Attitudes of primary care physicians to the management of asthma and their perception of its relationship to patients' work.

The results of a questionnaire on the attitude of family physicians and general practitioners to the management of asthma, and their perception of the relationship between working conditions and asthma are reported. Family physicians were three times more likely than general practitioners to treat asthmatic patients themselves, without referral to a specialist. However, there were no other major differences between these two groups regarding the weight they attributed to the occupational factor in asthma. Overall, both groups routinely asked patients about their job (78%) and exposure at work (75%), but at least in half the cases this issue was not followed-up to determine if occupation-related counselling or problem management were necessary. Differences in the primary care of asthmatics were also noted between physicians in Israel and America. In Israel, physicians tended to explain everything to the patients at the initial visit, and then leave them to cope on their own unless the episodes remained uncontrolled, whereas their American counterparts continued their educational activities in subsequent visits as well. We conclude that family medicine residency training in Israel, despite the inclusion of courses and lectures on occupational health in general and on respiratory diseases in particular, does not sufficiently emphasize this subject. Clinicians should be trained to take a more in-depth and active approach to this problem in order to avoid misdiagnosis and improve prevention.