Doctor Plays Prominent Role In Health Team

Press, Volume CVI, Issue 31326, 23 March 1967, Page 7

Doctor Plays Prominent Role In Health Team

r The doctor plays a unique role in the health team, partly for historical reasons and partly because of the length and scientific character of his training. Nevertheless he is only one of several partners and his efficacy depends on the co-operation of all other members of the team, says a news release prepared by the World Health Organisation. When man finds himself without food or shelter, he usually takes matters into his own hands, but when he is stricken by disease he turns elsewhere for help, to the supernatural, or to another man to intercede for him or to take care of him. He is now only a step from the witch doctor and the medicine man, traditional healers who are to be found even in the most advanced societies, and in certain parts of the world sick people still have no alternative to such healers. Strict Training The need for help which exposes man to the frailties of other men has led society t' regulate the practice of medicine. Nowadays only those whose training has prepared them for the unimpeachable practice of medicine are allowed to treat others. Medical education is the acquisition of knowledge that

makes it possible to use scientific judgment in interpreting the indications of disease, in deciding on treatment and in forming an opinion as to the outcome. It is difficult and long, requiring a minimum of six years’ university level education and perhaps four more of specialisation. There must be time for a strict training in ethics: changing nature by nurture. The medical man comes to know much that is intimate about his patients and can do great harm if he is not trustworthy. The Hippocratic oath that every physician takes is 2500 years old. Medicine and religion grew together and led to the establishment of universities. Changing Status

Only a few centuries ago medical education was mainly apprenticeship. Formal training gradually became the rule, shorter at first and lengthening with the advance of the sciences on which medicine is based. These advances have been particularly rapid in our times. Fathers of the present generation of doctors did not study microbiology at medical school: radiology is new, and techniques such as electrocardiography have quite recently become part of medical practice. As knowledge advanced and it became clear than noone should be allowed to practise medicine unless he had learned all the basic essentials, medical education became essentially the same in all countries. There is still room, and need, for familiarity with locally prevalent diseases, but the scientific basis of medicine is universal. There can be only one medicine —that which enables its practitioners to use the best possible scientific judgment. The responsibilities of medicine, and its intellectual, human and material rewards have for thousands of years attracted some of the best men of their time. While these attractions are still strong, other equally challenging and satisfying careers are now open, some of which are less expensive to study, less exacting and bring quicker and larger financial rewards. Many people who might have gone into medicine are now drawn to the technological sciences: others become research workers, sometimes

after they have studied medicine.

This expansion of knowledge has had other results, for a medical student cannot now learn . everything that medicine has to offer, nor can his studies be any longer than they are. In any case others can perform functions that do not require full medical education but are based on medical knowledge. The separation of pharmacists and dentists from medicine is relatively old. The separation of nursing as a profession dates from about a century ago. Later still other professions were recognised, optometry, physiotherapy, Xray and medical laboratory technology. Sanitation, which is the application of principles of environmental hygiene to protect man’s health, has become another profession, represented by the sanitary engineer and the sanitarian. Sometimes these are all grouped together as the medical professions. They have been also called “medical and allied subjects,” "medical and paramedical professions” and, collectively, the “health professions.” Responsibilities Shared

Whatever the term used, the fact remains that the care of health and the prevention and cure of disease have become a team affair rather than the responsibility of the doctor alone. The number and quality of the services he can perform depends to a great extent on the number and quality of the persons who share his responsibilities. In many cases some of the functions of each of these professions can be delegated to persons with more limited training called auxiliaries. There are auxiliary and assistant nurses, dental aids, sanitation inspectors, laboratory technicians. There are medical auxiliaries to whom a doctor can delegate certain functions in the diagnosis and treatment of common diseases. The greater the number of persons practising the paramedical professions and the more auxiliaries there are, the better the service a doctor can give. This service is of a nature that he alone is able to provide. It is common to judge the services available by comparing the number of doctors to total population. Some countries are relatively well provided for: Austria, Czechoslovakia, France, Israel,

Scotland, the United States of America and the U.S.S.R. have one doctor for between 500 and 1000 people. The proportion is very small in many others, especially some new independent countries like Mali, Niger and others, with one doctor for over 50,000 people. Never Enough This ratio gives only a rough indication of the situation. Doctors may be concentrated in one part of the country, very often in the cities where hospitals are to be found. If communications are good, people far away from a doctor may be better served than those nearer, but less accessible. The nature of the prevalent diseases in a country also makes a difference. Diagnosing and treating malaria or yaws is much less time-consuming than heart disease, cancer or mental illness. In places where the latter are common, people are more likely to call the doctor, for in such countries the preventable diseases have been reduced and the average age of the population has increased. It also makes a difference whether, in the main, the population depends on the private practice of medicine or whether medical care is part of the public and community health services. In fact, the ideal is difficult to define. Medicine is no exception to the economic rule that the satisfaction of one need creates other needs more difficult to satisfy. The demand for physicians increases with the development of the health consciousness of the population and the sophistication of the services it demands. In the United States of America, for example, it has been stated that America is not likely to ever be able to produce enough physicians to satisfy growing national needs. Help from W.H.O. For the last 20 years it has been the privilege of W.H.O. to help the countries of the world in their attempts to develop better services for the health care of their people, based on an adequate medical profession. W.H.O. puts the collective experience of its 127 member states at the disposal of individual countries. It is helping with fellowships to train doctors and paramedical personnel abroad, when educational institutions are not available in the country itself. It is helping countries to assess their needs, to set goals, to develop their own training facilities. It provides teaching personnel from institutions z of other countries. It is helping selected doctors, nurses, dentists, sanitary engineers, sanitarians to prepare for teaching and for careers in research. It is helping medical schools in their efforts to raise the standards of training while adjusting the programme to the local patterns of disease. It is teaching more about prevention and about the role of the doctor as a team leader to guide and supervise his co-workers.