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PRIMARY CARE: David K Lewis, Jude Robinson, and Ewan Wilkinson Factors involved in deciding to start preventive treatment: qualitative study of clinicians' and lay people's attitudes BMJ 2003; 327: 841 [Abstract] [Full text]

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First of all, an efficacious physical examination , e.g., with the aid of Biophysical Semeiotics.

Sergio Stagnaro   (10 October 2003)

Striving not to prescribe

Felicity J Fay   (13 October 2003)

First of all, an efficacious physical examination , e.g., with the aid of Biophysical Semeiotics. 10 October 2003
Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8. 16037 Riva Trigoso (Genoa) Italy Send response to journal: Re: First of all, an efficacious physical examination , e.g., with the aid of Biophysical Semeiotics.	Sirs, The authors of this interesting article underline rightfully the importance of patient-doctor’s relationship, now-a-days clearly compromised around the world. The statement, I agree completely with seems particularly interesting: “Quality of life and personal views were more important than an individual's age….. true dialogue is necessary between clinicians and patients before starting long term preventive treatment”. In my opinion, however, in addition to the above useful remarks, we must consider the paramount role played by the physical examination, if performed by an efficacious clinical method, such as the Biophysical Semeiotics (See HONCode web site 233736, http://digilander.libero.it). In fact, once again, beside doctors, who speak of “large” number of patients (EBM), there is a small group of physicians, expecially general practitioners, who take care of “the single” diseased individual. As I wrote in a previous letter to BMJ.com (http://bmj.com/cgi/eletters/326/7398/1048#32299 “Single Patient Based Medicine” versus EBM. Sergio Stagnaro,16 May 2003) we must go beyond well-known risk factors in order to know perfectly the single patient’s constitutions to prevent morbidity and mortality due to, e.g., arteriosclerosis complications, including MI. Primary Prevention of the most common and dangerous human pathologies, including malignancies, depends clearly by easy and rapid bed-side detecting individuals, even apparently healthy, but at "real" risk, i.e. affected by well-defined biophysical-semeiotic constitution(s), assessed clinically in “quantitative” way. In order to define clinically a “particular” constitution, based always on mitochondrial dysfunction (2), which does not exclude at all the presence of other(s), of course, it is necessary to think over the current possibility of gathering at the bed-side biophysical-semeiotic data, rich with biological and molecular-biological information on the various human organs, tissues and biological systems, so that doctor can describe numerous types of biophysical-semeiotic constitutions, even from the “quantitative” point of view, before suggesting whatever treatment. Otherwise, we can proudly accumulate papers on papers, but patients are going to be affected - and probably die – in identical manner, as in the past. 1) Lewis D K, Robinson J, Wilkinson E.Factors involved in deciding to start preventive treatment: qualitative study of clinicians' and lay people's attitudes. BMJ 2003;327:841 (11 October) 2) 2) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. Una Patologia Mitocondriale Ignorata. Gazz Med. It. – Arch. Sci. Med. 144, 423 (Infotrieve) 1985 Competing interests:   None declared
Striving not to prescribe 13 October 2003
Felicity J Fay, GP Principle Seaton Hirst Primary Care Centre, Ashington, NE63 ONG Send response to journal: Re: Striving not to prescribe	The results of the qualitative study by Lewis et al confirm that in primary care, the majority of "lay people" would prefer lifestyle change, allowing them to improve their own health, to medication, which transforms them into "patients". The problem for many is difficulty making the necessary lifestyle changes, which is where the GP is in a prime position to help. I recently attended a course on "changing behaviour in healthcare", which focussed on the use of counselling techniques to facilitate behavioural change. The course was well attended by dieticians, nurse, health visitors and physiotherapists, but as the only GP there, I wondered if I would have been better off attending the local drug sponsored lecture on medical management of hypertension. In fact the course proved extremely beneficial and has certainly changed my practice. Rather than reviewing patients repeatedly to change medications that are ineffective or unacceptable, I started actively listening to patients, many of whom return after several visits having decided to make key lifestyle changes, likely to have a spectrum of long term health benefits (1,2,3). This seems highly satisfying for both patient/ lay person and GP, also solving the fundamental ethical dilemma of balancing autonomy with beneficence, non-maleficence and justice. Sadly, resisting prescription will merit no target- meeting bonus points under the new GP contract. 1. Blair et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1196: 276:205 2. Heinonan A, Kannus P et al. Randomised controlled trial of effect of high impact exercise on selected risk factors for osteoporotic factors, Lancet 348 (9038);1343-7, 1996 3. Rockhill B, Willett W et al. A prospective study of recreational physical activity and breast cancer risk. Arch Intern Med 159: 2290-2296, 1999 Competing interests:   None declared