Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study

Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. Design: Qualitative study using focus groups and indepth interviews. Setting: Primary care in Northern Ireland. Participants: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. Main outcome measures: Participants' views about their own and colleagues' health. Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

Sustainable Value Added - ein neues Maß des Nachhaltigkeitsbeitrags von Unternehmen am Beispiel der Henkel KGaA

This article introduces a new approach to measure corporate contributions to sustainability called Sustainable Value Added. Existing approaches to measure sustainability are based on a comparative assessment of environmental and social burdens and can thus be characterised as burden-based approaches. However, these approaches suffer from severe limitations as a comparative assessment and aggregation of all relevant environmental and social burdens fails in practice. In contrast to these burden-based approaches Sustainable Value Added is value-based. It determines the value that is created by the reduced or increased use of different environmental and social resources. For this purpose the use of environmental and social resources is valued at their opportunity cost. Sustainable Value Added allows an integrated assessment of the economic, environmental, and social performance of a company and expresses the corporate contribution to sustainability in a single monetary indicator. This article explains the theoretical background of Sustainable Value Added, relates it to existing approaches to measure sustainability, and - using the example of Henkel KGaA - demonstrates its practical applicability.