[A comparative study of common diagnoses in the ambulatory care]

The study compared common diagnoses obtained from two ambulatory teaching sites from the department of Family Medicine with the corresponding data of three domestic teaching hospitals and three foreign large scale studies, derived from a literature review. We collected a total of 143,123 patients with 211,962 clinical diagnoses at the OPD, covering a period from Nov. 1, 1990 to Oct. 31, 1993 and 18,711 patients with 34,018 clinical diagnoses at the Shue-Ting group practice center, one of our community teaching centers, over the period from Nov. 1, 1992 to Oct. 31, 1993. The diagnosis cluster method developed by Schneeweiss and Rosenblatt was modified by adding three new clusters of diseases common in Taiwan, i.e. viral hepatitis/carrier/liver cirrhosis, tuberculosis and lipid metabolism disorders. The results revealed there was little difference between countries for the diseases belonging to internal medicine, but more patients with problems of other specialties visited primary care doctors in the United States, such as acute strain and sprain, dislocation and fracture, prenatal and postnatal care, sinusitis, otitis media, vaginitis and cervicitis. Although the training of family doctors in Taiwan covers a broad spectrum of diseases in primary care, this obvious internal medicine oriented practice was due to a particular style of help-seeking behavior of people. The study also showed several minor diseases seen in the community were not present in the teaching hospitals, e.g. laceration, dermatitis, eczema, conjunctivitis. In conclusion, to improve family physician training, it is necessary to increase teaching sites in the community to make physicians familiar with first contact care of different disciplinary problems. In addition it is also important to promote the family physician system by providing health education to change people's behavior and to strengthen primary care.