Dutch general practitioners receive similar excessive amounts of mail and are as overworked as their British colleagues—we like to think more so. But we are much more willing to answer questionnaires from our colleagues. Why should this be? Are we nicer, more obsessional, more anxious to express an option? Are we more supportive of research in general practice? Do we get paid for responding? The most important factors that determine the response rate to a questionnaire in any country are its subject, length, and quality, together with the "face" it presents. The Midlands study referred to by McAvoy and Kaner dealt with sensitive or perhaps even irritating subjects: general practitioners' attitudes to preventive medicine and to interventions about patients' alcohol use. Questionnaires about issues such as alcohol, ethics, yearly earnings, working hours, attitudes to genitourinary disease, or any subject that makes a general practitioner feel the need to make major changes in the way he or she works tread the same dangerous ground. A survey by our department of 494 Dutch general practitioners' attitudes to alcohol issues had the same low initial response rate, and three written reminders (compared with none in the Midlands study) improved the response rate to only 51%.
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