Exclusive, idiosyncratic and collective expertise in the interprofessional arena: the case of optometry and eye care in The Netherlands.

This paper addresses expertise as the foundation of professional boundaries and domains through a comparative study of four eye care occupations in the Netherlands. Claims of expertise are explored with an analysis of whether practitioners believe that expertise is exclusive to their profession. Results show that (a) established professions display a stronger sense of the 'exclusiveness' of expertise; (b) idiosyncratic expertise is more common among encroaching professions than among established ones. These findings substantiate trends towards professionalism, as jurisdictional disputes on professional domains and boundaries usually occur between more established medical professions seeking to protect their knowledge area, and encroaching ones trying to expand theirs. The study next addresses the ways in which claims to expertise influence practitioners' attitudes towards professional status and professional practice. Attitudes to expertise are influenced by age, and affect professional work in the workplace. Practitioners who considered expertise as a collective characteristic were younger, undertook more examinations, more diagnoses, gave more treatments, referred less, and perceived more problems regarding inter-professional recognition of their professional status.

Undiagnosed patients and patients at risk for COPD in primary health care: early detection with the support of non-physicians.

Given the increasingly heavy workload in the primary health care sector, the option of allocating activities involving the management of chronic diseases to non-physicians has recently come under scrutiny. The purpose of this study was to assess the feasibility of the support provided by non-physicians to general practitioners (GPs) in the early detection of chronic obstructive pulmonary disease (COPD). A convenience sample consisting of 231 patients [40-70 years; >10 pack years (number of packs of cigarettes smoked per day multiplied by the number of years the individual has smoked)] from eight general practices in the Maastricht region in the southern Netherlands, who consulted their GP for reasons unrelated to respiratory diseases, were assessed for their respiratory function. Prior to the first assessment, patients were interviewed about their medical history and symptoms. By taking the results of the lung function measurement as the starting point, the predictive value of medical history and symptoms in the identification of patients at risk for airflow obstruction or of COPD was assessed and compared with findings in the literature. Seventeen patients (7.4%) were diagnosed with COPD, 11 patients (4.8%) with asthma. In addition to age and moderate smoking history, breathlessness and a history of heavy smoking were identified as risk factors for airflow limitation and COPD. Early detection of COPD in primary health care by non-physicians is feasible and should be considered for middle aged, moderate and heavy smokers experiencing breathlessness.