November Focus

摘要

It is 30 years since the Alma Ata declaration of ‘Health Care for All by the Year 2000’. At the time its commitment to universal health care, and the clear statement that it could only be achieved through the establishment of comprehensive primary healthcare felt like a wind of change. It would be easy now to view such thoughts as naïve optimism, but the article on page 806 is by four authors, all of whom have been involved in bringing about fundamental changes to primary healthcare systems in their respective countries. In their analysis of the challenges facing ‘Primary health care in a changing world’, they examine how many of the principles we take for granted are threatened by social and medical shifts. Trisha Greenhalgh's Pickles lecture on page 798 picks up on the same theme, and identifies trends that we have to take into account: globalisation, modernisation, individualisation, and consumerism. Her lecture ends with a plea that we must try to retain the best aspects of general practice that Will Pickles' life represented — she describes them as core characteristics of old-fashioned general practice — that will be as important dealing with the problems of present and future societies as they were in his day. An affectionate portrait of such a doctor is on page 813. While few of us would feel able to make such commitments to our patients today, we might all hope that we were striving to forge those kind of relationships with our patients. The brief report on page 780 sheds a little more light on what's involved. Surprisingly trust was not independently predicted by seeing the same doctor, but by good interpersonal care, good care from the GP in the past, and any expectation or experience of further follow-up. In other words, all the things that a doctor might do, and a doctor seeing a patient more regularly might be trying to do. Even so, it's a reminder that simply seeing the same doctor might not do the trick, but it's what the doctor does that matters. There is a wonderful vote of confidence about what surgeons in training can learn from a spell in primary care (page 805).