THE "CLOSED" TYPE

Evening Post, Volume CXXIII, Issue 46, 24 February 1937, Page 6

THE "CLOSED" TYPE

DR. STOUT'S REVIEW

Various aspects of the Hospital system in New Zealand were touched on by Dr. T. D. M. Stout in his presidential address at the opening of the B.M.A. Conference last night, particular reference being made to the "closed" type of institution.

"We have a- hospital service composed ot public hospitals and private hospitals,", he said. "In the public hospitals, controlled by elected local bodies, the medical service is rendered by the profession under different conditions. In the larger hospitals the service.is carried out, apart from the superintendents who are mainly administrators, by a visiting medical staff acting in an honorary capacity, and a resident staff of house ' surgeons and registrars, composed- of more junior medical men. This method of staffing has enabled the inmates of our hospitals to have the services of the most highly-trained and efficient members of the profession, and has enabled the community to obtain the services of our profession in the treatment of those unable to pay for those services themselves, and- without any cost: to the community.-' -."■''

"In another group of 'hospitals, including several large hospitals in the large provincial towns in New Zealand, the hospitals are of what is called the 'closed' hospital type. By 'closed' is meant that the medical staff is entirely a whole-time stipendiary staff, working solely in the hospital, and without any contact with private practice outside its walls. The staff is necessarily a small one, and the senior members are called upon to carry out all branches of medical practice,'and to accept every kind of responsibility.

"The lack of contact with the medical profession outside the hospital ren.ders it impossible to make the hospital the centre of- medical knowledge and experience it should be in the community; and, besides shutting off the | staff itself from healthy interchange of ideas and experience with their fellows, prevents the proper development of experience in the profession in that locality. ; .This must, as; is readily recognised, inevitably react to the pre-! judice 'of the- interests of > the people in the community. :. There is. unanimous opinion -in ~ the. profession, amongst i the .leaders, and those of the greatest experience,, that, ;'the ■ closed hospital, though/ possiblyl, easier to administer, is definitely-much inferior in medical practice..-.'.../ NOT BRICKS AND MORTAR. "In this regard may I point out with all seriousness that a hospital consists not of bricks and mortar, or wood and iron, but of the human beings working" in -fliat institution, and particularly the medical staff, though I would be the last man-not to.give every credits- and praise to, our great cowOrkers/the nurses, and also the other members df the''hospital staff., I

/ f'"We have seen' during the war most efficient ' and- 'successful', hospitals in tents and; in huts', hospitals staffed by .doctor's;' drawn from civilian practice, where their- hospital experience, gained ;&S: irierhbers ..of the . visiting staffs of hospitals,';, ~was /readily " 'available. for t-ne^ser,yice!:; of •th eir ' countrymen. If oliriioSpitals^had all beeri. of the closed hospftaJJ'^Sfpe-f th ere. would not have been available an adequate supply of trained medical personnel suitable for the serious major surgery met with in war.

"7 "In the smaller hospital:; there are sevei'al types of-hospitals with differ-.j ent-,melhbds of Staffing, and1 catering.1] for^ different types ,of patients, andsome of these hospitals are.of the community hospital1 type, 'where all mem- j bers of the community ..can utilise 'the.;.: hospital, can pay-for accommodation, as they desire, ceut obtain the services':' of the medical.1, practitioner of : their ' choice,.and can also.have the satisfac'tiqn'; bf retaining {-their., independerice by'being ableta'pay for his services, :-:"As: regards the .private hospitals, there is a variation':between the very, large' hospitals, mostly, organised by religious orders, to the small hospitals generally setup.in converted pri-; vate houses. The..hospitals vary from: those fully equipped to deal with any type of. .patient to those equipped foronly ■ special types of patients. The., development of the larger private hospitals: ioi recent years shows clearly the need'for-further provision of beds of the: private and intermediate type, a need which',has not been, met in our public institutions."