Doctor-patient interaction in Finnish primary health care as perceived by first year medical students

BACKGROUND: In Finland, public health care is the responsibility of primary health care centres, which render a wide range of community level preventive, curative and rehabilitative medical care. Since 1990's, medical studies have involved early familiarization of medical students with general practice from the beginning of the studies, as this pre-clinical familiarisation helps medical students understand patients as human beings, recognise the importance of the doctor-patient relationship and identify practicing general practitioners (GPs) as role models for their professional development. Focused on doctor-patient relationship, we analysed the reports of 2002 first year medical students in the University of Kuopio. The students observed GPs' work during their 2-day visit to primary health care centres. METHODS: We analysed systematically the texts of 127 written reports of 2002, which represents 95.5% of the 133 first year pre-clinical medical students reports. The reports of 2003 (N = 118) and 2004 (N = 130) were used as reference material. RESULTS: Majority of the students reported GPs as positive role models. Some students reported GPs' poor attitudes, which they, however, regarded as a learning opportunity. Students generally observed a great variety of responsibilities in general practice, and expressed admiration for the skills and abilities required. They appreciated the GPs' interest in patients concerns. GPs' communication styles were found to vary considerably. Students reported some factors disturbing the consultation session, such as the GP staring at the computer screen and other team members entering the room. Working with marginalized groups, the chronically and terminally ill, and dying patients was seen as an area for development in the busy Finnish primary health care centres. CONCLUSION: During the analysis, we discovered that medical students' perceptions in this study are in line with the previous findings about the importance of role model (good or bad) in making good doctors. Therefore, medical students' pre-clinical primary health care centre visits may influence their attitudes towards primary health care work and the doctor-patient relationship. We welcome more European studies on the role of early pre-clinical general practice exposure on medical students' primary care specialty choice

Vaihtoehtoinen terveydenhuolto hyvinvointivaltion terveysmarkkinoilla

Alternative medicine has become visible, when the welfare state has reached its maturity and is getting into a crisis. It can be seen to reflect this process. This study includes seven original studies published earlier as separate articles and a summary as well as two appendices on the beliefsystems and the legal status of alternative medicine. The aim of the study was 1) to discover how alternative medicine is used and socially determined 2) to describe its cultural structure and 3) to analyse its role and functions in the welfare state especially in Finland 4) to explain alternative medicine as a representation of the health discourse in the welfare state. The methods used were two surveys with structured questionnaires, two interviews and a qualitative content analysis. The study shows that people use alternative medicine commonly and the use pattern is rather complementary than alternative. People are able to combine different official and unofficial treatments. The most frequently used treatments were herbal drugs, massage and different paramedical physical treatments. Usage of alternative medicine was determined by female sex and multidimensional ill health. Also, the study suggests that there are two different types of health cultures: modern alternative in urban areas and folk medicine in rural areas. Alternative medicine mainly operates in symbolic area, it gives explanations and meanings as well as coping methods in ill health. It includes parts of biomedical model, however, it also counteracts towards scientific medicine. In spite of great variation there are shared ideas: holism (mind body) naturalism, vitalism and purity. Alternative medicine is able to operate in natural and supernatural world. It is attempting to hold its privacy and to escape the role of social control agent in the private territory. It is satisfying the demands on the post-modern health markets. The crucial question in the future is whether alternative medicine is able to create freedom and strengthen autonomy of individuals or whether it exploits individuals by using symbolic manipulation

Unintended pregnancy and termination of studies among students in Anambra state, Nigeria: Are secondary schools playing their part?

This study evaluated efforts of secondary schools to prevent unintended pregnancy among students and their reactions to pregnant students before and after delivery. A cross-sectional survey of 46 teachers in three public and two private schools in Anambra state, Nigeria was carried out. Information was collected using self-administered questionnaire. Of all the teachers in the study, 87% reported unintended pregnancies among students in the previous 3 years. Expulsion (43%) and suspension (28%) were the most common reactions. Private schools were more likely to expel pregnant students than public schools. Following the delivery of their babies, 43% discontinued their education in the same school, whereas 37% continued their education in a different school. Counselling was given before suspension or expulsion in 4% of public schools and 15% of private schools. Majority of the schools (61%) did not have sex education as part of their schools' curriculum. Students should be re-admitted in order to ensure continuity of their academic development, prevent unemployment and mitigate poverty-induced repeat pregnancy.Cette étude a évalué les efforts des écoles secondaires pour prévenir les grossesses non voulues chez les étudiantes et leurs réactions envers les étudiantes enceintes avant et après l'accouchement. Nous avons mené une enquête transversale auprès de 46 enseignants dans trois écoles publiques et deux écoles privées dans l'état d'Anambra au Nigéria. Les données ont été collectées à travers un questionnaire auto-administré. De tous les enseignants concernés dans l'étude, 87% ont signalé les grossesses non voulues chez les étudiants au cour de trois ans précédents. Les réactions les plus communes ont été l'expulsion (43%) et le renvoi (28%). Les écoles privées avaient plus la possibilité d'expulser les étudiantes enceintes que les écoles publiques. Suite à l'accouchement de leurs bébés, 43% ont cessé de fréquenter la même école alors que 37% ont continué leurs études dans une autre école. Avant la suspension ou le renvoi, 4% des étudiantes enceintes dans les écoles publique ont reçu des conseils d'orientation et 15% dans les écoles privées. Dans la majorité des écoles (61%), l'éducation sexuelle ne figure sur programmes d'études. Il faut réadmettre les étudiantes pour assurer la continuité de leur progrès académique, prévenir le chômage et réduire la grossesse répétée causée par la pauvreté

Tutkimus yhteiskuntapolitiikan viitoittajana : professori Leo Paukkuselle omistettu juhlakirja

The first Chair of Social policy to be established in Finland was at the University of Jyväskylä in 1966. Social policy may be compared to the "Sozialpolitik" of German tradition. It stresses, however, the fields of overall direction and planning of society. The chair has been held from its inception by Professor Leo Paukkunen, on the occasion of whose 60th birthday his friends and colleagues have given out this album. Each writer, in his article, deals with his own field of interest, amongst other things, the methodology of social sciences, research into welfare and ways of living, policies of labour, education and culture, and into communal policy, health care and social welfare