Research Units ‘Essential Feature Of Hospitals’

Press, Volume CII, Issue 30312, 12 December 1963, Page 28

Research Units ‘Essential Feature Of Hospitals’

Sharp criticism of the suggestion by the Director-General of Health (Dr. H. B. Turbott) that the area available to the medical research unit at Princess Margaret Hospital be reduced is made by Sir Charles Burns in a letter to the editor of “ I he Press.” He suggests that if money for clinical research is short, it might be found by culling the drug bill.

Sir Charles Burns practises as a consulting physician in WelMngtoti. and is consulting physician and cardiologist to the Wellington Hospital Board. He has been a member of numerous committees set up by the Health Department. He is an examiner in medicine for the University of Otago, and is a prominent member of the Royal Australasian College of Physicians. of which he was tor two years vice-president (head of the college for New Zealand).

Commenting on Dr. Turboitit’s suggestion, made to the North Canterbury Hospital Board, Sir Charles Burns says: “It would seem that Dr. I'urbott is concerned at the expansion of these units within the hospital itself. the suggestion being that their growth and importance is to the detriment of regular hospital practice, and to the primary purpose of the very existence of hospitals—the medical care and treatment of patients. “If this is in fact the view of the director-general, then it is in flat contradistinction to medical thought and planning the world over. The fact is that in every civilised country in which there is a real interest in medical progress, research units are today an essential feature of the working structure of hospital services. In some countries, this holds for private as well as public hospitals. “Moreover, an important factor in preventing many of our trained post-graduate doctors now overseas from returning to New Zealand, is the dearth of full-time clinical! posts available here. The experience of working overseas in a modern hospital unit with research facilities teaches them that if they are to continue to develop their specialties until they have reached full maturity, and at the same time give of their very best to the patients under their care, they need full-time appointments for a considerable number of years at least. Early Practice “There was a time (which came to an end immediately following World War I) when the physician or surgeon made bis daily or perhaps thrice-weekly round of his hospital patients, accompanied only by his house surgeon and his ward sister and, if he was attached to a ‘teaching’ hospital, his group of medical students. His only material aids to diagnosis were his stethoscope, and such laboratory procedures as he himself could carry out in a ‘side-room’ attached to his wards, plus, in very modern hospitals for those days, an occasional X-ray film of rather poor quality, judged by modern standards. “If he happened to be particularly skilled as a diagnostician he was likely to be regarded by his juniors and the nursing staff as something of a ‘super-man’— i especially if his specialty was I surgery; but if he was a I humble man, and had a mind ■ cast in a scientific mould, he ; would himself know how often his diagnosis had been incorrect, his judgment faulty and his treatmenit fruitless, as demonstrated on the operating table or in the post-mortem room. “Hence it was that, some 40 years ago, the experiment was instituted in Britain of setting up full-time teaching and research units connected with medical schools in hospitals in which hand in hand with patient care and treatment went the training of medical students. These fulltime units have come to stay, not only in teaching hospitals but, in increasing numbers, in the larger hospitals in Britain as well as in all other Western countries. Science To Bedside “It is through the existence [ of such research units within the great hospitals overseas, i and indeed in this country, | too, that so many developments in technological science have been brought to the bed- [ side, and made to play such

an important part in the searching out of the true nature of many obscure illnesses—to say nothing of their treatment, in which there have been so many wonderful advances.

“Where the good doctor shows his superiority lies first and foremost in his insistence in obtaining a full history of his patient’s illness and a thorough physical examination, before he even thinks of asking for highlyspecialised forms of investigation. “Within the last 40 years, and at .an ever-increasing tempo, the development of diagnostic and therapeutic procedures of a highly-tech-nical kind has increased and multiplied to an overwhelming degree—so much so that it has become impossible for even well-trained and studious physicians and surgeons to keep up with even a fraction of what is being written on their subjects m medical journals. Hence it has come about that what at one time were the accepted specialties are in process of being broken up into splinter sections. based on the use of highly-technical procedures, demanding the building-up of teams of workers with the necessary specialised training. More to be Learnt “Moreover, as in every branch of modern science, so too with medicine and surgery—the more we learn, the more we realise what there is still to be learnt; and the more exact become our methods, the more and more highly-skilled persons from other scientific disciplines we must bring in to help. Hence, a modern medical or surgical unit ma; well include a trained analytical chemist and physicist together with their satellite technicians, to say nothing of a well-trained secretarial and record staff; in addition, statisticians, geneticists and other skilled persons are often employed part-time. “Working under and with him, in addition to the persons mentioned, the director of a modern medical or surgical unit needs trained clinical assistants of varying seniority and experience, the supervision of whose work necessarily demands a considerable portion of his time; but every member of such a team is concerned in some way or another with the diagnosis and treatment of illness. . , ,

“The plain fact is that there is so much to be learnt about human ills and their treatment that every doctor should be playing his part in research, however small it may be. After all, what is research in the clinical sense? Is it not the making of careful and accurate observations, the recording of them, their consideration and analysis and (where it would be o£ benefit to others) their publication? Director’s Responsibility “The fact that highlytrained persons need to be called in to make some of the technical observations is but a side issue, for it is the director of the unit, the doctor himself, who must put the finishing touch to the total findings and the conclusions to be drawn from them. If perchance he is one of those rare spirits possessed of the gift of inspiration, those conclusions may well from time to time contain some hitherto unrevealed truth of consummate value; research concerned merely with the careful meticulous collection of facts and their analysis has, however, its own intrinsic importance. “'Hie really good doctor has always welcomed consultations with others, partly to have his findings checked, partly to get the benefit of their knowledge and experience. Such consultations in days gone by took place at the bedside, and the consultant almost invariably gave liis opinion on clinical findings only, though more and more as time w r ent on he would suggest some further

investigation likely to hdp in assisting diagnosis. “Nowadays, except in a case of grave emergency, the patient is likely to have been submitted to a battery of special investigations before the opinion of a consultant is sought. In addition to inviting colleagues to see problem cases at the bedside, the modern physician or surgeon will submit the findings to a conference of several other doctors working in his specialty. “Grand Rounds"

“Not only do individual members within a given specialty or group confer over cases, but, in addition, there are weekly conferences ‘grand rounds’ of all the physicians and surgeons on the staff, sometimes with colleagues from other hospitals. At these conferences the patient gets the benefit of all who may have opinions to offer; but, in addition, new and important advances in methods of investigation and treatment are pooled for the benefit of the whole staff. “At the outset I referred to the physician or the surgeon of old, who, alongside his ward full of patients, had a small ‘side-room’ where he or his house surgeon could carry out simple laboratory procedures to help in diagnosis; and if a surgeon, his operating theatre. “In humble surroundings like these were carried out the simple researches of the giants of the last century, on whose discoveries modern clinical medicine and surgery are based. What they taught us will stand for all time; but with the simple tools which they then possessed they could but define diseases in their grosser and later stages. It has been left for us, with an ever-increas-ing variety of methods and techniques of delicate and intricate structure, to bring up to the light of day so much more about disease conditions in tlieir earliest stages and in their many varieties, with which information we can hope more successfully to plan appropriate and successful treatment. “But the more we know, the much more we find still to be learnt. How fortunate we are, then, with so many problems to be solved, that the passionate desire to ‘search out the hidden secrets of Nature (to quote William Harvey’s behest of 300 years ago) is so insistent m; the minds and hearts of so ■ many young doctors today.

“We must face the fact that the simple side-rooms of our forebears have given place to the clindcal laboratories of today, the organisation and equipment of which must, of necessity, vary in accordance with the specific requirements of the several specialties. Of necessity, too, the clinician of today must spend much more time in his laboratory than did his predecessor of the last century. The equipment he uses is tune con.-uming, for it is expected to yield extremely accurate information. In many cases, to operate it requires many pairs of hands--, in part those of trained medical personnel, in part those of technical assistants. Cut Drug Bill “If funds are in short supply, why not make a much more positive appeal to the medical profession and to the public in the direction of reducing our drug-biU? It is my belief that, if it could be promised that money saved on drugs would be made available for clinical investigation and research, the response would be a very real one.

“Neither the medical profession nor the public of New Zealand can be permitted to accept the suggestion that modem types of investigation as carried out by ‘medical units’ in our hospitals is something divorced from the care of the patients. It has been my experience the world over that, in those departments in whidi clinical investigation and research has reached its highest peak.

patients in the wards concerned receive m<xc meticulous care and consideration than in those in charge of physicians and surgeons not particularly interested in modern progress Integral Part “Rather than segregate our research teams, we should endeavour to follow what is being done elsewhere, and plan our future hospitals so that clinical investigation and research laboratories arc an integral part of the wardstructure, just as were the side-rooms in the hospitals of old. Quite recently the director of a new children’s hospital in Geneva said to me that modern hospitals, to give the best possible service, needed to have at least one-third if the available space devoted to laboratory investigation—pathological, X-ray. cardiological. metabolic, and so on. “Not long ago I spent some weeks in Boston at the Peter Bent Brigham Hospital, where there has been carried out in recent years some of the finest clinical investigation and research that the world has seen. ’ The director of the division of medicine there is Dr George Thorn, a worldfamous physician who was in New Zealand earlier this year. It so happens that his particular field of research—the internal glands of the body, or metabolic medicine—is along the same lines as that of the director of the medical unit at the Princess Margaret Hospital, Dr. D. W. Bea ven. Praise For Unit

“While in New Zealand, Dr. Thorn visited Dr Beaven ’ ■ unit, and saw it at work, and concerning it he made the following spontaneous remarks to me: ‘What Dr. Beaven has accomplished in a short time is astounding; he is carrying out research of a high order, and at the same time giving excellent service to the patients and students under his care and supervision. But he is doing the work of three men. and if something is not done about it, he just will not be able to carry on. -

I “What physician interested I in the work of clinical investigation and research in our hospitals here in New Zealand but would feel it incumbent on him to take up such a challenge? “That there should be any question of segregating the work of this unit so that it would be divorced from the routine clinical work of the hospital is an intolerable thought, to be resisted in every possible way, If clinical and research investigation units are part and parcel of m-xiern hospital organisation elsewhere in the world, why should we in this country choose to plan otherwise?” asked Sir Charles Burns.

Shearers Killed. — Ten African wool-shearers were killed yesterday and eight seriously injured when a truck in which they were travelling plunged down a steep slope at Umzimkul, near Richmond. Natal.—Durban, December 9.