PERSPECTIVES ON PREVENTION - THE VIEWS OF GENERAL-PRACTITIONERS

Over the years there has been increasing support from a number of different sources for General Practitioners and their primary health care teams to have greater involvement in prevention. However, while attention has been paid to what leading figures and official bodies such as the Royal College of General Practitioners say there has been less emphasis upon what the rank-and-file of GPs themselves think and feel about prevention. Hence, this paper reports on the results of a small-scale exploratory study of 40 GPs' perceptions of coronary heart disease (CHD) prevention. In particular it addresses three main issues: first, the value which GPs place upon prevention and their concepts of prevention; second, the extent to which they view prevention as problematic and the reasons given; finally, in the light of these issues, the manner in which they attempt to resolve these dilemmas. Whilst GPs appeared to positively endorse the principle of prevention, they nonetheless tended to view it as problematic and had limited personal involvement. In this respect five key themes emerged in GPs' accounts: i) that health promotion and prevention was tedious, dull and boring; ii) the constraints of time and the manner in which it detracted from curative medicine; iii) the uncertainties of risk factor identification and interventions; iv) ambivalence towards the effectiveness of behavioural change and the problem of patient motivation, and finally; v) a concern that it represented a moral intrusion and inflated patients anxiety levels unnecessarily. Beyond the voicing of these concerns, the main way in which GPs attempted to resolve these dilemmas was by delegating much of this work to a new and relatively low-status member of the primary health care team: the practice nurse