'In recent decades most of the international effort given over to studying and improving the safety of patient care has been focused in acute hospital settings. To some extent this was always something of a puzzle to those of us with a direct interest in this important issue...Now, however, the tide is slowly turning. Policymakers, healthcare leaders and research grant funders are beginning to recognise that greater evidence is required to understand more about what can and does go wrong in primary care, with increasing attention now being paid to what can be done to minimise avoidable harm to patients in this setting.' From the Preface This remarkable new book represents a substantial body of work - led by key educators and researchers - devoted to learning about and improving the safety of primary healthcare. It offers highly practical guidance and evidence for a broad range of related improvement methods, concepts and interventions developed and implemented by the NES primary care team, or as a direct result of fruitful partnerships between academic, professional, public or regulatory institutions across the UK and internationally. Skillfully presented, the book is organised into five interlinked parts, each with a number of related chapters. Safety and Improvement in Primary Care: The Essential Guide is ideal for frontline clinicians, managers and healthcare administrators needing practical guidance on safety and is also highly recommended for improvement advisers, patient safety officers, clinical governance facilitators, risk managers, and health services researchers wanting a critical review of theory and evidence.

Featuring highly illustrated, evidence-based information along with high-quality videos, A Practical Guide to Joint & Soft Tissue Injection is the definitive guide to effective injection procedures that can be performed with simple equipment in a variety of settings. Expanded and updated for the fourth edition, this practical, award-winning guide thoroughly explains the rationale and step-by-step technique for each procedure, helping you offer patients immediate relief from pain and discomfort. Covers a full range of musculoskeletal disorders, chalazions, keloids, warts, and occipital neuralgia, as well as the use of corticosteroids, viscosupplementation, and dry needling. Contains new sections on Orthobiologics, Musculoskeletal Ultrasound, and Advanced and Adjunctive Techniques. Includes all-new content on facial/head nerve blocks, treatment of intersection syndrome, hamstring tendon/ischial bursa, gluteal pain syndrome, Baker's cyst, and midfoot joint injections. Features new coverage of auricular battlefield acupuncture, barbotage, tendon brisement, fenestration, nerve hydrodissection, capsular hydrodilatation/hydroplasty, and percutaneous tenotomy with debridement. Includes 25% more video content, with all videos shown from the operator's viewpoint. Features full-color illustrations and photographs that help you identify landmarks and determine exactly how to proceed. Discusses anatomy and landmarks, when to refer, indications and contraindications, special medical conditions, equipment, complications, coding and billing, and much more. Provides helpful appendices with consent forms, aftercare handouts, and information on documentation. Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.

The Sixth Edition of Anatomy & Pathology: The World's Best Anatomical Charts features 52 new and updated anatomical charts created by some of the world's best medical illustrators. This reference is an essential addition to every library, whether you are a health professional, student, or interested consumer.
These anatomical charts show the human body in a format that provides a clear and visual understanding of human anatomy, physiology, and diseases. Medical terminology and easy-to-understand supporting text are printed directly on each chart so you never have to refer to a separate key card or manual. The convenient size and format make it ideal for studying, patient consultation or quick reference.
Systems of the Body: 12
Structures of the Body:16
Diseases, Disorders and Conditions: 24
58 pages
52 full color charts
size 10" x 12"
Spiral bound, soft cover

This book has been written with general practitioners primarily in view, describing common paediatric conditions that present in the outpatient clinics and those that require admission to hospital. The book is neither a textbook of paediatrics nor a handbook but is aimed to provide guidelines for the more commonplace conditions. Some aspects therefore, have been dealt with in detail, where felt relevant, while others are omitted on grounds of probable rare encounter. It is hoped that this volume will provide the family practitioner with an insight in the paediatrician's approach to many of the common problems in chifdren and to help him decide on the best course of action to follow. The care of children constitutes a significant and important part of a family doctor's work and practitioners are keen to promote optional care in all circumstances. It is hoped that the endeavours of this book will go in some small way to help put across the practitioner's approach.

Selected as a Doody's Core Title for 2022! Encompassing all occupants of aircraft and spacecraft-passengers and crew, military and civilian-Fundamentals of Aerospace Medicine, 5th Edition, addresses all medical and public health issues involved in this unique medical specialty. Comprehensive coverage includes everything from human physiology under flight conditions to the impact of the aviation industry on public health, from an increasingly mobile global populace to numerous clinical specialty considerations, including a variety of common diseases and risks emanating from the aerospace environment. This text is an invaluable reference for all students and practitioners who engage in aeromedical clinical practice, engineering, education, research, mission planning, population health, and operational support. Features eight new chapters including Precision Medicine, Musculoskeletal System and Performance, Human Spaceflight Mishaps and Incidents, and Crew Escape and Survival Systems. Covers important approaches to Human System Integration and Risk Management, as well as Aeromedical Certification. Addresses important aeromedical issues involving agricultural aviation, military aviation, long-duration spaceflight, and commercial spaceflight. An excellent review tool for the American Board of Preventive Medicine - Aerospace Medicine certification exam and Continuing Certification, with outstanding contributions from a team of expert scientists and medical providers. Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.

DDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was con cerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symp toms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. vii Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.

Read with two objectives: first, to acquaint yourself with the current knowledge of a subject and the steps by which it has been reached; and secondly, and more important, read to understand and analyze your cases. William Osler, The Student Life What follows is a collection of cases-or more aptly, the stories of our patients and friends who have been seen at The Ohio State University Hospitals where our faculty have provided their care and about whom this volume is written. Today many fear that our patients are being moved from center stage while we are being distracted by the technology of medicine. This volume was written with patients in mind. The idea is that the most intriguing questions and the most rewarding answers begin and end at the bedside. This is a story of our patients, told by expert clinicians and spiced with commentary along the way. This volume in no way at tempts to be comprehensive. Instead, it is like the practice of medicine, scattered, somewhat disjointed, while at the same time intensely personal and focused upon whatever problem the patient brings to us. The discussions are not so much about disease entities as they are about patients with problem." The two are uniquely dif ferent. For instance, when the physician suspects hepatitis, not every imaginable cause can be actively investigated. Instead, tests and procedures are discriminate ly chosen, a part of medicine that is still more art than science."

Motility is a fundamental property of living systems, from the cytoplasmic streaming of unicellular organisms to the most highly differentiated and de veloped contractile system of higher organisms, striated muscle. Although of motility have a long and in scientific investigations into the mechanisms teresting history, the knowledge of molecular processes, especially in the area of regulation of control of motility, has been developing at an ever more rapid pace with the utilization of multidisciplinary approaches from physiology, cell biology, genetics, biochemistry, pharmacology, and biophysics. In Volume 3, Cell and Muscle Motility continues the same philosophy as that of the preceding volumes. The essays are meant to focus on topics of current interest, to be critical rather than exhaustive, and to indicate the current trends of research efforts. The series is intended to foster an in terchange of concepts among various workers in a variety of disciplines and to serve as a reference for students and workers who wish to familiarize them selves with the most current progress in motility. Robert M. Dowben Jerry W. Shay Dallas vii Contents Chapter 1 Intermediate Filaments in Striated Muscle: A Review of Structural Studies in Embryonic and Adult Skelttal and Cardiac Muscle Maureen C. Price and Joseph W. Sanger 1. Introduction ................................................ ."

DDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was con cerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symp toms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. vii Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities."

1 Shepherd Coronary artery disease, the most important cause of death in the United Kingdom, kills about 200 000 Britons each year. Many victims are struck down out of the blue and in the prime of an active working life. Others survive the fIrst attack but are so debilitated by it that they are compelled to fall back on the efforts of their family and the Social and Health Services for their future survival. The epidemic proportions of the problem and the burden which it places on the community at large has led many health care professionals to reassess their attitudes to heart disease prevention. In the past, the clinician's attention has been directed primarily at the treatment of established ischaemic heart disease rather than focussing on forestalling its appearance by attempting to tackle those life-style habits within the population which appear to predispose to it. A number of recent developments make this approach hard to sustain. First, there is now convincing evidence that action taken against cigarette smoking, hyper tension and hypercholesterolaemia offers signifIcant protection to the individual. Secondly, effective and apparently safe antihypertensive and lipid-lowering agents have recently become available to the practicing clinician. Thirdly, developments in computer technology and laboratory equipment manufacture have brought the measurement of coronary risk factors right into the primary health care setting. And, last, but not least, political attitudes towards prevention now favour the enthusiastic general practitioner with an interest in anticipating and averting the development of degenerative diseases like atherosclerosis."

The Membership examination of the Royal College of General Practitioners has evolved and matured as a seal and a test on completion of vocational training. More than 1000 candidates are taking the examination each year and an increasing majority are trainees who have completed their three year training period. The whole concept and philosophy of the MRCGP has been questioned by critical cynics who refuse to accept general practice as a field of medical practice worthy of recognition as a specialty with its own core of know ledge, skills and expertise and with its own special epidemiology, pathology, clinical presentations and management. These cynical critics are being answered by the growth of the examination and its recognition within the profession as an important and necessary goal to be achieved. The MRCGP exam has arrived, it is here to stay and it will continue to grow and evolve. The exam is no easy obstacle to negotiate. It has a regular failure rate of I in 3 and it requires special preparation and study of its examinees if they are to understand its aims, contents and methods. It must not be assumed that even the brightest trainee can walk off the street, enter the examin ation hall and be confident of passing. It requires a few months of careful and guided preparation.

Medicine is news. There is constant public interest in health and disease; in medical miracles and in breakthroughs; in medical disasters, failures and malpraxis ; in deficiencies and defects ofhealth services; and in the rising costs ofhealth care. Medicine is 'big business'. Physicians co me out near the top money earners in most medical care systems. In the Uni ted Kingdom the National Health Service (NHS) now costs over [6000 million a year ($ ro 800 million), a free service that costs every British man, woman and child [120 a year ($216) in direct and indirect taxes. But this is less than the [500 ($900) a year that medical care costs each person in USA and West Germany. In developed countries health care costs are approaching ro% ofthe gross national product (GNP). It is big business also in that in Britain the NHS is one of the largest employers; about I million Britons work as employees of the NHS, caring for the other 54 millions and in the USA the numbers are 5 million caring for 2. 5 millions. The provision of health services is full of problems and dilemmas. These problems and dilemmas cross all' national boundaries. All countries share the same problems and dilemmas. Problems of objectives, of standards, of effectiveness and efficiency, and problems of relations between the medical profession, the public and govern ment. Medical care still is full of mystique.

The purpose of this book is to clarify the use of antibiotics in the management of the eommon respiratory illnesses seen in general practiee. The underlying philosophy, whieh embraees the avoidanee of unneeessary use, is that proper use entails a full understanding of the nature of the illness. The eoneept of seleetive antibiotie use reeognizes that respiratory illnesses eommonly eomprise multiple illness features, and that some of these features have a viral cause and some a bacterial one. In assessing antibiotic need, eaeh feature or eomponent part of an illness may be evaluated individually, so enabling adecision for antibiotie use in the illness as a whole. The nature of eaeh individual illness feature with its antibiotic indication is diseussed in sueeessive ehapters, and this aecumulated knowledge is of value in managing the more eomplex PUO and flu-like illnesses whieh are diseussed at the end of the book. The first two ehapters eneompass the principles of antibiotic use and the relationship between antibiotie preseribing and various states of the patient, e.g. allergy, pregnaney ete. An attempt has been made to justify every reeommendation or decision, and non-antibiotic management is diseussed where relevant.

One of the eXCltmg challenges of medicine has been the reaching of decisions based on less than complete evidence. As undergraduates in teaching hospitals future physicians are taught to think in clear and absolute black and white terms. Diagnoses in teaching hospitals all are based on supportive positive findings of in vestigations. Treatment follows logically on precise diagnosis. When patients die the causes of death are confirmed at autopsy. How very different is real life in clinical practice, and particularly in family medicine. By the very nature of the common conditions that present diagnoses tend to be imprecise and based on clinical assessment and interpretation. Much of the management and treatment of patients is based on opinions of individual physicians based on their personal expenences. Because of the relative professional isolation offamily physicians within their own practices, not unexpectedly divergent views and opinions are formed. There is nothing wrong in such divergencies because there are no clear absolute black and white decisions. General family practice functions in grey areas of medicine where it is possible and quite correct to hold polarized distinct opinions. The essence of good care must be eternal flexibility and readiness to change long-held cherished opinions. To demonstrate that with many issues in family medicine it is possible to have more than one view I selected 10 clinical and II non -clinical topics and invited colleagues and fellow-practitioners to enter into a debate-in-print."

DDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess is on what to do best for the ment and investigations, but the emphasis patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities."

Part one of the book presents the gastrointestinal problems that commonly face the general practitioner. Emphasis is placed on analysis of clinical data and how this may provoke the most profitable lines of investigation. Many of the investigation and treatment protocols are within the scope of general practice, but hospital management is also included. It was possible to deal with common oesophageal diseases under the heading of oeso phageal problems in Part 1. In contrast, it proved impossible to discuss adequately all of the common diseases affecting other organs of the digestive system under the problem headings. For this reason, a fuller ac count of many common alimentary diseases is provided in Part two. M. L.-5. K. G. D. W. 9 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation."

Over several years working in a district general hospital as a physician with a cardiological interest, the common problems in this field are clearer. This knowledge has come through normal out-patient clinic referrals, care of in-patients, and by working in a domiciliary consultative capacity. The problems that concern family physicians nowadays are somewhat different from the problems of two or three decades ago. The accent now is very much on the implications of hypertensive and ischaemic heart disease. Rheumatic fever is rarely seen, though its sequelae may still be discovered. Hence the approach of this book is to the common problems of today in family practice, and the book is not intended to be a reference text book of cardiology. It does not include references because it has been written from personal experience gained from the treatment and management of patients with common cardiac problems. It is hoped that it will be of value primarily to family physicians because it has been written in an attempt to fill a need as measured by the problems that are referred to specialists in the cardiological field. It may prove of value to those medical students and nurses who wish to consider medical problems in a practical way, that is from the ways that cardiac problems present in practice.

The fact that there are special problems in the care of the elderly in the community is ample justification for writing a separate volume on the subject. The knowledge that there are increasing numbers of older people in virtually every country in the world makes it all the more important that the family physician should have sympathy with and understanding of the problems of them, since they are lilcely to make up a significant part of his worlcload and, increasingly, will take up more of his time and energy. There is a progressive amount of disability with advancing years, and this is particularly true of those aged 75 years and over. Increasing age is associated with serious impairment of hearing and vision, senses which younger people take for granted. Old age sees the arrival of major diseases of middle age with much greater frequency, such as ischaemic heart and cerebrovascular disease, diabetes mellitus and osteoarthritis. There are other disorders that are virtually confined to the elderly, such as fractures of the femoral neck, Paget's disease and myeloma. We now know that the disintegration of the con ducting tissue of the heart is largely an age-related phenomenon. Ageing processes affect every major organ system in the body and the impairment of physiological perfor mance resulting from these affects the elderly individual's response to infections, disease and environmental changes in complex ways that are not seen in younger people."

This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation. All the authors write from hospital experience and from the viewpoint of their specialty. There are, therefore, matters important to family practice which should be sought not within this series, but elsewhere. Within the series much practical and useful advice is to be found with which the general practitioner can compare his existing performance and build in new ideas and improved techniques. These books are attractively produced and I recommend them."

In writing this short monograph on 'Problems in Peripheral Vascular Disease', I have tried to steer a course between a simplistic dogmatic approach more appropriate to an under graduate text, and a detailed specialist treatise of interest only to vascular surgeons. Although arterial surgery has been performed for centuries, the main indications in the past were to deal with the effects of trauma and aneurysm formation. The development of arterio graphy and the ability to see arterial blocks and stenoses allowed surgeons to carry out increasingly sophistidated operations for an enlarging range of pathological conditions. Even today, arterial surgery continues to develop, and although we are often dealing with the 'surgery of ruins', a successful outcome is just as rewarding for surgeon and patient alike. In this book I have also included a discussion on venous problems including a note about recent developments in direct surgery of the deep veins of the lower limb which could be a re warding field of endeavour for the vascular surgeon. The original descriptions by Buerger and Raynaud are taken from 'Classic Descriptions of Disease' by Ralph H. Major. While reviewing my own surgical practice, I have had the pleasure of reading once again the publications of H.H.G. Eastcott (arterial surgery), J.T. Hobbs (varicose veins), G.L. Hill (Buerger's disease), Adrian Marston (intestinal ischaemia), Martin Bimstingl (vasospastic disorders) and C.H. Hawkes (lumbar canal stenosis)."

This third edition of the Beecham Manual has its origins in a manual produced by Selwyn Carson for his general practice in Christchurch, New Zealand. He produced loose-leaf sets of instructions for his practice team and colleagues. Beecham Research Laboratories of New Zealand did a great service for the medical profession by publishing and distributing Dr Carson's manual there. The British version of the Beecham Manual had different objectives. The vocational training programme needed basic resources and the British Manual was created as an easy to read reference book on common prob lems and methods in general practice. The first and second editions met with enthusiastic approval from princi pals, trainers and trainees. This third edition follows the same general format but has been completely revised and updated and includes many new additions. The five sections are: o planned care of definable population and other groups o principles of teaching and learning o emergencies and their management o psychiatry o clinical care of common conditions We have kept to simple, clear and brief presentations of our conjoint views based on our experiences in our own practices. We dedicate this third edition to our colleagues involved in caring, learning and teaching. They may not agree with us completely but we hope that we will make them consider our suggestions and use them for thought, debate and discussion. We hope also that it will be used as a work book for the whole practice team."

The topics chosen for discussion represent the most common problems referred by family doctors to chest clinics. It was taken for granted that the reader will be familiar with the symptoms, signs, and natural history of respiratory diseases, so that the stress is on differential diagnosis and treatment. Tuberculosis once occupied nearly all the time of chest physicians. At present weeks go by without a single case presenting itself. There has been no comparable improvement in cancer of the lung, which remains one of the most intract able problems. Asthma was seldom referred to out-patient clinics when the disease was regarded as more unpleasant than dangerous. The hazards of severe attacks and the advan tages of liaison with a hospital department are now widely recognized. A similar change of attitude to the management of chronic bronchitis brought many new patients to the chest clinics in place of the vanishing tuberculous population. Some uncommon pulmonary diseases are included: allergic alveolitis, because of the importance of early diagnosis, and sarcoidosis in order to discourage unnecessary treatment. The book is intended to be a practical guide and is not a critical review. This might serve as an excuse for its didactic style and the exclusion of controversial subjects. Some statements are repeated at more than one place in order to help readers who wish to consult individual chapters bearing on some current problem. Source references are omitted and are replaced by a short list of books recommended for further reading."

DDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analyis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more defini tively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and as sessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional islation in the com munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities."

JOHN JOHN FRY FRY All All examinations examinations create create problems problems and and stresses stresses in in examinees. examinees. The The examination examination for for the the Membership Membership of of the the Royal Royal College College of of General General Practitioners Practitioners is is no no exception. exception. Although Although the the examiners examiners state state that that their their objectives objectives are are to to pass pass candidates candidates wherever wherever and and whenever whenever possible, possible, nevertheless nevertheless the the failure failure rate rate remains remains con sistently sistently at at 30% 30% plus plus of of those those taking taking the the examination. examination. The The reasons reasons for for failure failure fall fall into into a a number number of of groups. groups. The The candidate candidate may, may, through through over-confidence, over-confidence, not not have have prepared prepared for for the the examination. examination. He He may may have have assumed assumed that that it it is is not not necessary necessary to to read, read, learn learn and and digest digest data, data, facts facts and and experience experience on on general general practice. practice. How How wrong wrong that that is, is, he he will will discover discover when when he he sits sits the the exam. exam."

WHY WE MUST PRACTISE TRANSCULTURAL MEDICINE Health professionals and GPs should concern themselves with ethnicity, religion and culture as much as with the age, sex and social class of their patients. Transcultural medicine is the knowledge of medical and communication encounters between a doctor or health worker of one ethnic group and a patient of another. It embraces the physical, psychological and social aspects of care as well as the scientific aspects of culture, religion and ethnicity without getting involved in the politics of segregation or integration. English general practitioners and health professionals tend to regard everyone as English, and to assume that all patients have similar needs. Would that it were as simple as that! For economic reasons - based on supply and demand - the mass migration of working populations from the new Commonwealth countries, along with their dependent relatives (including their parents) to Britain took place during one decade - the 1960s. Broadly speaking, the workers were in their thirties and forties, and their dependent parents were in their fifties and sixties. All these will, of course, be 30 years older in the 1990s.