Did old-style family doctors give better value?

Press, 23 June 1981, Page 12

Did old-style family doctors give better value?

A recent meeting held in Canterbury by a group of doctors sought to establish a "guideline fee" for their patients. Dr P. W. Law, spokesman for the meeting’s organisers, said that the fee was established to be "in keeping with the service provided." The meeting decided to set a guideline fee of $11.25 for a consultation. This fee. according to Dr Law. was a gross one. offset by the normal medical benefit. If the medical service benefit were increased, the charge to the patient could be reduced. At present, the Government pays $1.25 for an adult. $3 for a pensioner, and $4.75 for a child up to 16 years, for an ordinary daytime consultation. The $1.25 subsidy has been increased only once since it was first introduced forty years ago. At that time the 75 cent subsidy made up more than half the cost of consultation, but the $1.25 subsidy is now worth less than 20 per cent. Perhaps the medical service benefit t>r doctors’ fees are due for a rise. Costs are going up all the time. Rent, nurses’ salaries, high insurance, premiums, office and equipment costs

have all sky-rocketed in the last few years. Fair enough. But if we are to pa>' more to see the doctor. either indirectly through our taxes if the medical benefit is increased, or directly as we leave the surgery, perhaps the time is ripe to reassess the service the general practitioner provides. The days of the family doctor as a father figure have gone. He had time for a few pleasantries before the consultation began, so you were relaxed and ready to come to the point. He made house calls'and was accessible by phone when a crisis in the home erupted. The family doctor' knew you. and probably your whole family, by name. Today, he has been replaced by an impersonal, often younger figure, who "deals" with your problem in 10 minutes, demands pay-

ment following the consultation. and rarely makes home visits. . Your health is a very personal matter and to have it dealt with in so brisk and off-hand a manner does nothing to reassure you about your anxieties — some of which you probably never

get to tell the doctor because of embarrassment or fear. Then there is the guilt feeling. I wonder how many patients begin the interview with the doctor by saying. "I hope I'm not wasting your time.” or "It’s such a little thing to trouble you with." It seems to me that a patient is entitled to his doctor's time if he or she is paying for it, and the ailment in question is usually no small thing to its sufferer. I'm not really suggesting that all doctors are unfeeling. disinterested in their patients and just shoving them through as fast as possible in order to get rich quick, but is the over-all service as good as it used to be? Economic and social changes over the last decade have meant a drastic change in the doctor-patient relationship. Soaring costs mean the surgery has to be run as a

more business-like venture. Today's families are more mobile, and will consequently change their doctor more often. A visit to the doctor is no longer regarded as a regular event, but more often a last resort after you’ve tried everything yourself.

Why? Because of lack of confidence in the doctor’s caring (I'm not questioning their medical expertise), or is it just that a visit to the surgery has become too expensive. Many New Zealanders, and not just the unemployed and those on social welfare benefits. can ill afford the national average fee of $8 to visit their doctor. This is reflected in the steady decline in attendances in doctors’ surgeries. In 1980. visits were down by 600,000. This is in spite of the fact that doctors have traditionally forgone a percentage of their fees where

thev consider patients are unable to pay. Obviously people have their pride. One trend that is emerging is the increasing number of patients attending the accident or outpatient clinic at the nearest hospital, where the service is free to them but expensive for the tax payer. At Christchurch Hospital’s accident and emergency department. attendances rose from 59.625 in 1970 to 73.347 in 1979. 'Outpatient attendances rose from 190.398 to more than 298.000. It cannot be denied that falling attendances at the surgery are related to cost. Yet some of the population at least are prepared to pay, sometimes quite high prices, for. medical advice. Witness, the growing number of" specialists.

In the Christchurch telephone book, of the 270 doctors listed. 74 are specialists. I’m not certain that the

raising of the medical benefit would necessarily be a good move. In Britain, where a visit to the doctor is on-the National Health, waiting rooms are filled to overflowing with patients who consult their over-worked doctors about the most trifling ailments. Many New Zealanders are. finding’ medical insurance schemes the .best way to finance their medical care. Twenty per cent of the population now belongs to the Southern Cross Medical Care Society, the largest of the medical insurers operating in this country." But there will always be those who cannot afford to pay for an occasional visit to see the doctor, let alone regular medical insurance premiums, tax deductible or not. In these cases let us hope as Dr Law. assures us, that; "Those with financial problems will be known to their family doctors, or they should make these known, ■and they will be fairly treated.” That requires good communication. So it’s back to that doctor-patient relationship again.