HOSPITAL EXPERIENCE NEEDED TO SECURE SAFE AND EFFICIENT SURGERY

Manawatu Times, Volume LIV, Issue 6859, 14 March 1929, Page 8

HOSPITAL EXPERIENCE NEEDED TO SECURE SAFE AND EFFICIENT SURGERY

Request of Medical Profession ONE MAN HOSPITALS MEAN LOWERING OF STANDARDS ‘ ‘ The policy of employing a minimum number of stipendiary officers to do all the surgical -work at the larger hospitals appears to be increasingly favoured by Hospital boards in different parts of the Dominion. This policy in the opinion of the College is a bad one, inasmuch as it must inevitably lead firstly to a stereotyped and unprogressive standard of surgery as practised in the hospitals, and secondly to a lowering of the standard of surgery as practised outside the hospitals. To perpetuate a policy of exclusion of a visiting staff from our larger hospitals will in the opinion of the College be most unwise and, will be fraught with all the ugly possibilities of incompetent surgery.”

These were the concluding remarks delivered by Sir Louis Barnett (Otago) when urging upon the Hospital boards’ conference in Palmerston North yesterday, the need of a revision of the system of employing medical men in the hospitals of New Zealand. Sir Louis added:—

“Any intelligent and fairminded layman who gives a little study to the

aims and ideals and policy of the oldestablished B.M.A, and the recently established Australian College of Surgeons, will recognise that these bodies aro not close corporations of doctors banded together with the one object of advancing and safeguarding their own financial position, but are truly as much concerned with the public welfare as they are with their own interests. The College of Surgeons of Australasia, although its Fellows (I think without exception) belong to the B.M. A. is a separate organisation which concerns itself particularly with the practice, progress, and honesty of surgery. One of the main objects of the College, an object on which great stress is rightly laid, is tho provision of adequate post-graduate surgical training in hospitals, whereby medical practitioners may have opportunity of acquiring that, practical knowledge and experience which aro of such vital importance in tho conduct of serious surgical cases. You may say—surely if a man has gone through a six years’ course of instruction at a good medical school and has been granted a diploma entitling him to practice medicine, midwifery and surgery, he is fit to do any surgical work he has tho confidence to undertake. True it is that there are surgeons in practice who are doing well and who have the confidence of tho public and who nevertheless have had little or no post-graduate hospital experience, but gentlemen, these aro tho rare notable exceptions which prove the rule, and these men successful as they may be, would undoubtedly be more efficient if they had had hospital advantages. "The College of Surgeons claims that tho proper way, and with few exceptions the only way, to acquire the training and experience necessary to fit a medical practitioner for tho responsibilities of major surgical practice, is by a long period of several years’ surgical service in a hospital, at first in a junior and later in a senior capacity. ‘‘Only by the provision of ade quote facilities for the obtaining of such surgical training and experience in our main hospitals is it possible for the community to be supplied with an adequate number of safe and efficient surgeons. "Without such facilities major surgery could still be done and would stili bo done, but doctors know and tho public ought to know that in general sound and safe surgery cannot be expected under such limitations to efficiency. Therefore it was resolved at the annual meeting held last month at Wellington, that this deputation should wait upon you, and explain how vitally important it is in the interest of the public welfare that facilities should be provided at our public hospitals for the training of a sufficient number of competent surgeons to supply the needs of the communitv.

The College’requested boards to give 1 earnest consideration to the following recommendations:— (1) That facilities should he provid--1 ed at the public hospitals for the training of an adequate number of compe- . tent and trustworthy surgeons to supply the needs of the community. (2) With this end in view, thcro should be appointed at every hospital of 100 or more beds one junior or assistant surgeon and one senior surgeon for every 25 surgical beds in the hospital. (3) That these appointments should have a tenure of three years, the holders at the end of their term being eligible for re-election or promotion. (4) That the Hospital boards in dealing with applications for these appointments should seek the advice of a medical committee. Sir Louis was supported by Mr. B. S. Wylie, of Palmerston North, who stated that the former had admirably expressed the opinions of the College of Surgeons regarding the question of Hospital staffing and its importance in the production of sound, efficient surgery, not only for tho hospital concerned, but for the community at large. The question had arisen regarding the efficiency of what had been termed the “One Man Hospital/' that is, a hospital where the medical service consisted of one or more stipendiary medical officers who performed the entire professional work of the hospital. For some two and a half years he acted us director of the division of hospitals with tho Health Department, during which time he inspected and visited annually nearly every hospital in tho Dominion, (certainly all those of any size), and thereford had better opportunities than the majority of people of forming an opinion regarding the character of tho professional work done in those hospitals. What did an inspector look -at in determining in the course of a more oi less brief visit the nature of the professional work done? Records wero one of the chief things he looked at. Well-kept, well-ordered up-to-date hospital records meant efficiency and well-cared-for, well-looked- i after patients. At the dates of his in- ' spections the hospital records were in a large number of cases poorly and inadequately kept, and often not forth- i coming, and follow-up systems did not ’

exist. For these and other reasons he did not form a favourable opinion of the majority of one man hospitals, and felt sure then as he did now that, the presence of a properly organised body of medical men in a hospital of any size was essential for the proper conduct of the clinical work of the hospital and for its professional progress.

Sir Louis Barnett stated that reference had been made to the question of remuneration but that should be a question for each board to consider, having Tegard to fairness to both patient and medical men. The medical profession always gave gratuitous service to the needy poor but it would be scarcely fair to expect them to attend wealthy people for nothing. However, no demands were being made at the present time. Mr. Wylie amplified his address by stating that what was needed was a regular medical inspection of all hospitals. Would capable medical men accept the position of assistant surgeons? asked Mr. J. 11. Hornblow. Sir Louis replied that a young doctor who wanted to make good would not refuse any chance of improving his knowledge. Mr. Hornblow: They all want to bo seniors. Sir Louis: Tako no notice of that man. The chairman considered that the Dominion’s young men should be given every chance to make good and no doubt the Hospital boards would do their best to assist the College of Surgeons in its endeavour.