Systematic review: the perceptions, diagnosis and management of irritable bowel syndrome in primary care--a Rome Foundation working team report.

OBJECTIVE: To review studies on the perceptions, diagnosis and management of irritable bowel syndrome (IBS) in primary care. METHODS: Systematic searches of PubMed and Embase. RESULTS: Of 746 initial search hits, 29 studies were included. Relatively few primary care physicians were aware of (2-36%; nine studies) or used (0-21%; six studies) formal diagnostic criteria for IBS. Nevertheless, most could recognise the key IBS symptoms of abdominal pain, bloating and disturbed defaecation. A minority of primary care physicians [7-32%; one study (six European countries)] preferred to refer patients to a specialist before making an IBS diagnosis, and few patients [4-23%; three studies (two European, one US)] were referred to a gastroenterologist by their primary care physician. Most PCPs were unsure about IBS causes and treatment effectiveness, leading to varied therapeutic approaches and broad but frequent use of diagnostic tests. Diagnostic tests, including colon investigations, were more common in older patients (>45 years) than in younger patients [<45 years; five studies (four European, one US)]. CONCLUSIONS: There has been much emphasis about the desirability of an initial positive diagnosis of IBS. While it appears most primary care physicians do make a tentative IBS diagnosis from the start, they still tend to use additional testing to confirm it. Although an early, positive diagnosis has advantages in avoiding unnecessary investigations and costs, until formal diagnostic criteria are conclusively shown to sufficiently exclude organic disease, bowel investigations, such as colonoscopy, will continue to be important to primary care physicians.

Personal values related to primary care specialty aspirations.

BACKGROUND AND OBJECTIVES: Two recent studies showed that personal values influence specialty choice. However, both studies assessed the perceived influence of values instead of measuring values directly. The present study measured and compared the values of aspirants to primary care versus other specialties. METHODS: In 1993, first-year medical students, entering residents, and graduating residents at a private Midwestern medical school completed a questionnaire on their specialty aspirations and completed the Schwartz Values Survey, which measures the importance of 10 types of values: achievement, benevolence, conformity, hedonism, power, security, self-direction, stimulation, tradition, and universalism. A three-factor MANOVA (specialty aspiration, gender, level of training) was performed on the importance ratings. RESULTS: The three MANOVA main effects were significant. Primary care aspirants rated power and self-direction values lower and benevolence values higher than did aspirants to other specialties. Women gave higher ratings to universalism and benevolence and lower ratings to power, tradition, and conformity values than did men. Medical students rated security values lower than did the two resident groups. CONCLUSIONS: This study demonstrates the relationship of personal values and specialty choice and provides empirical support for admissions policies that incorporate personal values into the admissions process.