Conflicts between personal and public health care: can one GP serve two masters?
Year: 2007
Type: editorial
Abstract: General practice has always been placed between personal care and public health duty. But the latter has not been an integral part of general practice for very long and is still poorly integrated in countries like Germany, Austria, and France. But even in those countries, working as a GP often includes a public health approach, and GPs' role — in the language of social science — is defined by public health, as well as by the requirements of personal care.1,2
During the past few years GPs have experienced a shift from performing a personal care role to a public-health function. For instance, in the pursuit of public health we are paid for treating a percentage of our patients in areas such as raised blood pressure, screening for a variety of conditions, and immunisation programmes. Such programmes, more or less, make it possible not to inform patients of the primarily public-health function of most of the screenings and most of the treatments in low-risk groups. Informing patients would reduce participation, and obstruct the public-health goal.
At the same time we are told to give only evidence-based treatment or none at all, although we know that evidence-based medicine only gives answers for selected groups in studies that are not always applicable to our individual patients.
There are other examples where GPs, sometimes unwittingly, start to follow a public-health approach. For instance, treating cystitis with trimethoprim instead of a quinolone is following a public-health approach, focusing on limiting bacterial resistance and reducing costs for society. …
Source: PubMed
Author: Heinz-Harald Abholz
Institution: Düsseldorf University Hospital
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1956049345