ, et al. Reye's Syndromeand medication use. JAMA 1982; 248: 687-691.

7. Hurtwitz ES, Barrett MJ, Bregman D, et al. Public Health Servicestudy on Reyes Syndrome and medications. Report of the pilotphase. N Engi J Med 1985; 313: 849-857.

8. Remington PL Rowley D, McGee H, et aL Decreasing trends inReye Syndrome and aspirin use in Michigan, 1979 to 1984.Pediatrics 1986; 77: 93-98.

9. Morbidity and Mortality Weekly Report 1986; 35: 66-67.10. Anonymous. Leads from the MMWR, Reye's Syndrome - United

States, 1985. JAMA 1986; 255: 1415.11. Committee on Safety of Medicines. Reye's syndrome and aspirin.

Br Med J 1986; 292: 1590.12. Cassidy JT. Treatment of children with juvenile rheumatoid

arthritis. N Engl J Med 1986; 314: 1312-1314.13. Paynter AS, Alexander FW. Salicylate intoxication caused by

teething ointment. Lancet 1979; 2: 1132.14. Hall S. Reye's Syndrome and aspirin. Br Med J 1986; 293: 54.

AcknowledgementsIt is a pleasure to acknowledge both the assistance of Dr Mary Glen-Bottof the Department of Health and Social Security, and the courtesy of DrSusan Hall, who has permitted access to the prepublication data of the BritishReye's Syndrome Surveillance Scheme study.

Address for correspondenceDr R.D. Mann, Department of Health and Social Security, MedicinesDivision, Market Towers, 1 Nine Elms Lane, London SW8 SNQ.

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CirculationThe Journal of the Royal College of General Practitioners ispublished monthly and is circulated to all Fellows, Membersand Associates of the Royal College of General Practitioners,and to private subscribers. All subscribers receive Policystatements and Reports from general practice free of chargewith the Journal when these are published. The annualsubscription is £55 post free (£60 sterling or $100 overseas).

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Notice to readersOpinions expressed in The Journal of the Royal College ofGeneral Practitioners and the supplements should not be takento represent the policy of the Royal College of GeneralPractitioners unless this is specifically stated.

Journal of the Royal College of General Practitioners, September 1986 421

FACULTY MEMBERSHIPEvery Member and Associate of the College is automaticallya member of a faculty and receives information and notices ofthe many faculty activities. The names and addresses of facultysecretaries are available from 14 Princes Gate.

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COLLEGE JOURNALThe Journal of the Royal College of General Practitioners ispublished monthly and is circulated free of charge to all Fellows,Members and Associates of the College. The 1986 subscriptionrate for non-members is £55 (£60 sterling or $100 overseas).Post free. Half-year subscriptions are available from Julyonwards. Single copies and back numbers cost £5.00 each(£5.50 sterling or $8.50 overseas). The Journal also publishesSupplements from time to time which are distributed with theJournal and are available free to Members and subscribers.Editor: E. G. Buckley, FRCPE, FRCGP, 8 Queen Street, EdinburghEH2 1JE. Tel: 031-225 7629.Non-members' Journal subscriptions, enquiries and paymentsshould be made to Bailey Bros and Swinfen Ltd, Warner House,Folkestone, Kent CT1 9 6PH. Tel: Folkestone (0303) 56501/8.Members' enquiries should be made to the College.

COLLEGE PUBLICATIONSThe Publications Office of the College is responsible for Reportsfrom General Practice, Occasional Papers and PolicyStatements. The former are distributed free of charge to allFellows, Members and Associates of the College and carry theapproval of the College. The Occasional Papers are discussiondocuments and are for sale at prices shown regularly in theJournal. The Exeter office is also responsible for coordinatingmaterial for the annual RCGP Members' Reference Book andfor publishing a number of books for the College. All Collegepublications are available by post from the Central Sales Office,Royal College of General Practitioners, 14 Princes Gate, LondonSW7 1PU.Honorary Editor: D. J. Pereira Gray, OBE, MA, FRCGP, 9Marlborough Road, Exeter, Devon EX2 4TJ. Tel: 0392 57938.

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Journal of the Royal College of General Practitioners, September 1986

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432

LIBRARY AND INFORMATION SERVICEThe RCGP now offers a Library and Information Service whichconsists of:

LibraryThe Geoffrey Evans Library has been collecting material ongeneral practice since 1960. It has a unique collection of books,pamphlets and periodicals and a special collection of generalpractitioners' theses. Since 1975 it has produced New Readingfor General Practice, a listing of current material which iscirculated to postgraduate medical centres, researchers,trainees and trainers.Although the Library is a reference library only, it provides theusual services, including photocopying.Librarian: Miss Margaret Hammond.

Online Search ServiceThe Online Search Service offers access to numerous publiclyavailable computerized databases on virtually every knownsubject and specializes in Biomedical Sciences including GeneralPractice. The College's trained Online Searcher carries outsearches taking a fraction of the time that a manual searchwould involve. Online searches can easily accommodatemultiple search terms and can print out the results at a veryhigh speed.Charges: Fellows, Members and Associates £5.00 per search.Non-members £1 5.00. Pre-payment is preferred.Online Search Manager: Roger Farbey.

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Management Appreciation CoursesAs part of a developing service on management, the RoyalCollege of General Practitioners is pleased to offer a series oftwo day Management Appreciation Courses for GPs and seniorpractice staff. Further details may be obtained from the CollegeInformation Service.

CENTRAL SALES OFFICEThe Central Sales Office is open from 9.30 to 16.30 hours,Monday to Friday, for personal callers to view and purchaseCollege publications and gifts. Appeal goods are also availableby post, on a cash-with-order basis, Visa and Access welcome.All orders for Medical Record Cards are processed by this office,on a cash-with-order basis, Visa and Access welcome.Central Sales Officer: Mrs Norma Wimbleton.

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RESEARCH DIVISIONThe Research Division is designed to promote research inprimary care throughout the British Isles. Advice on researchproblems obtainable from the directors of the units, or throughthe headquarters' staff.Chairman: Professor John Bain, MD, FRCGP, DCH, DObstRCOG,Aldermoor Health Centre, Aldermoor Close, Southampton SO 16ST. Tel: 0703-783111.Divisional Secretary: Mrs Sue Smith, 14 Princes Gate.

Birmingham Research UnitThe work of the unit is based on the morbidity data routinelycollected from practices throughout the UK. The unit hasdeveloped diagnostic and other registers for use in generalpractice and is developing Practice Activity Analysis, whichconcerns a standardized system of audit by self-evaluation.Director: D. L. Crombie, OBE, MD, FRCGP.Research Fellow: D. M. Fleming, FRCGP, Lordswood House, 54Lordswood Road, Harborne, Birmingham Bl 7 9BD. Tel:021-426 1125.

Leigh Clinical Research UnitThis unit, which has its own research laboratory, is studyingthe factors involved in ischaemic heart disease. It is particularlyinterested in the part played by lipoproteins and fibrinogen.Director: M. C. Stone, MD, FRCGP. The Health Centre, GrasmereStreet, Leigh, Lancashire WN7 1XB. Tel: 0942 676864.

Manchester Research UnitThe unit has special experience in the processing of large scaledata resulting from multi-observer projects. It is responsible forthe oral contraception and attitudes to pregnancy studies.Director: Clifford R. Kay, CBE, MD, PH.D, FRCGP.Deputy Director: Peter Frank, MD, FRCGP, 8 Barlow Moor Road,Didsbury, Manchester M20 OTR. Tel: 061-445 7771.

Swansea Research UnitThis unit is mainly concerned with the epidemiology ofinfectious diseases and is currently engaged in a study of therespiratory sequelae of whooping cough.Director: W. 0. Williams, OBE, MD, FRCGP, Department of SocialAnthropology, University College of Swansea, Singleton Park,Swansea, West Glamorgan SA2 8PP. Tel: 0792 205678, ext.5315.

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Journal of the Royal College of General Practitioners, September 1986 433

News and reports

Christine A. Lesley, A.M. Lewis, Andrea J. Lewis, C.P.M. Lewis, A.B.G.Liddle, Rosalind A. Lightstone, Catherine B. Lindley, Janet B. Lindsay,A.M. Liston, G.A. Littman, T.J. Lockwood, Susan Lofthouse, D.J.Lombard, A.C. Long, Judith P. Longley, D.G.R. Lowden, C.H. Lowe,Kenneth Lowe, John Luby, J.P. Luckett, G.G. Luckraft, Hilary C.Luscombe, Helen C.M. Lydon, A.R. Lyon.

K.G. MacCormack, C.E. MacDonald, J.K. MacDonald, FionaMcGillivray, Bronagh M.C. MacGreevy, Jean Maclntyre, J.A.B.MacKenzie, Linda D. MacLellan, I.S.C.S. MacLeod, James MacLeod,Moira C.M. MacLeod, Donald MacVicar, Ronald MacVicar, D.R.Macdonald, Lesley Macdonald, Alexandra M. Mackenzie, Anne C.M.Mackenzie, G.M. Mackenzie, J.S. Madden, K.J. Magee, John Mahony,Ashok Maini, Brian Malcolm, D.R. Malin, P.A. Manley, *B.G.Mansfield, Elizabeth A. Mapson, Linda M. Marshall, A.D. Martin, AvrilMartin, Christine Martin, *E.E.J. Martin, Gillian R.C. Martin, PamelaMartin, M.K. Mashru, I.H. Mason, Paul Mason, H.N.C. Mawson, C.D.May, Vivienne E. May, Patricia D. McAllister, S.P. McAndry, A.A.McArthur, Rosemary A. McCann, A.A. McCauley, A.J. McClelland,I.C. McColl, M.S. McCormick, M.G. McCullagh, Elizabeth E.McCulloch, Hilary McDermott, M.W. McDevitt, C.M. McDonald, ClaireF. McDonald, Valerie M. McDougall, *Jean S. McGill, Joseph McGivern,A.W. McGovern, P.N.P. McGregor-Wood, L.P. McGrogan, R.I.McGrouther, Anne Y. McGuire, Frank McGuire, *D.A. McHardy,Loretto M. McHugh, Susan E. Mcllhinney, M.R. McIntyre, *C.H.W.McKee, George McKeeve, D.S. McKerrell, Lizbeth J. McKinlay, G.S.McLaren, Sheila McLaskey, Claire M. McMahon, Pamela M. McMann,D.K. McManus, Catherine M. McMichael, S.A. McMinn, FrancisMcMullan, I.T. McNicoll, Jack McQuade, Gillian M.L. McSweeney, SallyJ. Meakins, J.D. Mee, Diane Meek, Hilary G. Melrose, Scott Menzies,Catherine Michael, Sandra A. Michael, D.M. Miles, S.A. Miller, S.W.M.Miller, Hazel L. Mills, G.J. Milne, Sheena M. Milne, P.M. Milner, JenniferS. Mindell, P.W. Mitchell, T.J.F. Mitchell, C.J. Moncrieff, A.D. Mone,J.L. Monteiro, Michael Morgan, S.J. Morgan, Paul Moroney, Fiona M.Morrison, Gillian E. Morrison, Jillian M. Morrison, R.H. Morrison,A.J. Mortimore, Hadrian Moss, S.N. Mottram, A.H. Mounstephen, A.J.Mowat, D.P.R. Muir, Gordon Muircroft, Patricia E. Muirhead, G.A.Mulvaney, G.J.J. Murphy, Fiona Murray, Heather D. Mycock.

R.J. Neep, Sandra J. Nehring, Dilys J. Neill, R.A. Neill, D.N. Newell,Angela W.Y. Ng, M.E. Nicholl, P.J. Nicholson, P.A. Nicol, W.S. Nicoll,P.B. Nightingale, K.W. Noble, W.J. Noonan, D.R.H. Norminton, M.A.North, Helen P. Norwood, J.P. Nugent.

D.J. O'Brien, P.J. O'Brien, T.J. O'Carroll, P.G.M. O'Connell, J.P.O'Keeffe, M.Y. O'Mahony, Anthony O'Neill, Mary B. O'Neill, D.A.O'Regan, C.D. O'Reilly, D.K. O'Shea, J.G. Oates, Angela E. Oliver, S.D.Oliver, Gail C. Ord-Hume, Margaret J. Orr, C.J. Osborne, N.W. Osborne,Elizabeth C. Osmond, Janet Oswald, R.D. Overy.

Julia M. Pallant, Rachel M. Palmer, R.W. Park, Chander Parkash,S.A. Parker, *Julie Parkes, S.J. Parkinson, D.G. Parry, G.J. Parsons, EileenP. Partington, D.R. Partridge, Jitendra Patel, Rowena A. Paton, SusanM. Paton, Bernadette M. Paver, K.E. Pearce, A.D. Pearlman, BrendaPeek, M.E. Pelly, Adrian Penn, M.R. Perry, M.S. Perry, D.J.M. Peterson,P.J.S. Petrie, Katherine M. Phelan, G.M. Phillips, Eileen M. Pickering,*Hilary B. Piercy, Julia E. Pigott, Barbara S. Pilkington, G.H. Pitt,Graham Platt, M.H. Player, *J.L. Pocock, Mary E. Polkinhorn, A.C.Pollock, R.S. Pollock, Lesley Pontefract, A.W. Potter, S.W. Powell, *A.M.Press, C.E. Price, D.M. Price, A.N.M. Pryde, Wendy A. Pugh,Saw K. Pui.

R.F. Quigley.J.M.C. Radford, Linda M. Rainey, R.S. Rainey, P.D. Ramsay, R.B.

Ramsay, Aly Rashid, Steven Rawstorne, S.W. Redfearn, M.J. Redmore,Sharon Redpath, Shirley M. Reed, Susan C. Rees, Jane H. Reid, MargaretM. Reid, S.C. Reid, Susan E.H. Rendel, R.R. Rhodes, Steven Rhodes,S.A. Richards, Sally A. Richardson, D.W. Richmond, D.J. Riddell, K.S.Rigg, Fiona A. Ritchie, Amanda J. Roberts, D.H.G. Roberts, HeatherA. Roberts, M.D. Roberts, Paula Roberts, Joyce B. Robertson, R.A.Robertson, Susan J. Robertson, Alexandra J. Robinson, Jane F.Robinson, S.D. Robinson, Marion J. Rodin, Alan Rogers, Sally J. Rogers,J.N. Rolfe, A.G. Rollo, M.V. Roman, D.J. Roper, P.W. Roper, CarolineJ. Rose, Mary E.M. Rose, Allison M. Ross, Juliette Ross, Pamela S. Ross,M.G.P. Rossdale, Elizabeth M. Rous, J.F. Rowan, M.J. Rowe, M.J.Y.Ruck, D.J. Russell, J.G. Russell, D.P.M. Ryan, J.J. Ryan, S.V. Ryan,Gillian P. Rye.M.A. Sadler, A.K. Sahdev, Manjeet K. Sandhu, Linda H. Sandle, N.J.

Sayer, Sarah M. Scambler, Julia K. Schofield, S.J. Schofield, Nicola M.Scott, R.J. Scott, Wendy E. Scott, J.E. Scriven, James Seddon, SusanE. Selmes, *A.G. Selwyn, R.N. Sewell, F.M. Shackleton, E.R. Shanahan,Claudia R. Shand, Anil Sharma, John Sharp, Judith M. Sharpey-Schafer,C.R. Shaw, Johnstone Shaw, Kathryn S. Sheehan, Lynn J. Sheldrake,

P.A. Shenton, Susan J. Shepherd, P.J. Shortall, Catherine J. Shuster,P.C. Siggins, Kathleen M. Simmons, Judy H. Simpson, P.F. Skehan,Richard Slade, J.E. Slater, Carolyn Smalley, *D.S. Smalley, Amanda J.Smith, Anne M. Smith, C.J. Smith, Deborah A. Smith, G.J. Smith, H.R.Smith, Katherine S.H. Smith, N.A.L. Smith, R.W. Smith, Catherine J.Snape, D.D. Spackman, J.P. Spalding, N.J. Speak, Margaret J. Spinks,P.D. Spurrier, R.J.R. Stanger, Susan M. Stanton, M.S. Stead, M.R. Steel,A.D. Steele, M.A. Steele, Diana C. Stevens, L.F. Stevens, M.D. Stevenson,Peter Stevenson, M.J. Stewart, J.A. Stirling, Catherine J. Stoker, A.K.Stone, N.A. Stones, N.R. Storer, P.J. Strickland, Teresa M. Strong, GillianStubbens, Hugh Sturgess, S.R. Summers, D.F. Sutherland, J.A.Sutherland, Seonaid A. Sutherland, Rosemary J. Sykes, R.C.F. Symons,S.A. Szweda.

G.J. Tamlyn, S.J. Tanner, K.N. Tarrant, Gillian D. Tasker, ChristineM. Tattum, K.T. Tattum, B.W. Taylor, Catherine E. Taylor, F.T. Taylor,Robin E. Teoh, *Michelle J. Terleski, Alexander Thain, Judith A.Thomas, Kathryn M.J. Thomas, R.G. Thomas, Fiona C. Thompson,Simon Thompson, T.H.R. Thompson, A.W. Thomson, J.D. Thornhill,Marie B. Tobin, J.D. Tolliday, Diane Tomlinson, J.D. Tomlinson,Catherine W.S. Tong, Christopher Townsend, Beverley A. Travill, HilaryA. Trigg, *Freda M. Trimble, R.F. Trotter, M.P. Twomey, Margaret M.Twomey, Nicolette M. IV'rrell.

D.J. Unwin, J.R. Usher.M.J. Valentine, Karen A. Van Den Brul, Malcolm Venables, R.P. Verrill,

N.R.J. Vincent, S.N. Voss.D.P. Waind, J.H. Waldron, F.C.E. Walker, R.I. Walker, A.S. Wallace,

N.R. Walter, *Stephen Walter, Caroline E. Walton, I.J.. Walton, N.G.Walton, A.E. Ward, A.G. Ward, D.J. Ward, Suzanne C. Waterer, R.A.M.Watson, S.J. Watson, Carolyn S. Watt, G.C.M. Watt, J.P. Wearne, SusanM. Weatherhead, R.D. Weaver, P.G. Weaving, D.J. Webborn, Jane J. Weir,Larysa 0. Werchola, Barbara A.K. West, *D.M. Whistler, Elizabeth A.White, H.G. White, W.H. Whitehead, P.N. Whitfield, D.L. Whitford,Susan E. Whittles, Julia C. Whitworth, I.F. Whyte, G.G.E. Wilcox, ClareE. Wilkinson, Joanna R. Wilkinson, M.J.B. Wilkinson, *S.J. Wilkinson,Ian Williams, P.H. Williams, Ruth G. Williams, I.G. Williamson, *EmilyWills, Janie M. Wilson, Judith M. Wilson, Margaret C.G. Wilson, MaryS. Wilson, Patricia H. Winter, A.W.J. Withers, Celia H. Withey, J.S.B.Womersley, Sally M. Wood, J.P. Woods, P.J. Wrigglesworth, AnthonyWright, G.A. Wright, I.C. Wynne.

Elizabeth L. Young.

DIARY DATES

College Summer PartyThe President is holding an evening summer party for membersand guests at the College on Thursday 25 September 1986, from18.30 to 22.30 hours. Music will be played by students from theGuildhall School of Music and there will be an art and sculptureexhibition. Supper, with wine, will be at 19.30 and the concertfromr20.45 hours.

Tickets are £12.50 each and can be obtained from Mrs JanetSmith at the College. As numbers are limited it is advisable tobook early.

Consumer/patient information for healthThe five North of Englan'd regional associations of Librariansin the Health Service are planning a one-day meeting on 'Con-sumer/patient information for health' for Wednesday 10September 1986 in the University of Leeds Medical and DentalSchool.Although this meeting is being organized by librarians the

issue of patient and health promotional information is of greatimportance in today's consumer-conscious world and themeeting is open to all who are professionally involved with thehealth and welfare of the public, including hospital andcommunity medical and nursing staff, health educators, com-munity health councils and public librarians.The course fee is £15.00 (which includes lunch) and bookings

should be made to: Mrs S. Thompson, District MedicalLibrarian, Airedale General Hospital, Steeton, Keighley, W.Yorks BD20 6TD.

Journal of the Royal College of General Practitioners, September 1986 437

Primary care book shelf

are 'difficult' and where referral to colleagues raises ethicalproblems.Does this 'backwards' approach work? Is such an in-depth

series of discussions too anecdotal to have wide applicability?Every general practitioner will recognize the sort of problemsdealt with in the book, and, for the most part, it is written ina way which clinicians will readily understand. For these reasonsalone this book is likely to have considerable appeal, and thiswill help the reader to come to grips with some of the morerecondite philosophical and ethical concepts discussed.The book is rooted in Canadian and American philosophies

of primary care and British readers will be struck by the em-phasis placed on family aspects of care. Possibly because of itstransatlantic setting, moral and ethical implications of govern-ment's involvement in the provision of health care is underem-phasized and more should have been said about confidentiality.

Despite these shortcomings, this is the most appropriate bookon this subject available for general practitioners - especiallythose involved in undergraduate education and postgraduatetraining. This is more than a handbook of ethics for family doc-tors. The National Health Service general practitioner will behelped towards a clear appreciation of his role as he comparesand contrasts his mode of practice with that of his Canadiancounterpart, while non-general practitioner readers will be af-forded considerable insight into the true nature of primary care.

J.D.E.K.

The eye in general practice first appeared in 1957. It has nowbeen completely rewritten and is published in an eighth editionnearly 30 years later. I was surprised to discover that it is 10 yearssince the seventh edition was published and great strides havebeen made in ophthalmology in this time, particularly in thefield of laser technology. Thus the book includes a new sectionon diabetic retinopathy, with emphasis on early recognition ofvascular complication and the subsequent reduction in diabeticblindness.

Other eye problems are presented in a comprehensive andreadable manner. An early chapter is devoted to common eyeproblems with reference to the subsequent chapters, where theeye diseases are arranged on an anatomical basis. Most of thephotographs are superb, and the diagrams and tables excellent.The final chapters are devoted to visual standards for variousoccupations, screening of children for visual defects and defini-tions, benefits and useful addresses for the blind and partiallysighted.

I have had a now well-worn copy of The eye in general prac-tice on my bookshelf for many years, and have referred to iton many occasions. It was particularly useful when sitting theMRCGP examination - little time is given to the teaching ofophthalmology at either undergraduate or vocational traininglevels.

I am delighted to see this rewritten version, and will continueto recommend it as a worthwhile addition to any general prac-titioner's library.

T.R.D.

Retinal detachment is a clearly set out instruction manual onthe diagnosis and management of retinal detachment. Theauthor introduces the subject with concise definitions, classifica-tion and applied anatomy. This is followed by examinationtechniques, pathogenesis, prophylaxis and differential diagnosis.Chapters on preoperative considerations, surgical principles andtechniques, early postoperative considerations and latepostoperative considerations are also included.

This book is expertly illustrated with drawings andphotographs which complement the easily understood text on

how to manage uncomplicated cases of retinal detachment withsafety and efficiency.

Retinal detachment is intended primarily for traineeophthalmologists and those ophthalmologists looking for an up-date in the subject. However, general practitioners would quicklyunderstand the basic principles of this serious eye condition ifthey were to browse through this excellent manual.

R.J.R.

Making the most ofyour doctor is a light-hearted, family guideto dealing with the general practitioner. It aims to reduce themystery and anxiety evoked by medical authority, while introduc-ing the concept of sharing, communicative doctors. Readers areencouraged to ensure that their general practitioner is someonethey can talk to and trust, who is accessible and medically sound.The wide variation in personality, style and mores of individualdoctors is exposed, and the reader is reminded that he is freeto choose the doctor to suit his needs.

Patients are encouraged to explore their own attitudes towardsachieving good health care and practical tips ranging from listingquestions for the family doctor before a consultation to takinga survival kit to ease a long wait in a hospital outpatient depart-ment are given. A checklist to assess the quality of care availablefrom a new practice helps the reader to make an informed choice

Preventive health care is stressed throughout the book, withemphasis on immunization, antenatal care and avoidingischaemic heart disease. Although various screening proceduresare recommended, general health checks offered by private com-panies are decried.The final chapters provide informative accounts of sensitive

issues such as confidentiality, access to records and complaintsprocedures.

Written by two social psychologists and one family doctor,this helpful little book is also valuable reading for medicalstudents, general practitioner trainees and anyone practisingmedicine. It encourages critical appraisal of the acquired ar-rogance which may distance doctors from their patients.

In summary this is an excellent book for laymen who lackconfidence or feel poorly informed about obtaining health care.

C.W.

BOOKS RECEIVED

THE ROLE OF PROSTAGLANDINS IN LABOURInternational Congress and Symposium Series, Number 92Clive Wood (Ed), Royal Society of Medicine, London, 1985.100 pages. Price £10.00

EPILEPSY AND THE LAW - A MEDICAL SYMPOSIUM ONTHE CURRENT LAWInternational Congress and Symposium Series, Number 81Peter and Elizabeth Fenwick (Eds), Royal Society of Medicine,London, 1985. 88 pages. Price £9.00

DISTANCE LEARNING IN SOCIAL WORK EDUCATIONAvril Osborne, Central Council for Education and Training inSocial Work, London, 1985. 151 pages. Price £5.00

NHS MANAGEMENT PERSPECTIVES FOR DOCTORSKing Edward's Hospital Fund for London, London, 1985.127 pages. Price £5.50

A SYNOPSIS OF OCCUPATIONAL MEDICINE (2nd edition)FH. 73rer and K Lee, John Wright, Bristol, 1985. 227 pages.Price £12.50

THE DIABETES REFERENCE BOOKPeter Sonksen/Charles Fox and Sue Judd, Harper and Row,London, 1985. 283 pages. Price £4.95

Journal of the Royal College of General Practitioners, September 1986 439

Primary care book shelf

A GUIDE TO MEDICAL ENDOCRINOLOGYTarek Hassan, Macmillan, London, 1985. 269 pages. Price £17.00

INTEGRATED CLINICAL SCIENCE. GASTROENTEROLOGYPeter F. Jones, Peter W Brunt, N. Ashley and G. Mowat,Heinemann Medical Books, London, 1985. 365 pages

IN SEARCH OF HEALTH AND WHOLENESSThe Division of Social Responsibility of the Methodist Church,London, 1985. 80 pages. Price £1.95

ATTITUDES TO DOWN'S SYNDROMEJanice C. Sinson, Mental Health Foundation, London, 1985.52 pages

POLICIES FOR QUALIFYING TRAINING IN SOCIAL WORK.REPORT OF CONSULTATIONS. CCETSW paper 20.4Central Council for Education and Training in Social Work,London, 1985. 85 pages. Price £3.00

MANAGEMENT OF ARTERIAL HYPERTENSIONF. Gross, Z. Pisa, TJ Strasser and A. Zanchetti, World HealthOrganization, Geneva, 1985. 72 pages. Price Sw.fr.ll.-

MOTILITY: A FORGOTTEN FACTOR INGASTROINTESTINAL DISORDERSInternational Congress and Symposium Series, Number 91Clive Wood (Ed), Oxford University Press and Royal Society ofMedicine Services, London, 1985. 39 pages. Price f7.50

BURN AND SCALD ACCIDENTSWorking Party of the Child Accident Prevention Trust, BedfordSquare Press/NCVO, London, 1985. 65 pages. Price £3.95

EMERGENCIES IN GENERAL PRACTICE (2nd edition)A.J. Moulds, PB. Martin and TA.I. Bouchier-Hayes, MTP Press,Lancaster, 1985. 215 pages. Price £13.95

COMPUTER APPRECIATION COURSESFOR GENERAL PRACTITIONERS

AND PRACTICE MANAGERS/SENIORPRACTICE STAFF

The RCGP Information Technology Centre is pleased to offera series of computer appreciation courses for general practi-tioners and their senior practice staff. These events are heldat 14/15 Princes Gate, where overnight accommodation isavailable if required.The course content and presentation assume that

participants have either only superficial or no knowledge ofcomputing. The principles, language and technology of com-puting are discussed in lay terms, with particular emphasis onthe problems of, and potential solutions to, the introductionand management of the new technology in the practice.The cost of the course for members and their staff is £160

(inclusive of Friday's residential accommodation) and for thosenot requiring overnight accommodation, the cost is £135. Fornon-members, the course fees are £180 inclusive of Friday'saccommodation, and £155 exclusive. The fee includes all meals,refreshments and extensive course notes.

These courses are zero-rated under Section 63. Underparagraph 52.9(b) of the Statement of Fees and Allowances,practice staff attending the courses may be eligible for 70%reimbursement. Staff should confirm eligibility for reimburse-ment with their FPC.

The dates for 1987 include: 16-17 January, 13-14 February,6-7 March.

Application forms and further details are available from:Course Administrator, Information Technology Centre, TheRoyal College of General Practitioners, 14 Princes Gate, LondonSW7 1PU. Telephone: 01-581 3232.

THE ROYAL COLLEGE OF GENERALPRACTITIONERS

ANNUAL SYMPOSIUM'QUALITY IN ACTION'

Friday 14 November 1986

The Annual Symposium will be held on Friday 14 November1986 at the Barbican Conference Centre, Barbican, LondonEC2.

The overall aim of this year's Annual Symposium is to produceagreed guidelines for general practitioner care in four impor-tant areas. Participants will choose two of these - either ter-minal care or child care and either asthma or chemicaldependency. They will be expected to do some preparatorywork based on data collection in their own practices. This willform the basis of the group work which will occupy much ofthe day.

Zero-rated approval under Section 63 has been received.

For further details and an application form please write to:Dr Michael Varnam,Education Division,The Royal College of General Practitioners,14 Princes Gate,London SW7 1PU.

SOMALIA: PRIMARYHEALTH PROJECT DOCTOR/

HEALTH WORKER

CIIR, in conjunction with the Somali Ministry of Health, seeksa Doctor/Health Worker to join a team of people in a newPrimary Health Project.

The person appointed will work with a local counterpart pro-moting the project amongst the local community, assessingproject plans, and organising training courses for communityhealth workers. Previous work experience in the Third Worldor in similar demanding situations is essential.

CIIR provides a 2 year contract, language training, extensivebriefings, salary adequate for a single person, allowances,insurance, etc.

For further information send a SAE andyour CV to

X ^ | | J CIIR Overseas Programme,22 Coleman Fields, London Ni 7AF.Quote Ref: HW/JGP/2.

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440 Journal of the Royal College of General Practitioners, September 1986