THE DOCTOR AND HIS PATIENT

Grey River Argus, 5 December 1940, Page 10

THE DOCTOR AND HIS PATIENT

Under Capitalism and Under Socialism

By a Socialist Doctor

Wc print below the first of a series of articles by a Socialist doctor who, for professional reasons, must remain anonymous. Ed.

“FROM THE SIXTEENTH CENTURY on, with the development of a new economic order, medicine in the Western world became a trade. We do not like to admit this fact. Wc still talk as if mcdiicine were a rnis-i-ion fulfilled by physicians from humanitarian motives . . . To-day medicine is a service that is purchased by the patient and sold by the physician under a competitive systemThe physician has to charge for every service he sells. The sicker the patient is, the more service will be j required, and the better off the phy sician will be. The system is. par ticularly unsatisfactory since the patient cannot possibly judge how much service his case demands, has to trust his physicians, who wil endeavour to do whatever medical science requires in a particular cas irrespective of costs. And yet wor ing under a competitive system, the physician must try to hold his patient,) to satisfy him within definite financial limits. Every physician knows of such conflicts.” The above is a quotation from the • book “Socialised Medicine in the , Soviet Union” by Henry E. Sigerest, professor of the History of Medicine in the Johns Hopkins University. In this book he shows how under feu- . dalism doctors were salaried officials “to a court, to the house-hold of a nobleman, or to a number of bourgeois families.” And that later on they never sent out bills but received what their patients thought fit and were able to give them. the medical profession was ultimately drag- ■ into the competitive capitalist ■ svstem much against its will. Traces of this resistance still remain in med- ' ical etiquette and the strict rule ; against advertising. i The Conflict Between j Doctor and Patient i 1 When a doctor is confronted with a i patient, one of his first thoughts na- < turally is, can and will this patient < pay me? Usually the doctor has 1 some out-of-pocket expenses in medP 1 cin.es, dressings or petrol, which if i the patient does not pay means a de- < finite financial loss. The doctor is t compelled to consider this, if he ; wishes to survive as a doctor. The 1 patient on the other side is probably < wondering how much the bill is go- c ing to be, and possibly worried as to t how he is going to pay it. Here we 1 have a basic antagonism between the ; doctor and his patient, when the re- j lationship .ought to be one of mutual t confidence, 'll is surprising how,

under a system which penalises the doctors who allow humanitarian motives to influence them, they as a class usually do not allow financial gain to interfere with the ideals of their calling.

Curative and Preventative

Medicine

That prevention is better than cure, everyone will whole-heartedly agree, lyet under our present system preventive medicine is relegated to a quite minor position, and the vast majority of doctors are occupied practically entirely in curing sickness, much of which might have been prevented. Even under capitalism in certain instances preventive medicine is a paying proposition, otherwise certain insurance companies in the United States would not encourage !their policy holders to undergo periodic medical examinations at the expense of the company. That the prevention of ill health is to the advantage of every member of the community is obvious, but unfortunately it is also obvious that it is not to the advantage of the medical profession under a system of the competitive marketing of medical treatment.

Do we Get the Medical Attention we ought to Have?

The answer is “yes” if we can afford to pay for it, but as only the rich can afford to pay for it without restricting their expenditure on other items, often necessities, the answer for the majority must be “no.” People do not consult a doctor when they ought to, because they know it will be difficult or impossible to pay him. This applies more especially to the country districts where the mileage fees are often prohibitive to the poorer members of the community. The Hospital Benefit has, of course, relieved the situation in the case of serious illness, but still a doctor’s consultation fee is a consideration to most people who are not members of a lodge or medical association. Under our present system the tendency is for the rich to get too much attention as, because they are able to pay, they are encouraged to consult the doctor frequently and their ailments are made a lot of, which is not always the best thing for the patient, while the poor are apt to be dismissed as quickly as possible with only a cursory examination.

(To be continued).