SummaryFamily physicians are confronted with new challenges in view of economic, socio-demographic and health policy-related changes. Among these challenges, a critical reflection on core principles of medical professionalism is required. According to the widely acknowledged Charter of Medical Professionalism (published in 2002) these principles refer not only to the preservation and improvement of well-being of individual patients, but equally to physicians‘ societal responsibility. This responsibility includes the strengthening of evidence-based professional performance, the availability of universal access to health care services, and the physicians‘ commitment to a reduction of social inequalities in population health. This paper traces the current debate on medical professionalism back to its origins in medical sociological research, and illustrates specific examples of primary care activities that contribute to a reduction of the health burden of socially deprived population groups. Keywordsmedical professionalism; family physicians; social responsibility; health inequalities; medical sociology
Background: General practice as an elective in the final year of the German medical school curriculum (= Praktisches Jahr) has been introduced in Tübingen in 2006. The curriculum development includes both insights into already existing international curricula for undergraduates and own experiences from teaching these students. As teaching physicians have direct contact with the students, they can provide relevant information on their own teaching experience and on the students’ learning situation. Therefore it makes sense to include the views of the teaching physicians when developing the curriculum.Methods: In a modified nominal group technique the views of our 16 teaching physicians on their most important learning topics for the elective within the Praktisches Jahr were collected. The mentioned learning topics had to be weighted and rated as “successfully implemented in teaching” or “unsuccessfully implemented”.Results: The five most important successfully implemented learning topics were “physical examination”, “history taking”, “communication skills”, “decision making”, and “diagnostics in family medicine”. The five most unsuccessfully implemented learning topics were “aspects of the doctors’s role”, “pharmacotherapy”, “aspects of long-term-care”, “efficiency in doctoring”, and “theoretical background for diseases”.Conclusion: Based on this information, it seems possible to close practical training gaps. The results are important for further curriculum development – also for other German medical faculties, as they have a comparable starting situation for the elective “general practice” within the practical year.
Qualitative Results of a Mixed-Methods Study on Antibiotic Prescribing for Urinary Tract InfectionsBackground: Individual therapeutic decisions are a contentious point in the context of medical quality work and guideline implementation. In the course of a mixed-methods study on antibiotic prescribing for uncomplicated urinary tract infections (UTI) a sustained change in prescribing could be demonstrated. The complex intervention comprised a self-conducted practice test of trimethoprim (TMP). The aim of the qualitative part was to evaluate the attitudes of the family physicians (FP) towards guidelines, the making of their therapeutic decisions and the effect of the practice test on their opinions.Methods: The study was conducted in a before-after design with qualitative elements. The qualitative part consisted of focus-groups and single interviews, semi-structured by discussion guides that had been developed by an interdisciplinary team of researchers. Evaluation of the transcribed discussions and interviews was done according to the method of qualitative content analysis by Mayring.Results: Guidelines first were widely perceived as out of touch with reality and rejected as a whole. Antibiotic choice was seen as reflex like, mainly driven by former hospital training. The interest of the single patient was clearly paramount to the common good of preventing antibiotic resistance. Concerning this task the FPs missed any solidarity within the health care system. In the three months practice test TMP had a success rate of 94%. This strongly changed opinions towards the use of TMP. Peer group opinion, self-reflection and personal experience in the practice test were predominantly seen as the change inducing agents.Conclusions: The choice between broad- and small-spectrum antibiotics mirrors the conflict of the FP’s responsibility for individual and collective at the same time. The good of the individual patient stood clearly in front of the public health goal of avoiding bacterial resistance. Prescribing of broad-spectrum antibiotics appears thus to be logical and reasonable from this perspective. The practice test and ownership of the process of knowledge acquisition convinced the participants that with TMP both goals are achievable. Possibly it is the public-health perspective of guidelines that sometimes blocks their translation into practice.
