Decision-Making in General Practice by Michael Sheldon, John Brooke, Alan Rector

By Michael Sheldon, John Brooke, Alan Rector

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It must bring together the doctor- and patient-centred models, so that illnesses may be understood, not only in mechanistic terms, hut also in terms of their meaning for the patient. I believe that general practice is at the leading edge of this change. This is why the virtual exc1usion of general practice from many medical schools, and the unreformed state of medical education, is such a serious matter. Acknowledgements I am grateful to Professor Arthur Elstein and Doctors John Nicholas, Martin Bass, Carol Buck, Moira Stewart, Eric McCracken, Wayne Weston and John Biehn for many helpful comments on early drafts of the manuscript.

T81 358 u 20 10' 85. _ _ _ _ _ __ 6&+ I1 I • Figure 5 Patients' estimate of ease of communication with doctor in relation to age and sex The Consultation Process So perhaps the major improvement we can make in decision-making is easing the constraint of time and there are many ways in wh ich we can do this, such as reduction in list size or more delegation. The coming of the computer may be of help in providing better information recall and a move to better organisation certainly helps to ease the burden of time, but both computers and better organisation are not without problems.

All this is not intended to minimize the value of appropriate precision, when it has been weighed in the balance with other values. The weakness of the doctor-centred model in its extreme form is its failure to recognize that precision is one among many values, and that greater precision does not necessarily reduce uncertainty, or lead to a more accurate definition of the problem. In the patient-centred model, the appropriate level of precision is an important issue. Uncertainty is accepted as inevitable and the physician focuses on the evaluation of different therapeutic choices.

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