ABSTRACT
In the first chapter I drew attention to the fact that general practitioners regard a great deal of their work as ‘trivial’, ‘unnecessary’, and ‘inappropriate’ – the usual estimates varying from half of their work upwards (Cartwright, 1967: 44). The same phenomenon, although less well-documented, exists in the hospital outpatient clinic where many consultants feel they are wasting their time having to deal with cases the general practitioner should never have referred. At the same time evidence is accumulating from a number of sources that many patients with severe medical difficulties do not consult the doctor at all (below pp. 163–4). In this chapter, therefore, I will review the available evidence concerning these issues and consider the factors involved in ‘becoming a patient’. A review of this evidence, although not answering the question as to when and under what conditions individuals consult a doctor, does, I think, have important implications for the practice of medicine.
