The global impact of the Chernobyl reactor accident.

Radioactive material was deposited throughout the Northern Hemisphere as a result of the accident at the Chernobyl Nuclear Power Station on 26 April 1986. On the basis of a large amount of environmental data and new integrated dose assessment and risk models, the collective dose commitment to the approximately 3 billion inhabitants is calculated to be 930,000 person-gray, with 97% in the western Soviet Union and Europe. The best estimates for the lifetime expectation of fatal radiogenic cancer would increase the risk from 0 to 0.02% in Europe and 0 to 0.003% in the Northern Hemisphere. By means of an integration of the environmental data, it is estimated that approximately 100 petabecquerels of cesium-137 (1 PBq = 10(15) Bq) were released during and subsequent to the accident.

Primary care gatekeepers in HMOs.

The most pressing issue in health care delivery today is inflationary cost increases. The gatekeeping role of primary care physicians, particularly family physicians, may lower health care costs through a more judicious use of specialty referrals, expensive tests, and hospitalization. The study of such an impact is most readily carried out in the practice setting of health maintenance organizations (HMOs), where there is a defined patient population. Incomplete data and lack of sensitive indicators of the gatekeeping effect are limitations of this preliminary study. The results show, however, that the internal organization of an HMO does not influence hospital and ambulatory care utilization rates, with the exception that HMOs staffed by a group of salaried physicians (staff HMOs) reported higher ambulatory care utilization. No significant differences were demonstrated in hospital or ambulatory care utilization rates among the HMOs using more primary care physicians or family physicians than others. The results indicate that ambulatory care utilization rates are proportional to the number of physicians per 1,000 members. The results also suggest that there may be an inverse relationship between hospital utilization rates and the number of primary care physicians, especially if they are family physicians. Further studies need more specific indicators to evaluate the effect of the gatekeeping role in health care delivery.

Methodological, technical, and ethical issues of a computerized data system.

This report examines some methodological, technical, and ethical issues which need to be addressed in designing and implementing a valid and reliable computerized clinical data base. The report focuses on the data collection system used by four residency based family health centers, affiliated with the University of Massachusetts Medical Center. It is suggested that data reliability and validity can be maximized by: (1) standardizing encounter forms at affiliated health centers to eliminate recording biases and ensure data comparability; (2) using forms with a diagnosis checklist to reduce coding errors and increase the number of diagnoses recorded per encounter; (3) developing uniform diagnostic criteria; (4) identifying sources of error, including discrepancies of clinical data as recorded in medical records, encounter forms, and the computer; and (5) improving provider cooperation in recording data by distributing data summaries which reinforce the data's applicability to service provision. Potential applications of the data for research purposes are restricted by personnel and computer costs, confidentiality considerations, programming related issues, and, most importantly, health center priorities, largely focused on patient care, not research.

Teaching styles in the faculty-resident relationship.

As part of an effort to train family physicians to be more effective teachers in family medicine, a teaching styles workshop program was developed. The aim of the program is to help physician teachers to become more flexible in matching a teaching style to a particular teaching context. The program consists of three components: (1) a scheme for classifying teaching behaviors as belonging to one of the four basic styles identified, (2) videotaped models of each of the four basic styles, and (3) structured role playing by workshop participants in which the four styles are practiced and critiqued. The program, as used in two different sets of faculty development workshops, is described and recommendations for its use by others given.

Case oriented group discussions for family physicians.

Curriculum in family medicine and primary care includes various areas of concern for educators in the behavioral sciences. Most of this concerns the physician-patient relationship as the focus for teaching and learning. This paper outlines the work of a longitudinal, case oriented group of family physicians as it reflects the correlation between the actualities of practice and the curriculum in behavioral science for family practice residents. Also discussed is the issue of potential "typologies" as elaborated in the family physicians' reasons for case presentations. Such groups assist faculty and practitioners in their own awareness of educational and patient care issues in the physician-patient relationship as well as serve as a foundation for building a relevant behavioral science curriculum for residents and students.

LSU Medical Center initiates family medicine clerkship program for third year medical students.

This article takes note of the family physician shortage in Louisiana and the continuing need to inform medical students of the career choice in family medicine. Drs English, Gatipon, and Catlin describe the planning stages, the training of clinical teachers, and the implementation of a third (junior) year required clerkship in family medicine at LSU School of Medicine in New Orleans. The students who participated in the pilot year of the program have been enthusiastic about the value of the experience in their total medical education.