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A simple and standardised measure of perceived health status, the Nottingham Health Profile, was used to assess the effect on perceived health status of surgical intervention in a variety of non-acute medical disorders. Patients were assessed a few days before their operation and again two months later and were compared with a control group who had not undergone surgery. Results showed very little change in subjective health from before to after surgical intervention. The experimental group had similar perceived health scores to the control group on the pre- and post-tests. It is suggested that the period allowed to elapse after surgical intervention was too short, or that the level of problems experienced by patients prior to surgery was too low to show significant change. It is also possible that the particular presenting disorders were only one possible somatic representation of general feelings of minor ill-health in the group. The findings of this study point to the need to look at the differences between doctors and patients expectations of the outcome of surgery, the decision to seek care and the factors that govern wellbeing.

Data from the fifteen Hospital Regions of England and Wales were used to determine the utility of health outcome indexes, derived from existing health statistics, for monitoring the quality and effectiveness of health services. Outcome measures reflect not only the impact of the system of care but also the sociodemographic characteristics of the population. An attempt therefore was made to identify those outcome measures most sensitive to variations in medical care and least affected by sociodemographic differences. In general, most indexes examined in this paper appear to be more sensitive to variations in the sociodemographic characteristics of the population. However, thosoutcome measures related to provision of care in hospital appear to relatively more sensitive to variation in medical care than those which are community based. This suggests that, at least for monitoring the effectiveness of medical care in the community, it may be necessary to move away from the more "traditional" health indexes toward measures that take into consideration the different patterns of care and the social and behavioral aspects of health.

The current recognition of the importance of perceived health status as a predictor of need for, and utilisation of, health services has led to attempts to produce indicators which assess subjective rather than objective health problems. The development of the Nottingham Health Profile is described, together with a study which tested the validity of the instrument on four groups of elderly people differing in health status. The results showed that the profile was capable of discriminating between groups differing in terms of diagnosed chronic illness, number of consultations at primary care level, and physiological fitness. Age, sex, and marital status were not significant overall in affecting scores. In these elderly subjects, perceived health status accorded well with objective health status. Further tests of the profile are now taking place on younger groups of subjects.

The arguments for and against medical auxiliaries are over and interest must now shift to ways of maximising their effectiveness. An important issue is to what extent the findings of high-technology medicine can be successfully combined with the barefoot concept of delivery. An important question for the future is to what extent they can be applied by the individual to himself.

533 (77.3%) of a random sample of 690 general practitioner (GP) principals in Britain replied to a postal questionnaire about the appropriateness of nurses undertaking, after suitable training and under the supervision of a doctor, but on their own, certain clinical tasks (history taking, examination, diagnosis, and advice on treatment) in general practice. Those who replied were representative of British GPs. Two-thirds were in favour of the extended role and were prepared to delegate clinical tasks to a nurse. Their opinion was unaffected by whether or not they had worked with or observed the work of medical auxiliaries. 65% of those in favour would prefer to work with a woman. The characteristics most significantly associated with acceptance of this new role for the nurse were: doctors aged less than 50 years and practices in which regular formal meetings took place between doctors, nurses, and other practice staff.

A scheme by which clinical students follow, after discharge from hospital, the progress of patients for whom they have had responsibility in the ward supplements students' knowledge of the natural history of disease and emphasises the importance of communication and the use of community resources. By commitment to a patient and his problems for a long period, the student can take an active role in care and, in presenting his patient's progress, finds himself in the role of teacher.