Everything from how to treat ingrown toenails to how family doctors care for patients dying from cancer will be discussed by almost 4,000 general practitioners in Dublin next week in one of the biggest medical conferences to take place in the State. From over 70 countries, the doctors will converge on the RDS tomorrow for Dublin Wonca '98. They will be discussing the role of the family doctor in a changing environment, where patients no longer take their word without question. The theme of the conference, hosted by the Irish College of General Practitioners (ICGP), is "People and their Family Doctors - Partners in Care".

This is the 15th world Wonca conference and it is the biggest. Yet again, according to the organisers, Dublin has proved its pulling power. As well as the doctors there are over 1,000 partners in the capital, staying in 50 hotels around the city. Spending estimates are difficult, but it is thought they will leave at least £6 million behind them. The conference rotates triennially to different continents. The ICGP made its pitch in 1992 in Vancouver, Canada. It was successful following a "lively" presentation. "The fact that it was to be held in Dublin was a factor then," said Mr Fionan O Cuinneagain,

ICGP chief executive. But with the level of registration, he added, it is certainly of greater significance now. Mr O'Cuinneaga in said the face of general practice has changed dramatically in the last decade. But he believes Irish GPs will be surprised next week at how well they compare to colleagues in other countries.

"I think they will be surprised at the level of advancement compared to other countries. Irish general practice has been fairly insular over the last few years but that has changed with Wonca. Presentations from Irish GPs compared very well and were well ahead of many others. The levels of academic and clinical activity and management are on a par with the best in the world, except perhaps Australia and the US."

The chairman of the organising committee, Dr Michael Boland, said the theme for the conference was chosen "because general practice is defined by the fact that GPs look after a specific group of individuals. It is not defined by a part of the body. GPs are in a specific place with a specific group of people to look after".

The conference will focus on the relationship between the doctor and patient. "The day of the family doctor taking a paternalistic approach and taking all decisions for the patient is gone. When it comes to deciding on what sort of solutions there are to patient problems, those solutions should be made in partnership.

"We are examining the notion of consumerism, looking at how the balance of power has changed. Patients want to know what is wrong and what the treatment options are. It used to be that this questioning approach was confined to a small number of people in educated, upper middle-class areas, but this is no longer the case," said Dr Boland.

Because of their role in primary care GPs are expected to know more about individual patients, their family history, significant people in their lives, individual circumstances. "That information changes decisions they would make about people and their lives. So many health problems have to do with who people are and the kind of lives they lead," said Dr Boland.

The ICGP has spent £60,000 promoting the conference with assistance from Bord Failte and Aer Lingus. Planning began in 1994. As well as organising the logistics, including accommodation, transport, catering and entertainment, 1,400 abstracts were reviewed, of which 90 per cent were accepted.

Wonca is the international organisation for national bodies concerned with the academic aspects of family practice. Established in 1972, it represents 150,000 family doctors worldwide. The objective of the organisation is to improve the quality of life of people around the world by maintaining high standards of care in family practice.

The President, Mrs McAleese, will perform the opening ceremony tomorrow night. On Monday morning the first group session deals with women's health, which examines the background to the plan for women's health introduced in Ireland in 1997. After that delegates "break out" into 30 rooms for discussions and workshops on various aspects of general practice. The conference continues until Thursday.