[Antibiotic use in general practice in Belgium and France: between collective factors and individual responsibility]. / Prescription d'antibiotiques en médecine générale en Belgique et en France: entre déterminants collectifs et responsabilité individuelle.

The mechanisms that might explain the antibiotic use in ambulatory practices go widely beyond microbiology and epidemiology. Sociocultural factors (help-seeking behaviour) and structural factors (liberal fee-for system), similar in France and Belgium, explain how an inappropriate health demand and an inappropriate supply are supporting each other, to keep the two countries high in European ranking. Beyond these collective factors of antibiotic use, the general practitioners' individual responsibility is also discussed.

[General medicine in the 21st century]. / La Médecine générale du XXIe Siècle.

General medicine is the main pivot of our healthcare system. General practitioners' tasks are numerous: front line responsibility, networking coordination, long-term patient care, community medicine and also primary care research. In the framework of general medicine that has been undergoing profound change for many years, we have chosen to develop three of these facets: general practitioners' knowledge of family, psychological, social or environmental factors and their capacity to coordinate with other health workers will help them in their primary and secondary prevention and also quaternary work by sparing patients unnecessary treatment and examinations. General medicine will increasingly become a discipline, one of which specific expertise will be to manage bio-psycho-societal complexity. Multidisciplinary action will be the rule: general practitioners will no longer be able to claim they can deal with all the curative, preventive and health education tasks. And the research in general medicine is essential because general practitioners can deal with over 80% of the health problems identified by patients and because the symptoms leading to the treatment cannot only be studied by laboratory or hospital research.

[Medical certificates: law, deontology and practice]. / Des certificats médicaux: loi, déontologie et pratique.

At the start of the 21st century, in a society that gives the impression of switching century every five years because of its never-ending evolution, the general practitioner is confronted every day to more complex situations, including problems encountered at the legal level. These last few years, the legal interrogations relevant to medicine and its progress became considerably more extensive in Belgium, as in many other countries. The medical law and its regulation are the subject of many front titles in the press and of animated political debates. The main issues concern the organ transplantation, the meddling with human genetics, the questions related to the reproduction, euthanasia or the protection of the patient's rights. All these legal problems, without exception, are the subject of a great deal of attention in society and create to many controversies. The growing number of regulations in many fields of medicine, as well as their growing complexity, reinforces the importance of the medical law as a distinct discipline of legal sciences. More and more, the doctors of any qualification are required to guarantee, by adequate certificates, the health, the aptitude, the situation of disease of their patients. The patients can then have certain advantages granted by society. Out of concern for their patients, the experts are sometimes tempted not to be perfectly objective. This attitude can lead to penal or disciplinary sanctions and may undermine the confidence of people who exercise authority to give the requested advantages. The initial mistrust, which led to the system of the certificate, extends to those who were supposed to fully collaborate. How to leave this infernal round that sterilizes, denatures the medical act? While waiting for men of goodwill to consider the system and reform it, it remains with the writers of certificates to avoid the traps lying in their path. The purpose of this work is to propose models of certificate that experts can fill in accordance of the circumstances. It is only a guide and consequently, it sometimes requires an interpretation. This is why each model is described together with its justification and its traps.

Substantial use of primary health care by prisoners: epidemiological description and possible explanations.

OBJECTIVES: To describe the use of primary care services by a prisoner population so as to understand the great number of demands and therefore to plan services oriented to the specific needs of these patients. DESIGN: Retrospective cohort study of a sample of prisoners' medical records. SETTING: All Belgian prisons (n = 33). PATIENTS: 513 patients over a total of 182 patient years, 3328 general practitioner (GP) contacts, 3655 reasons for encounter. MAIN RESULTS: Prisoners consulted the GP 17 times a year on average (95%CI 15 to 19.4). It is 3.8 times more than a demographically equivalent population in the community. The most common reasons for encounter were administrative procedures (22%) followed by psychological (13.1%), respiratory (12.9%), digestive (12.5%), musculoskeletal (12%), and skin problems (7.7%). Psychological reasons for consultations (n = 481) involved mainly (71%) feeling anxious, sleep disturbance, and prescription of psychoactive drugs. Many other visits concerned common problems that in other circumstances would not require any physician intervention. CONCLUSION: The most probable explanations for the substantial use of primary care in prison are the health status (many similarities noted between health problems at the admission and reasons for consultations during the prison term: mental health problems and health problems related to drug misuse), lack of access to informal health services (many contacts for common problems), prison rules (many consultations for administrative procedures), and mental health problems related to the difficulties of life in prison.