Zur Bedeutung von Sozialmedizin in der vertragsärztlichen Praxis

In the German statutory social security system, the necessity of long-term care for chronically ill persons with multi-morbidity and reduced performance has made the socio-medical management of illness and its consequences an important characteristic of primary medical activity. In routine practice a discrepancy between the practical demands and social-medical insights has often been observed. With this in mind, the aim of our pilot study was to systematically collect data on the state of the art and attitudes towards the relevant spheres of work in a defined group of physicians and analyse this data. The study was carried out in the form of a voluntary questionnaire within the medical association (Arztlicher Kreisverband - AKV) in the area of Erlangen-Hochstadt. The database was a computer-processible, anonymous questionnaire with which first of all general socio-demographic and activity-related data was collected. The following 10 questions included, in addition to an estimation of the participants' own socio-medical knowledge, questions on the general status of socio-medical knowledge and how the individual gained this knowledge and the importance of socio-medical themes in routine practice. The data was evaluated using descriptive statistics in the form of exploratory data analysis. Of the 320 physicians registered at the time of the investigation (4/96), 89 (31 female doctors, 58 male doctors) sent back a questionnaire that proved useful (returns: approx. 28%). Significant sex-related or specialisation-related differences with regard to participation in the study were not observed. The ratio of female to male doctors and of general practitioners to specialists in the study collective corresponded more or less to the distribution in the total group. The participants had a median age of 41 years (minimum 31, maximum 71) and had been in practice for a median of 11 years (maximum 43 years, minimum 1 year). 36% were general practitioners, 64% specialists. 97% regarded sound knowledge in socio-medicine as essential for doctors wishing to set up practice. 70% regarded their own knowledge of socio-medicine as being in need of improvement. 85% regarded their knowledge as having been insufficient at the start of their medical careers. With regard to doctors gaining socio-medical competence, routine practice and their own autodidactic capabilities played an important role. 84% would like to see increased teaching of socio-medical themes during specialist training courses. For over 70% socio-medicine is a part of medical studies as a subject in its own right. The content and aims of New Public Health were known to 45%. Among the areas of socio-medical work the care of chronically ill persons was given highest priority. Preventive measures were also accorded high relevance by the participants, and they were particularly interested in preventive medicine. Taking into consideration conceptional problems (e.g. the size of the random sample/selection effects) it was found that: - despite many years of practice in some cases, doctors feel there is a deficit in their socio-medical knowledge - practical knowledge is mainly gained autodidactically during routine practice (learning by doing). There is a clear wish for increased consideration of socio-medical themes in specialist training courses. - The great importance of socio-medical tasks as part of medical practice is undeniable to the study collective. The results underline the necessity for improved communication and co-operation between doctors involved in primary medical activity and in socio-medicine.