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The general practitioner is regularly confronted with aggressive patients. He will have to spot the very first signs in order to manage as quickly as possible such a situation. The ideal is to remain calm, to listen actively and to try to understand the cause of the aggressiveness, knowing that it is not always directed against the doctor. Putting limits is also important to avoid situations that could degenerate. The generalist must also be able to share his difficult experiences with his colleagues, among others in the framework of a Balint group.

Medical studies have recently undergone three reforms in Belgium : passing from 7 to 6 years, the " Paysage " decree and the organization of a competition at the end of the first year. The article analyzes these reforms and organizational and educational consequences.

In 2007, due to the number of invasive pneumococcal infections and resistance to antibiotics, Belgium introduced juvenile anti-pneumococcal vaccination, recommending the 7-valent conjugate vaccine which provides better immune protection and memory than the 23-valent one for adults. In 2011, due to the increase in non-vaccine serotypes, the decision was taken to replace the 7-valent vaccine with a conjugate 13-valent one. Henceforth, essentially high-risk adults are given a 13-valent vaccine followed 8 weeks later by a 23-valent one, with a 23-valent booster every 5 years.

The "global medical record +" can be offered to all 45 to 75 year-old patients in the form of a prevention module within the global medical record and which the general practitioner and the patient will regularly update. It will include in particular an assessment of cardiovascular risk, cervical, breast and colon cancer screening, a check of main adult vaccinations, as well as a primary prevention section focused on smoking, alcohol consumption and various hygiene and dietary measures. The inclusion of this module in a computerized medical record will make it more efficient and will lighten the practitioner's workload.

A care procedure for type 2 diabetics was set up in Belgium in 2009. A three-way contract can be concluded between some patients, their general practitioner and their diabetologist to improve support, to promote communication among the care givers and to stimulate the patients' active participation and self-evaluation. The care teams are backed up by instructors, dieticians and podologists. Financial incentives have been set up for the patients as well as for the doctors. A global evaluation will take place in 2012.

General practitioners, central to Belgian healthcare, can have an impact on its cost, e.g. by rationalising the prescription of antibiotics. Among the tools enabling them to reach this objective, and thus also influencing the decrease in resistance, one finds good practice recommendations. However, the reality of work on the field leads general practitioners to take their global knowledge of their patients into account. Moreover, the diagnostic and therapeutic approach which is specific to primary care does not always allow for a strict application of these recommendations. Patient and society pressure is another factor general practitioners are confronted with. An intensification of continuous training, a greater front line collaboration in establishing guidelines, an improvement in quick diagnosis tests and the maintenance of a privileged dialogue with patients are the way forward to improve the present situation, Belgium being for the moment one of the European leaders in antibiotics prescribing.

In Belgium, on 10 millions of inhabitants, there are more than 31.000 divorces per year and we estimate that 600.000 children are experiencing separation of their parents. The general practitioner (GP) have inevitably the responsability of the medical follow-up of some of these children. The possible professional implications related to these young patients, concerning the GP have never been the subject of a study so far. Consequently the aim of this research was to reveal what is happening in the daily practice of the family practitioner related with the children of separete parents. There were some hypothesis notably about particular working conditions for the GP in connection with possible consequences for these children and possible necessity of special professional attitudes. A qualitative research in focus group was organized with GPs in order to get an interaction between the participants and to go past the concepts supposed before the study. Therefore between September and December 04, 8 focus groups of 10-18 generalist practitioners were set up in Brussels and Mons. Each meeting was axed around couples separated for less than 3 years and children between 0 and 15 years. Finally, 120 GPs discussed about 242 cases of divorces from their practice. The debates totally typed word by word were analysed with assistance of the software QSR N5. The point of view of the GPs is: 1) A divorce affects the working conditions of the general practitioner, for example the parcelling out of the medical follow-up of the child and the fact " of being used" by the family. 2) The conflict between the parents after the separation increases the difficulties for the GP in his daily practice. 3) The parental's separation influences the choice of professional attitudes of the GP, notably vis-a-vis the conflict (for instance to try or not to try the conflict's management). 4) Mainly in conflict situation, parental divorce is a risk for the child; psychological or behavioural disorders, physical health problems, school difficulties, ... 5) Certain professional attitudes of the general practitioner can influence positively the evolution of these children, for example to speak to the two parents. 6) Some professional actions aggravate the situation of the these children, for instance to product certain official written documents (attestations, reports, certificats, ...) in a conflicts context. In conclusion, this study desmonstrates that parental separation affects the medical follow-up of the children by the GPs and that professional attitudes influences positively or negatively the child's evolution. For the first time, some negative consequences of the divorce on children are described in the first line. All this results must be confirmed by quantitative research work.

The law relating to patients' rights, published in 2002 in Belgium, could change communication and even relations between general practitioners and their patients. This law stipulates, among other things, the information to be communicated to the patient, the rules for file sharing and litigation procedure. In the field, this law should be applied more by the spirit rather than the letter so as to preserve trust, the source of a real partnership. Moreover, one could be surprised by the fact that a law on patients' rights is not followed by rules also defining their duties.

Adults have insufficient vaccination coverage in Belgium today. It is up to the general practitioner, who is a key player in the Belgian health system, to ensure that this coverage is improved. The most efficient measures are: systematic patient notification, population and practitioner instruction, reduced cost for the patient, improved access to vaccination services and vaccination reminders to practitioners. These measures will be made easier by the development of the Global Medical Record and the Computerised Medical Record.

The new law relative to euthanasia does not explicitly foresee the implication of the general practitioner when an euthanasia procedure is carried out an hospital. At home, the law confers a central role on the general practitioner as far as information and coordination are concerned. There is a risk that the foreseen procedure will, in some cases, come up against the profoundly dual and intimate aspect of the patient-doctor relationship. The general practitioner is also given an administrative role. The doctor will, after having helped the patient die with dignity, have to fill in a registration document.