Informal complaints procedure in general practice: first year's experience.

OBJECTIVE: To evaluate the first year's experience of an informal patient complaints system that encourages extensive patient participation. DESIGN: Audit of an informal complaints procedure. SETTING: The Marylebone Health Centre, London. SUBJECTS: 39 complaints received over the audit period. MAIN OUTCOME MEASURES: Types of complaints (administrative, about doctors or medical care or both, staff about patients, mixed, other) and resolution of complaints (how complaints were dealt with and their resolution). RESULTS: 37 of the 39 complaints were resolved within two weeks. Two complaints sent direct to the family health services authority were resolved (with patients' agreement) by the informal complaints procedure. CONCLUSIONS: The informal complaints procedure was more cost effective than the family health services authority system and was comparatively straightforward to implement within the practice without major organisational restructuring. The two way process of the procedure ensured patients received a quick response to complaints and helped morale of health centre staff.

Alternative medicine: methinks the doctor protests too much and incidentally befuddles the debate.

Dr Kottow in his paper Classical medicine v alternative medical practices (1) places the alternative/orthodox medicine debate within an historical context of anti-quackery literature. My paper explores the nature of science as it is applied to clinical practice and challenges the narrow view of the diagnostic process as outlined by Dr Kottow. Research methodologies more appropriate to 'whole person' medicine are suggested as having more ethical value than those based on the clinical trial.

Relaxation and imagery in the treatment of breast cancer.

OBJECTIVE: To see whether stress could be alleviated in patients being treated for early breast cancer. DESIGN: Controlled randomised trial lasting six weeks. SETTING: Outpatient radiotherapy department in a teaching hospital. PATIENTS: One hundred fifty four women with breast cancer stage I or II after first session of six week course of radiotherapy, of whom 15 dropped out before end of study. INTERVENTION: Patients saw one of two researchers once a week for six weeks. Controls were encouraged to talk about themselves; relaxation group was taught concentration on individual muscle groups; relaxation and imagery group was also taught to imagine peaceful scene of own choice to enhance relaxation. Relaxation and relaxation plus imagery groups were given tape recording repeating instructions and told to practise at least 15 minutes a day. END POINT: Improvement of mood and of depression and anxiety on self rating scales. MEASUREMENTS AND MAIN RESULTS: Initial scores for profile of mood states and Leeds general scales for depression and anxiety were the same in all groups. At six weeks total mood disturbance score was significantly less in the intervention groups, women in the combined intervention group being more relaxed than those receiving relaxation training only; mood in the control group was worse. Women aged 55 and over benefited most. There was no difference in Leeds scores among the groups. CONCLUSIONS: Patients with early breast cancer benefit from relaxation training.

Community office experience for family medicine residents.

Departments of family medicine have certain responsibilities for administering and supporting an office-based program for family medicine residents. A firm belief in the importance of the program and the provision of adequate financial remuneration for preceptors are necessary for the program to succeed. The problems and issues related to setting up such a program are described in this article. The role of the family preceptor is an active one. He will probably need to make alterations to his practice to accommodate the resident. Evaluations of a recent program by both residents and preceptors are discussed. They indicate that ongoing teaching seminars as described in this paper help in preparing and monitoring such programs.