[Need for social medicine competence of ambulatory care physicians in the treatment and management of diseases]. / Sozialmedizinischer Kompetenzbedarf der ambulant tätigen Arzte bei der Behandlung und Bewältigung von Erkrankungen.

There is a great demand for sociomedical competence of general practitioners who as "family doctors" must be consulted by the patient first before consulting a specialist (so-called "primärärztliche Versorgung" according to German compulsory statutory sickness insurance legislation). Special and continuing education of general practitioners is sadly neglected within the legislative framework governing medical studies and training. The biopsychic care concept can be translated into reality only by means of high-level sociomedical competence. Increase in competence seems possible only if medical sociology is liberated from its preclinical isolation.

A randomized, controlled study on the effect of diabetes counseling in the offices of 12 general practitioners.

The design of the study was "2-period changeover"; each period lasted 6 months and 6 counseling sessions were offered during each period. Group 1 (n = 81), counseled in the first period, was controlled by a noncounseled group 2 (n = 82). Randomization of patients into the 2 groups took place at each office. The primary variable for consideration was the postprandial (pp) blood sugar level (mg/dl). Weight reduction of overweight patients was also considered. A highly significant (p less than 0,01) difference of mean pp-blood sugar reduction between the groups was found during both periods. In view of the large estimated difference in the residual effects of both treatments (counseling, no counseling) a crossover analysis was excluded. The best pp-blood sugar effect was obtained for patients with high pp-blood sugar level (greater than or equal to 250) at the beginning of the counseling period.