[Practice guidelines and accreditation: highlights from 50 years of quality management by the Dutch College of General Practitioners]. / Standaarden en praktijkaccreditering: hoogtepunten van 50 jaar kwaliteitsbeleid van het Nederlands Huisartsen Genootschap.

The Dutch College of General Practitioners (NHG) was established 50 years ago in response to the threatened position of general practitioners in The Netherlands. The NHG promotes quality care in general practice by aiding in the translation of scientific evidence into daily practice. The NHG practice guidelines form the core of its quality improvement programme, which comprises a cohesive package of continuing educational materials that support adoption in daily practice. The NHG practice accreditation programme is a new method for measuring and improving practice quality. This programme provides the basis for granting stamps of quality to general practices.

The implementation of guidelines in The Netherlands.

A comprehensive system for quality improvement in General Practice has been developed in the Netherlands during the last decade. The basic principles of the quality system are discussed. Practice Guidelines are developed by GP's for GP's in a four step procedure. A range of methods and products based on the guidelines is produced to enhance the implementation of practice guidelines.

[The role of the consulting physician in situations of active euthanasia]. / De rol van de consulent bij actieve levensbeëindiging in de thuissituatie.

The cases are reported of two patients, a man aged 69 with a metastasized bronchial carcinoma and a woman aged 65 with a frontotemporal glioblastoma no longer responding to irradiation. Both requested active euthanasia. In both cases, euthanasia was performed by injection, after a general practitioner from the same locum group had acted as consultant. The requirements of meticulousness in handling a request for active euthanasia are concerned with the request (which has to be voluntary, thoroughly considered and constant), the suffering (which has to be protracted, unbearable and incurable), consultation and the written report. The consulting or second physician in cases of active euthanasia confirms that the requirements of meticulousness have been met. In addition, the second physician may assist the general practitioner in the detection of factors that may impair correct decision-making by the doctor or the patient. The second physician will be aided in performing these tasks if he is a member of the same locum group as the treating physician. However, if he considers himself too involved, a physician outside the locum group should be available at all times.