It is difficult to convey in statis

It is difficult to convey in statistical terms a true picture of the content of family
practice. One approach is to record the diagnosis made at each patient–doctor
encounter. By this means, it is possible to obtain an accurate picture of the family
physician’s experience with well-defined diseases such as diabetes. Many illness
episodes seen by family physicians, however, are much more difficult to define
and label. The reader will obtain some idea of the difficulty by reading Case 8.1 in
Chapter 8. This patient’s problems cannot be expressed by simple disease labels.
There is no diagnosis in the usual sense of the term. Another approach is to record
the patient’s main symptom or complaint. Here again, however, the result may be
a very partial picture of the illness because a statement of the symptoms says little
or nothing about its origins. If we were classifying Case 8.1 by disease labels, we
could call the illness anxiety state or insomnia. If we were classifying the case
by symptoms, we could call it insomnia or gastrointestinal symptoms. Whichever
route we take, we provide only a partial picture, because we are doing something
equivalent to taking a two-dimensional slice through a three-dimensional
object. Another diffi culty is that we have no assurance that any two physicians
will classify the same illness in the same way. If one physician classifi es the illness
as anxiety state, it will appear in the statistics under the rubric of mental
illness. If another classifi es it as gastrointestinal symptoms (not yet diagnosed), it
will appear under the rubric gastrointestinal diseases. Given these difficulties of
nomenclature and standardization, it is small wonder that there are wide variations
in such estimates as the amount of psychiatric illness in family practice.
Despite this, however, there are some important areas of agreement regarding
the content of family practice in countries with high general standards of living.
The collection of reliable data has been enhanced by development of standardized
coding systems for primary care (e.g., ICHPPC-2, and ICPC-2-R) by the
training of recorders, and by the validation of data. Morbidity studies, some of
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