PERSPECTIVES ON PREVENTION - THE VIEWS OF GENERAL-PRACTITIONERS

Over the years there has been increasing support from a number of diff erent sources for General Practitioners and their primary health care teams to have greater involvement in prevention. However, while attent ion has been paid to what leading figures and official bodies such as the Royal College of General Practitioners say there has been less emp hasis upon what the rank-and-file of GPs themselves think and feel abo ut prevention. Hence, this paper reports on the results of a small-sca le 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 preve ntion; second, the extent to which they view prevention as problematic and the reasons given; finally, in the light of these issues, the man ner in which they attempt to resolve these dilemmas. Whilst GPs appear ed 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 he alth promotion and prevention was tedious, dull and boring; ii) the co nstraints of time and the manner in which it detracted from curative m edicine; iii) the uncertainties of risk factor identification and inte rventions; iv) ambivalence towards the effectiveness of behavioural ch ange and the problem of patient motivation, and finally; v) a concern that it represented a moral intrusion and inflated patients anxiety le vels unnecessarily. Beyond the voicing of these concerns, the main way in which GPs attempted to resolve these dilemmas was by delegating mu ch of this work to a new and relatively low-status member of the prima ry health care team: the practice nurse.