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BMJ No 7108 Volume 315 Press Releases Saturday 6 September 1997 Embargoed: 00.01 Hrs 5 September 1997 UK time
GPs better than psychiatrists in dealing with drug abuse
A cluster of articles and letters in this week's BMJ looks at the issues surrounding the treatment of drug misusers in the health service.
GPs are better placed to look after drug addicts than are psychiatrists, says a paper in this week's BMJ. The author, a clinical director from Glasgow, says that GPs have the knowledge, the skills, and the appropriate attitudes to manage drug misusers, particularly since "most people with drug problems are not mad". Psychiatrists who limit themselves to treating patients with a dependence syndrome will fail to deal with the physical consequences of drug misuse, says the author. "Doctors also need to listen to hearts and feel for spleens, and sensibly interpret the findings." Many GPs now play a pivotal part in the management of drug misusers; for example, almost a quarter of practices in Glasgow now run drug misuse clinics, and the number of patients using methadone has risen tenfold over the past five years. "Perhaps it is more important that doctors looking after drug misusers have the correct attributes for the task rather than a particular job title," concludes the author.
Contact:
Glasgow Drug Problem Service Dr Scott is on holiday until 15 September and is therefore unavailable for comment.
Primary care services are often the first point of call for drugs misusers and many general practitioners have risen to the challenge of treating this group of patients. However, even where practices have been well developed, the complex problems presented by drug using patients, means that a wide range of skills are needed to treat them, says Dr Michael Farrell, in an editorial in this week's BMJ. Shared care practices, developed in alcohol treatment and applied to drug misuse services, involve the joint participation of specialists and generalists (such as psychiatrists and GPs, but also community pharmacists). Better communication and greater mutual awareness, says the author, are therefore at the heart of improved services for this group.
Contact:
National Addiction Centre
Tel: 0171 740 5701
or 0171 919 3829
Policy makers are not getting accurate information on the extent of drug misuse, says a paper in this week's BMJ. The authors studied the reporting of "episodes" (new clients or clients who attend after an absence of six months) to the North Thames regional drug misuse database and found under reporting of between 9% and over 30% depending on the type of agency involved. The database does not measure the prevalence of known problem drug takers, say the authors, which means that it is inadequate for planning services, and "provides a false picture of trends of visible drug use". The database should be changed in order to provide better information, conclude the authors. Contact:
Imperial College School of Medicine
Tel: 0181 846 6565
Separating frozen food such as beefburgers, crumpets and sausages, with a sharp knife is responsible for an increase in the number of hand injuries seen in accident departments, says a paper in this week's BMJ. The authors examined the case notes of patients at three hospitals together with the Department of Trade's home accident surveillance database, and found injuries ranging from damage to the skin of the hand through to tendon lacerations and nerve damage. Tendon injuries can cause people to miss up to three months work, and hands with nerve injuries never recover their previous level of function, say the authors, who call for frozen food packaging to warn against this type of injury and include instructions on how best to separate individual items of food.
Contact:
St. Andrew's Hospital
Tel: 01268 594177
Doctors wishing to go into research who embark on academic medicine training are losing out all round, says an editorial in this week's BMJ. A group of trainees engaged in research at the Institute of Child Health and Great Ormond Street Hospital, London, said that the lack of a national career structure had led many trainees around the country, to question their future in academic medicine. There is no uniformity in the training and research components of research fellow and lecturer posts in the UK, they have said. "The lecturer is often regarded as an extra ward registrar, with or without a research project; as someone to teach the medical students; organise exams and courses; and undertake any other additional clinical duties required." Lecturers nationwide, often have little time for research and no formal training or supervision, and many research fellows are in a similar position. The authors call for nationally agreed minimum standards for research fellows and lecturer posts to be established, and for the posts to be accredited and monitored. "If academic medicine in Britain is to continue to attract enough high calibre trainees, it needs to offer comparable training programmes with a clearly defined academic structure," they conclude. In the same issue, Raymond Hoffenberg discusses the future of medical education in South Africa, and D G Grahame-Smith reflects on how Socrates and Hippocrates might have felt about the present situation.
Contact:
Institute of Child Health and Great Ormond Street Hospital (Authors: Dr Bill Chaudhry and Dr Paul Winyard) Tel: 0171 405 9200 xtn 5974
Contact: Tel: 01451 844 545
Dr Grahame-Smith Rhodes
University Department of Clinical Pharmacology Not available via telephone
Embargoed: 00.01 Hrs 5 September UK time
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