General practice medical records: is coding appropriate?.

Codes in general practice have been used for some time to facilitate medical research and for the gathering of health statistics. Coding is used to standardize terminology and avoid ambiguity. In general practice, this coding has usually been done some time after the notes are recorded and often by a person not involved in the consultation. This has been necessary because most medical records are recorded on paper using natural language. Does coding have any place with the individual general practitioner (GP) if health statistics or medical research are not involved? General practice notes are extremely variable; they are a collection of free form text, diagrams, idiosyncratic, and standard abbreviations and are usually stored on paper and often include several summary pages. This type of record does not easily lend itself to coding. With the increasing use of computers, the electronic record will become more common and may eventually replace the paper record [1]. As this occurs, the possibility of universal coding will increase, and there may be some pressure for all GPs to record their notes in a standard format and/or use standard codes.

Emergency and after-hours work performed in country hospitals.

Country doctors perform emergency work in addition to their conventional general practice role. Over a one-month period 17 general practitioners in four Hunter Region towns recorded all emergency calls describing the time they were called, the severity of the patients' conditions, the skills used and the time taken. A scale to measure severity of illness was devised and tested for this purpose. There were 1197 emergency calls, mostly seen at the local hospital, either in the outpatients department or on the wards. They were unevenly distributed in time, with fewer calls at night, but the doctors were disturbed during nearly half of their nights on call. Of the calls 15% were for trivial reasons, 34% were for patients who needed standard general practice care, and 50% were for patients who needed the services of the hospital or were already inpatients. Most attendances were brief, but 15% took more than 30 minutes and some much longer. Counselling skills were used for 47% of patients and technical skills in 22%. The strain of the work involved and the disturbance of personal life justify extra payments to country doctors, and the adequacy of current pay schedules is questioned. However, the peculiarities of funding result in the State Health Department underwriting most emergency costs in country towns, whereas in the cities the Commonwealth Department of Health pays for a larger proportion, leading to concern about the high apparent costs of country hospitals. The information in this survey may help improve planning for training and remuneration of country doctors to help ease the current shortage.