This book is about four ways of using the consultation in primary health care. One ofthem is very familiar, the other three a little less so. But they should all be as much a part of the repertoire of doctor or nurse as examining some system of the body or relieving pain and discomfort. If each is not used when appropriate, the full potential of the consultation is not achieved. This is the practical message of the book. Simultaneously it is concerned with the more theoretical problems of clarifying the role of the generalist in contemporary medicine and of relating it to the wider world of people's day-to-day lives and decisions and to their interest in seeking health for their children and themselves. Is primary care too broad and general to be manageable? Is it a pot-pourri derived from other disciplines or is it distinct? If distinct, exactly how does it differ and can its principles be stated in a clear and practical way? How can it respond effectively to people's wants and needs? The same four uses of the consultation, presented in a diagram which can be easily remembered, serve as a simple map for outlining the role of the doctor or nurse in primary care. The details of the map are filled in with clinical anecdotes and copious reference to studies from all over the world
CONTENT
1. Meeting the Patient: Ideals and Realities -- Reasons for Consulting Patterns -- 2. Extending the Consultation Goals -- The Surface Anatomy of Primary Health Care -- 3. From Episodic to Continuing Care -- Continuing Care as Part of the Discipline of PHC -- Familiarity and Familiarity Blindness -- Methods Which Can Facilitate Continuing Care (Area C) -- Conclusions -- 4. Help Seeking: How, Where, Why, Wither? -- The Meaning of Health and Illness -- What Is the Practical Importance of Having an Understanding of Help Seeking? -- Help Seeking and its Modification: Concluding Examples -- 5. Primary Opportunistic and Anticipatory Health Care -- Three Sources of Innovation -- The Antecedents of Health Behaviours -- Levels of Opportunistic Anticipatory Care -- Skills and Practices in Opportunistic Anticipatory Care -- Priorities for Anticipatory Care -- Presymptomatic Diagnosis -- Conclusions -- 6. The Refuge: Ethics, Practices and Problems -- Five Themes and an Ethical Dilemma -- The Burning Question -- The International Discipline of Primary Health Care -- Appendix I Declaration of Alma-Ata -- Appendix II Hand-out for Clinical Tutors in Primary Health Care
