OUR HOSPITALS.

Auckland Star, Volume LVI, Issue 124, 28 May 1925, Page 9

OUR HOSPITALS.

PAYMENT OF "HONORARIES. , J. T833 PRINCIPLE APPROVED. ATTITUDE OF B.M.A. RELATION'S OF DOCTOR AND PATIENT. it J "That hospital boards are recom to adopt the suggestion of thf 0 Dircctor-Ocnera! —that the honorary j medical staff of public hospitals may he ,f; remunerated for whole or part time it : services.' , ,? i This was a remit which the Hospital 'Boards' Conference proceeded to discus? o ' immediately upon reassembling to-day. -, i Dr. Watt, Acting-Direetor-Ccneral ol c Health, said that the Government had "; recognised the great self-sacrifice and n devotion to duty of the honorary work nf the doctors. The medical men in '• j some instances had the benefit of experi 1 ence ami of meetinc people inside; but c in the majority of cases they hnd served 7 without hope of reward and solely in I the interests of the Buffering sick. In I the past they had worked in the position t thnt they had treated people in the s public hospitals who could well afford i pay for medical treatment, and who in many cases were willing to do so: and in this respect there had been a certain exploitation of the services of the medical men. It was nnw proposed that this system should be scrapped, and the suggestion was that there should lie a full-time stipendiary staff, or. alternatively, a part-time stipendiary stuff. There was an objection to the first suggestion on the ground that only a few men would be thus made available. In the part-time proposal, it was suggested that applications should be called for part-time medical men, for a term of, say. two years, which would be renew- ," able. The positions should he in two grades—senior and junior—and in the j ordinary course of events the senior 3 positions should be filled from below. The remuneration need not be very , much, the swepestinn being that the ,i medical men should receive a salary or I stipend somewhere in the vicinity of i £200 or £300 a year. Tn return for this. i the medical man would be required to > nttend the hospital at certain fixed hours i and undertake certain definite duties. 1 ! However, this was only a tentative •J scheme. The Department did not pro--1 pose or suggest any revolutionary • scheme. • Consulting the Profession. I Mr. Carrick Robertson, on behalf of i the medical profession, congratulated ! the conference on its choice of a presi- ■ dent and the president on the honour • accorded him. He had been asked to make it plain that the B.M.A. did not question the right of the hospital boards to administer the hospitals, but felt that the profession, having given freely of its time and services, should at a time like this, whpn radical ehanees were contem- j plated in regard to hospitals, doctors and patients, be consulted na to its opinions. The British Medical Association was in favour of the Toronto system, not on financial grounds, but because it made for more efficient treat- | ment. Far from desiring special private I wards, the medical men believed that] ' under the community system all patients ; I should be housed in the same block, so I that the same advantages could be I obtained in public hospitals, as well as the added advantage that the attending physicians and surgeons would have all their patients under one roof, and be j I enabled to spend the greater part of the i I working day in the institution. Thej j patient who" was most, ill and in the most need could thus receive prompt attention from his doctor. Xo -medical j man would ever do anything else but give first consideration to the patient who most required this attention, be he rich or poor. The fact of all patients being in one building would be the best thing possible for all. and would do away with cla=s distinction of'n kind that was deprecated under the Toronto or community system, and it could only lead to added benefits to the patients. Th«"y did not need additional buildings in which to work the Toronto system: he did not see why patients could not pay! for a private room "'ith one or two beds i "n the present buildings, and make their | own arrangements for paying their doc-' 'tors. There was a rule now which said i that no member of the honorary medical i I stnff should accept payment from j patients in hoenital. T?v deleting this , ! clause in its rules, the Hospital Board* j 1 could take the first step in the desired ; i direction. The doctors would be receiving ! pft-rment from some of their patients, under this system, end it seemed hardly • I necessary to spend £0000 or £SOOO a year . on salaries —a= would be the ease nt . Auckland if stipends were paid. The i -doctors would be adequately paid by: patients, according to tlieir arrange- | rnents with their patients. There mielit. j perhaps, be a small stipend paid at som" | iof the small hospitals for doctors to at- j I tend patients who could not afford to i pay. He recommended that the assoeja- [ tion appoint a committee to visit those j smaller hospitals where the eomm-initv I system was in vomip. as in operation in , A Critical Point. Dr. Hardie Xeil also congratulated the P.ssociation and the -Speaking from the standpoint of the general prac- : titioner. who carried otit the bull: of the work. Dr. Xeil said that when the nee-1 j arose for institutional treatment the ' patient was removed from the care of . h's doctor out«ide and placed in hospital This doctor was therefore "p.a'ile to follow up hi= treatment of the patient with all the sppcinl department-* available it the public ho.pitnN. wirh 'he re«nlf th.v he must slip back, however well Jns primary education had been carried out. ■ This must have a reaction on th" community, because it must suffer by reason of any inefficiency of the medical service ! outside. The standard of education was rising, and the public now nn increased efficiency from its medical mc;, and n <rrear<--r length of =*-: ly qrvl a. knowledge of medienl a ejenep. ! Medical men were not foreigners amona us: many of us would 6.:,<.n n r or !:!T<-r j have relatives entering the profession, and if we did not leaislate n ny in ord»r | that these m"n could enjoy rh« benefit* j of hospital work, the profession would ' only attract an inferior e^, s nf m"n. ! and that wonld react detrimentally on the public. This was the most r-rri-al in relation to tho public, and he sincerely trusted the conference would look j upon the matter from the point of view of the hardest worked and most poorly paid professional man in Xew Zealand— the general practitioner.

Affirming a Principle. The chairman (Mr. Wallace) eaid that the whole question was entirely a matter for individual boards to settle , for themselves; the motion merely affirming a principle. The Auckland Hospital had an honorary staff of 37. It was a most important problem. In I the past the honorary system had filled la great gap, and the services of the J honorary staff had been invaluable. If ; counted in money value only, the honorary staff gave £20,000 worth of work to the hospital each yenr. He thought, J seeing that, they were going to open the J door to all the Eirk who sought admission to the hospitals, it was largely a n- j question for every board. The confeie renee did not wish to bind any hoard in 7 ' respect to the staff of its institution. 1 Dr. Skcrmnn. of Wanganui, declared )e ,'that his hospital could not afford to pay visiting doctors £200 or £:iuo a year ■OF erect new buildings for private !l [ patients. If they started the community Byptem they would have to do it in " ? , the" present building!*. , i Every Kind of System. , J Mr. Quelch (Otagoj said that in Otago they ha.', every kind of system. Doctors, ,in one instance, were paid a certain k sum to attend to all patients, and they „ J were allowed to place their own patients . ' iti hospital and charge thorn, the patients 'paying only ordinary ices to the >t, hospital. rl .Mr. l.uke (Wellington , , said hospitals n ! should be open to all, unci no one should !be debarred through having the "misn fortune" to be rich. If a person liked to n come in and pay more than the c ordinary fee. and to pay his own doctor ( \ for attending him there, there should be nothing to debar it. The services given by the doctors could not be measured in v pounds, shillings, and pence, and they n should be allowed to charge patients who c wer« abl" and willing to pay them, t Mr. Hnrtnn I Canterbury I expressed c himself similarly. a Mr. K. H. Potter (Auckland* l " emphasised the very great. service f-1 rendered the Dominion by honorary '■- medical attendants. The value of ■ v lin.-pitnl treatment given in the Dominion n was £1.000.000 a year, and the total' '1 payment received by tlie hosital hoards j J was £206.000. All 'the speeches in the] f. world would not overcome the fact that | '■ they were getting a tremendous lot lor! o nothing. It would be simple for the c authorities to set aside private wards, r without providing new buildings. Sir James Wilson (Bulls) praised y the surgery of New Zealand, and said c it was clear the hospitals. nra>t employ r the highest -skill. As f.ir as his board f was concerned, it would continue with '. the honorary system, which gave them 0 the be=t skill available. a In reply to n question, Dr. Watt said i. I that a doctor was allowed to follow his c ! patient into a maternity hospital, and '■ charge for his attention, but medical men y outside the honorary staffs were not allowed into public hospitals to practice, and menbers of the honorary staffs were 1 The Only Discrimination. Dr. ITardie Xeil accepted tho invitation r; to reply to the discussion, and he] , I repudiated the idea that the medical men | 11 sought any share in the management of j the hospitals. A few "hot heads" had t made unauthorised statements, but they , would shortly be submitted to dfe- , ciplinarv mea-urt-s. .Any medical man . J who regarded his. hospital patient's , j financial position "with a. fishy eye," as. , one delegate had put it. would" certainly . get that optic discoloured by the board. , (Laughter.) A-s to doctors discriminat- . ing between patients—that was a hateful . idea to the medical profession, and he had , never seen any attempt at discriminajtion, excepting that the doctor gave his '. ! first attention to the most urgent i'patients. (Applause.I The whole prof.es- j , sion was anxious to help the hospitals , and to perfect its medical knowledge. , I The civic system, if brought into beinp, I would jive to the profession the chance ,! to benefit itself, and at the same time , I benefit the public' by the spread of; ~ medical knowledge. He pointed out that!. , i the community =yst.. m , which would ' allow patients the choice of their own! I J medical attendants, would increase the! .| interests of the profession in the; hospitals, and give the patient the. ' ; benefit of the treatment of the individual . practitioner under whose treatment he . had been, and in whom he hnd close . confidence. Aj rer-arded the capability .of the medical man. whereas twenty 1 years ago there might have been two or ' j three highly skilled men in Auckland- . who were highly skilled in surgery.,' to-day there were a score whose services ' , were at the disposal of tho public. ' . I The chairman expressed the opinion ! j that some discrimination had Ijeen .revealed by the Bryee inquiry at ! Palmer-'on North—hen.-c the remit in ■ this business paper. Hospitals must have '■. J the most highly skilled men. Were they ' ; rrointr to trust their patient to young- , 'inexperienced men? Xo '. Who were"goinn- ' jto train the young men? The highly ■ I skilled, elder, experienced men. The I 'hospitals could not afford to lose the i services of the men they had in their j honorary staff's to-day; therefore, some 'method of remunerating them must be I found. ■ The motion was carried, with only a 1 I single voice raided in distention. '■•