THE FAMILY DOCTOR

Greymouth Evening Star, 6 December 1929, Page 4

THE FAMILY DOCTOR

advantage over specialist. It is a platitude that the backbone of medicine is the general practitioner, and a moment’s thought shows that this backbone is rapidly changing its functions and shdpe. Whereas a hundred years ago people were content to live and die under the auspices of their family doctor, they nowadays de-, iriand treatment from hospitals, advice from specialists, and public services of every kind from whole-time medical officers (writes a medical correspondent in the London “Observer”). The baby of our own times gets his greater longevity at the expense of employing (at various stages of his career) an obstetrician, paediatrist, laryngologist, radiologist, abdominal surgeon, physiotherapist, aurist, psychologist, neurologist, dentist, oculist, and pathologist? —not to mention many other authorities —and the days have gone by when the ordinary citizen was content with a cheerful doctor and a respectful undertaker.The various specialists have developed inevitably with the growth of knowledge, and so much has been learnt in each of them that, unfoitunately, only the expert can appreciate its significance. Every h un ?an disorder requires high technical Skill for its proper treatment, and often foi its diagnosis, and the obvious moral is that all delicate decisions should be taken out of the hands of the family doctor—whose little knowledge can only be dangerous —and that we should watch without regret his gradual degeneration into a well-man-nered shopwalker who will direct customers to the right department for specialist advice. This leads up to the conclusion that genuine general practice is out of date and must give place to a highly organised system of hospitals and clinics. To a certain extent this is true, but there is also much to be said for another ancient platitude which says “You must treat the patient, not his disease.” What are the wants of our patients as opposed to the needs of their Since illness is essentially a failure to cope with environment, and this failure always has a mental side, the first requirement of a sick man is usually relief from anxiety, and especially responsibility for the conduct of his treatment. Is this to be secured by letting him wander unhappily from specialist to specialist, a reed shaken in a wind of words, not knowing which to believe? Is it even to be got by tying him down in a bed and loosing on him every kind of investigator and enthusiast? No. It can only be arranged by putting him 5 in the hands of some wellinformed and sensible doctor, who will take over the case wholeheartedly and see him through to the other side (whichever that may be) with the least possible torment of body and mind.

No sensible person would ever want to dispense with the admirable service which every kind of specialist can render in his proper place, but when one is ill a few specialists go a long way, and the war against disease is better waged by a dictator than a committee.

The general practitioner is in theory the proper person to assume dictatorship in time of catastrophe, because he should have the confidence of those he serves in times of peace. He, after all, is the man who rightly said that Henry’s abdominal pains were not due to appendicitis, despite their superficial resemblance to those of Mrs Johnson’s child, who was taken to the infirmary last week. He it was who explained that it is not really necessary to eat brown bread as a routine if it causes continuous indigestion. He it was who reassured us' when the newspaper said that smoking led to cancer of the tongue, and he it was who fully earned his high fee by his encouraging daily visit when we had influenza. In a hundred and one ways the family doctor is capable of smoothing the rough places of everyday life, thereby increasing his prestige, and therefore his value, when exceptional troubles arise. In this he is doing work which no one else can do so well. The hospital, the specialist, the medical officer of health, the philanthropist, the social worker —even the journalist—none of them has his chances. And especially none of them can have the same useful influence on the developing lives of children, whose care should take a principal place in his thoughts. These are some of the reasons why the general practitioner should be the main standby of the people in health* and disease. The only way in which the family doctor can remain efficient and hold his own is by being given a share in the working of hospitals and clinics controlled by the public services. Already public bodies largely employ whole-time officers to look after fevers, insanity, tuberculosis, and venereal diseases, and have assumed responsibility for school children, factories, and maternity and child welfare. The result is a steady decline in the ability of private medical men to deal with these branches of medicine.

If the public hospitals are to follow the same policy and lose the present chance of co-opting general practitioners to their staffs, it will ultimately go far towards freezing this part of the profession out of existence. For it is useless to expect efficiency from men who are cut off from many of the tools of their craft and from the professional co-operation which gives that craft the best chance of success.