Fax/modem board communications decrease preceptor communication costs.

BACKGROUND: Mail and the telephone are common communication links between departments of family medicine and their community-based preceptors. The availability of low-cost fax/modem boards offers the potential for new communication methods. This study compares the cost of personal computer-based fax/modem board communications with traditional mail and telephone linkages. METHODS: The department's community preceptor faculty served as the study population. Sixty-eight physicians (54%) had fax machines; these physicians received faxes instead of mailed communications. The remaining 59 physicians (46%) received mailed communications. All preceptors received standard telephone calls. Costs for telephone, mail, and fax/modem board communications were tracked over a 4-month period. RESULTS: Faxes were significantly less expensive and more efficient than either telephone or mail communications. Telephone communications were the most expensive. CONCLUSIONS: The study suggests that fax/modem boards offer a communication linkage with preceptors that is more economical than either mail or telephone.

Patient preferences for physician gender in the male genital/rectal exam.

This paper presents the results of a descriptive survey assessing male patients' past experience, current preferences, and concerns regarding the gender of the physician performing the male genital/rectal exam. The sample consists of 72 male patients seen at a university-based family practice clinic located in a small rural community in Michigan. Patient age and physician gender preference were the main independent variables of interest. This study found that 51.5% of all male patients in the sample indicated a preference for a male physician to perform the genital exam while 48.5% indicated no preference for physician gender. In contrast, for the rectal exam, 61.5% of all male patients indicated no preference for physician gender while 38.5% did express a preference for a male physician. No one expressed a preference for a female physician for either the genital or rectal exams. Further analysis revealed that male patients over the age of 40 who prefer a male physician do so, at least in part, because it would be embarrassing to have a female physician perform the exam. Few, however, would refuse to allow a female physician to perform the exam. Respondents preferred certain positions for the exam and these are a means of minimizing potential embarrassment in the older patient.

The diaphragm.

Use of a diaphragm plus spermicide provides effective protection against pregnancy in motivated women and decreases the risk for some sexually transmitted diseases. Potential risks of this contraceptive method include the development of urinary tract infections and the possible teratogenic effects of nonoxynol-9, the active agent in most spermicides. Contraindications include a large cystocele or rectocele, uterine prolapse and recurrent urinary tract infections.

The influence of work on the outcome of low-risk pregnancies.

In this study, the relation of white-collar work on the outcomes of low-risk pregnancies was investigated. The medical records of 300 primiparous women whose pregnancy outcomes were known were selected sequentially from prenatal care log books over a 6-month period in three private, group obstetric practices in a university community. The majority of these women worked outside the home and included 220 white-collar workers (73 percent) and 28 blue-collar workers (9 percent). Thirty-four women (11 percent) were homemakers. Within this sample, 197 women (66 percent) met the selection criteria for low-risk pregnancies based on known sociodemographic, medical, and health risk factors. Although the sample numbers were small, comparison of low-risk white-collar workers (n = 141) with low-risk homemakers (n = 24) showed significant differences for rates of Cesarean section for failure to progress (16 percent versus 0 percent, P less than 0.05) and a summary index of poor delivery and/or infant outcome (21 percent versus 4 percent, P less than 0.05). No other adverse outcomes were significantly associated with occupation. This study suggests that increased pregnancy risks may be associated with white-collar work in otherwise low-risk women.

A Decline in Generalism for Family Medicine? First-Practice Profile Ideals cf. Realities.

The authors compare the ideal composition of medical practice, as seen by graduating family medicine residents, with the characteristics of practice these residents were about to enter. This exploration of practice ideals finds somewhat anemic interest in several of the more technical aspects of practice. A substantially higher percentage of graduates was expecting to do obstetrics on graduation then would do so by choice, suggesting the possibility of a further decline in obstetrical activity should opportunity occur. A similar pattern emerges for family counselling, nursing-home activity and house calls, producing a composite picture of potential evolution toward more exclusive office practice. Substantial variations are shown to exist, however, among the five programs studied, both in relation to the ideals expressed by the graduates and also in relation to their first-practice profiles. Possible implications for residency programs and the profession are discussed.