BMJ Press Releases, Saturday 19 October 1996
Volume 313 No 7063

EMBARGOED 00.01 HRS 18 OCTOBER 1996

PARENTS AND PATIENTS - WHAT MAKES THEM CALL THE DOCTOR

[What worries parents when their preschool children are acutely ill, and why: a qualitative study] [Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study]

[Editorial: Listen to the Parents]

[Patients' accounts of calling the doctor out of hours: qualitative study in general practice]
As family doctors all over the country focus on managing the rising demand for out of hours care, new research in this week's BMJ throws light on why patients - and in particular parents of young children - consult their GPs and why mutual dissatisfaction can arise.

Dr Joe Kai, a Newcastle GP and University lecturer in primary health care , writes about what worries parents when their preschool children are acutely ill. His findings, based on interviews with 95 parents in a disadvantaged inner city community, show that they feel disempowered by their experiences of inadequate information sharing and variation in the behaviours of doctors.

"Parents feel they are in a no win situation," says Dr Kai. "They are torn between wanting to act as competent parents and not bothering the doctor for trivial illnesses. Conflict between parent and doctor could arise because of contradictory expectations of patients' behaviour. Doctors believe that patients should use their judgement about when to seek medical advice but later expect patients to abandon any claims to expertise in the consultation and defer to the doctor's judgement" Greater recognition of parents' difficulties might help to reduce potential disharmony, says Dr Kai.

Fever, cough and the possibility of meningitis were the main concerns of parents when preschool children became acutely ill, reports Dr Kai.. While parents were ever vigilant for a rash which might signify meningitis "few parents had accurate knowledge of the rash". Parents' concerns about fever and cough reflected erroneous beliefs, says Dr Kai. Their worries about failing to recognise a serious problem serve as a reminder that what constitutes common knowledge for doctors may not be readily accessible to parents. Better understanding of parents' concerns and what causes them may promote more effective communication between health professionals and parents, says the report. Contact: 

Dr Joe Kai
Dept of Primary Health Care
Newcastle University Medial School
Newcastle upon Tyne NE2 4HH
e-mail: joe.kai@newcastle.ac.uk

CALLING THE DOCTOR AT NIGHT

Medical symptoms, while important, are only part of the reasons prompting patients - or parents of young children - to call on a doctor at night, according to a study by psychologist Jane Hopton and colleagues in this week's BMJ .

Social deprivation, high expectations in affluent areas, and a high proportion of young children are associated with higher rates of out of hours calls. Jane Hopton points out that the patients' viewpoint has been neglected. She writes:"From the patients' point of view a wide range of contextual factors as well as the particular medical problem or symptoms, influence the use of out of hours services." Previous experiences of health professionals and services, such as past frights when illnesses turned out to be more serious than expected, were important in users' explanations of current use of the health service. The paper advises that educational campaigns that focus on symptoms and neglect the context of the out of hours call may be too simplistic.

In a BMJ editorial, Dr Helen Roberts of Barnado's Policy and Development Unit, points out that parents are the principal health carers of their children and doctors would do well to listen to them.

LEAD IN TAP WATER AND BOTTLE FED BABIES

[Is lead in tap water still a public health problem? An observational study in Glasgow] A study from Glasgow in this week's BMJ reports that although levels of tap water lead and maternal blood lead concentrations have fallen substantially in the past decade, 13 per cent of babies are exposed via bottle feeds to tap water lead levels above the World Health Organisation guidelines.

Mothers and babies in the study came from the Loch Katrine water supply area where about half the households have lead pipework, and where maximum water treatment measures have been used to reduce lead solvency. Professor Graham Watt and colleagues found that maternal blood lead concentrations were generally within the safe limits for adults, however: "tap water lead is still a public health problem in relation to the lead exposure of bottle fed infants."

As a precautionary measure, says the paper, tap water could be assessed for lead levels in the homes of pregnant women. Where concentrations were raised, women could be advised to use lead free bottled water during pregnancy or until lead pipework could be replaced. "Mothers in these homes should be strongly advised in favour of breast feeding". Lead concentrations in breast milk are usually about one tenth of the concentrations in blood.

Contact:

Jane Hopton
Research Psychologist
Dept of General Practice
Edinburgh University
EH8 9DX

Contact: 

Dr Helen Roberts
Policy & Development Unit
Barnados
Barkingside 
Essex IG6 1QG

Contact: 

Prof Graham Watt
Dept General Practice
University of Glasgow
G20 7LR

STEROIDS IN THE GYM

[Use of anabolic steroids has been reported by 9 per cent of men attending gymnasiums] Over nine per cent of men using gymnasiums have taken anabolic steroids, according to a study in the letters section of this week's BMJ. More than 1300 men, and 349 women in 21 British gymnasiums were asked about drug use. Only eight of the women (2.3 per cent) but 119 of the men (9.1 per cent) had taken anabolic steroids. The youngest user was 16 years old. Three of the 21 gyms reported zero use, but prevalence of use elsewhere was as high as 46 per cent (28 of 61 respondents). During in depth interviews with 110 anabolic steroid users, 54 men reported having experienced testicular atrophy and eight women reported menstrual irregularities. Taking more than one drug was common.

Contact: 

Pirkko Korkia
Snr lecturer in sport and exercise science
University of Luton 
LU1 3JU
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