'Do as I say and not as I do'? An audit of clinical management in teaching compared with service work

The work of five principals in a teaching general practice was audited to examine differences in prescribing, investigation and follow-up between teaching and service work over a 3-week period. The patients seen in clinical teaching were found to be representative of those consulting in normal service sessions for both morbidity and age. Some big differences in clinical management were found including a strong tendency to prescribe less but investigate and follow up more when teaching. The prescribing differences were variable between morbidity groups. It is suggested that large differences correlated with areas where the doctors were least confident in their behavior, such as the use of antibiotics for respiratory illness and the use of tranquillizers for problems without a psychological diagnosis. It is concluded that while reductions in prescribing probably reflect better patient care, increases in investigations are more for the students' benefit.