HOSPITAL AMALGAMATION SAID TO BE IMPRACTICABLE

Northern Advocate, 1 December 1936, Page 5

HOSPITAL AMALGAMATION SAID TO BE IMPRACTICABLE

WHERE DOCTORS DIFFER: DEPARTMENTAL ADVICE SOUGHT

At a special meeting, the Bay of Islands Hospital Board received reports from its medical superintendent and secretary which confirmed it in its attitude of opposition to ihe scheme of an improved medical service by amalgamation, as sponsored by Dr. G. M. Smith and the Hokianga Hospital Board. Following a full discussion, it was decided, with a view to obtaining further advice to forward both Dr, Smith’s proposals and the reports to the Health Department.

The meeting also passed a resolution in favour of Combined action by the Northern hospital boards to impress upon the Government the necessity of providing assured means for a-n improved medical service for Maoris, and so relieve a liability• which was considered to be undoubtedly one devolving upon the State.

Dr, Frengley’s Report.

medical superintendent of such has to have a sound knowledge of medicine, surgery, midwifery and the simpler types of ear. nose and throat, and orthopaedic surgery. It is also obvious that he cannot become an expert in any one department, but is saved from the bias that so many specialists develop towards their own branch. The major surgery that we perform is not at all difficult for anyone with a good knowledge of anatomy and a sound surgical technique. The major surgical emergencies such as acute peritonitis, torn bowel, and depressed fracture of the skull, show results that will compare favourably with much larger institutions. In fact I would welcome any inspection into my surgical records. The vast majority of surgical cases are cut and dried, diagnosis is comparatively straight forward, and you operate. Many medical cases tend to be obscure, and on the whole medical cases have caused me more anxiety than surgical. The occasions on which I have called in a consultant have nearly always been medical cases. The weakness of a one-man hospital lies in errors of diagnosis.

The medical superintendent of the Kawakawa Hospital. Dr. Q. J. Frengley, submitted his report as follows: —

Is a surgeon-specialist necessary? —At present we send to Auckland cases of cancer or suspected cancer. Modern experience shows that the best results are gained by a team of specialists (surgeons. radiologists and radium experts) constituting a cancer clinic. In many cases, radium needles should be inserted into the surrounding tissues at the time of operation, and if deep X-ray treatment follows the operation, it should be administered by a radiologist in immediate touch with the surgeon. Therefore, cancer cases should still go, and the vast majority of such cases can travel very comfortably to the centre where the special facilities are available. We also send a number of the more severe and specialised cases to eye, ear, nose and throat, geneto-urinary and orthopaedic specialists. Since these cases are seldom those of desperate emergency, they can easily travel to Auckland. At the rate that Northland is developing, I expect that it will not be more than a year or two before an eye and throat specialist will be in constant practice in Whangarei. Such cases are best treated by the specialist throughout the whole time. Therefore, it is better for the patient, and hauch more economical, to send the patient (to Auckland rather than bring a specialist to him. Further, since the majority of cases are not longer than two or three weeks, the separation from their relatives and friends is not serious. There are a number of other cases, not necessarily surgical, which for various reasons are sent to Auckland. The majority of such should still go there.

I am of the opinion that the best method of overcoming this would be to appoint a first-class physician as consultant to the four hospitals.

A sound physician is an excellent surgical diagnostitian and in doubtful surgical cases of more value than a specialised surgeon, who is too prone to say, “Let’s open up and see.”

Could any surgeon-specialist do the work outlined in the scheme? —That is extremely doubtful. Consider what he has to do: (a) Run his own hospital and see all the patients twice daily; (b) Do all the major surgery for the combined districts. I presume he will arrange to visit the three main hospitals in rotation at about four or five days’ interval (it should be more often,if he is to be responsible for his own cases as he should) and perform all major surgery collected in the interval. But what about urgent major surgery? (As a rule urgent surgery is more difficult than routine major surgery). For instance he might have to perform three operations at Kaitaia. He would probably arrive the night before so as to be fresh in the morning. Then it is not at all improbable that a surgical emergency might be admitted to one of the other hospitals, say a perforated gastric ulcer at Kawakawa. Back he would have to come, tearing three hours when every hour counts with the patient, perform that operation and go back to Kaitaia to keep faith with the patients who are all screwed up and expecting cheir operations. Then there might bo a case of head injury with depressed fracture at Rmvene to attend to immediately, and so on. Judging by the frequency that urgent work crops up, such a picture does not seem at all unlikely. Of course the medical superintendents would have to do some of the work, but there is a very real danger that if this scheme is carried , into practice, the medical superintendents at some of the hospitals might not be able to do major surgery, for the reason that a man able to do major surgery is not likely to take a position in which he would be just a super house surgeon. A strong man might be able to stand the strain of the surgeon-specialist for a year or two, but his surgery must de[teriorate.

It is obvious wherein lies the weakness of -the one-man hospital. The

Can five men give a free service to the population of the four boards? — I am emphatically of the opinion that it is impossible. A free medical. service always means that the patient will demand the doctor to see him in his own home. Why should he pay money to go and see a doctor? Many years ago a medical club was formed locally. It had to be disbanded because no one would go to the doctor, but all expected him to come to them. The extra district nurses are not much safeguard. They will save the doctor some trips by sending patients direct to hospital, but in the majority of cases he will have to follow them—a wasteful service. The local population within less than a five-mile radius is over 1400. That is about all the local superintendent will be able to cope with, unless he has a house surgeon. Incidentally, a net sum of £1250 is unsatisfactory. It could be reduced a little, but there must be some definite arrangement on a mileage basis for his car. There are at present in the combined districts six private practitioners. there may shortly be seven (Broadwood). The people in these practices will demand that they should be able to have free attention from their own medical attendants. This will mean an additional expenditure of at least. £6OOO. Further, the exacting demands of a free medical service on the doctors will necessitate more private practitioners.

Will it be satisfactory to have the surgeon-specialist operate in different hospitals? —The surgeon who performs an operation must always be entirely responsible for the patient's aftertreatment. Therefore the surgeonspecialist should see his operation cases every two or three days. Any ether arrangement will be unsatisfactory.

Will the surgeon-specialist be able to relieve the medical superintendents? —lf the specialist is to relieve the superintendents and have his own holidays, he will have to be away from his base for five months of the year. That would be impossible, therefore no saving can be allowed under this heading.

Can the medical superintendents relinquish the control of their hospitals? —Emphatically no.

Can the X-ray plant be transported about the country?— Portable x-ray outfits are made but they are not as powerful or efficient as those at present installed in two of the hospitals. More elaborate x-ray installations are designed to be erected in a permanent position. They are also too heavy to be transported. Sihce fractures cannot be transported easily or comfortably. a central x-ray plant would not be suitable. Could nurses be sent from a slack hospital to a busy one?— A hospital must be staffed up to capacity as it is never known from day to day how many new patients will be admitted.