HEALTH CENTRES

Poverty Bay Herald, Volume LXIII, Issue 19139, 7 October 1936, Page 12

HEALTH CENTRES

TEAMS OF DOCTORS A VISION OF THE FUTURE B.M.A. HEAD’S SCHEME “The ‘health centre’ is not very easy to define, but, I envisage a. central hoard, based, geographically as it Were, on the chief hospital, voluntary or municipal as the case may be, but representative of all interests and institutions concerned with •tlia*health of the district.

“Rorthd the table would be seated not only the municipal lions and the voluntary lambs, but, where a medical school is included, delegates of the more academic departments of medicine. “The chief duty of such a board would that of co-ordinating all the preservative, preventive, aiul curative, services!' within the district, of avoiding overlap and wastage, and 1 of thus assuring the public that its financial contributions to the common cause of health, both ivoluntary and levied, ate used to tiie Ifest economic advantage. “The general practitioner has often been,'called the backbone of the profession. ,Ho should, I suggest, in future l o regarded as the-finger of the .profession. Fingers are the most sensitive parts of our peripheral anatomy, the most highly trained instruments for. detecting irregularities and abnormalities in the objects with which they ccnn© jn contact, ancl it is to those fingers o| the profession, the

ers, that we must look for the discovery of imperfections in our midst. It should be the obligation of the health centre, in its capacity of co-ordinator of all services, public as well as private, to make sure that general practitioners are rightly regarded, and employed as priests of preventive medicine,’’' recently stated Sir Farquliar Buzzard, president of the British Medical Association. GREATER PUBLIC INTEREST The ordinary man of £0 years ago took but little interest in matters of medicine and health, for lie had the feeling that it was a subject for the doctors and the specialists. Blit nowadays, when the president of the British Medical Association, Sir Farquliar buzzard, in his address visualised the creation of “Health Centres,” in different parts of the country with the doctors working in teajns and the general practitioners taking their share of this work —tho ordinary man begins to take, notice. The Lancet, referring to this subject, says: “Tho specialist has somehow acquired a higher status, both in profession snil in the eyes of the public. Ihe practitioner tends to feel that, by comparison lio is small fry, and the. public begins to think that in any serious illness the sooner the specialist, is obtained the better. . “A specialty is often an easier task than, the general practice, and frequently firings greater financial rewards; at other times it offers greater scope for intellectual ability and energy; general practice comes to he regarded! by students as less attractive, and those who eiiier it often do so because they Ikiao less educational equipment or less money than their fellows.

“Once in it they find themselves hard worked and closely tied in an engrossing day-to-day task, and few of them will deny that in. the course of their twenty, thirty, forty years of practice, medicine marches on, and they get sadly and unavoidably left behind. DOCTOR-PATIENT RELATION “On the other hand, the great strength of the practitioner is his unique opportunity of coming to know his patients intimately an,l personally over the years, aiul his power to help them both in sickness and in health which that close relationship gives. “It, is universally agreed that this doctor-patient relation must be preserved. It is coming to lie realised that if (lie doctor feels himself turning more and more into a specialist’s usher and a filler-in. of forms, working harder and harder at a duller job ill order to matte a living, he will become so bad a doctor I that, the doctor-patient relation will not • ho worth preserving. “This danger is not. to he avoided! merely by a jealous defence of the present state of general practice against I ! further specialist encroachment, by j State services or otherwise, but. only by ['incorporating the practitioner in a unit, larger than one or two or three-man 1 partnership. < “Sir Farquliar Buzzard adumbrates' such a unit and calls it a Health Centre —a local structure, based on: a large, fully equipped hospital, and controlling all tho preventive and curative medical services of its district—a pattern not dissimilar from that formulated by Lord Dawson and others some years ago. PART TIME IN HOSPITAL I “The practitioner must foci teat he belongs to that centre or that hospital,

just as much as the senior physician or surgeon does; Sir Farquhar j’uz/.ard would give him some responsible parttime appointment in the hospital' or one of the associated services. We can. picture him frequenting its buildings and getting to know the specialist members of its stall personally. “lie may yield the control of bis patients to others while they are in need of specialist management, but he should have time and opportunity to know and understand what is happening to them, and to share with the specialists his knowledge of the patient’s history and circumstances.

“Given sneli real co-operation nnioi»" all those whoso concern is. for the health of 1-lie sick fund of Ute healthy), the practitioner might lrally become, in Sir Earquhar Hu/.x,aid’s happy metaphor, the sensitive and skilful lingers of the professional structure: he would lose something of his present independence and isolation, hut the closer contact with his colleagues and the motive of loyalty to the local ‘centre’ to which, they all belong would compensate by adding interest, to bis work, and perhaps lightening its burden. “Sir Earquhar Ruzzanl would bring all the practice of a district, and all the practitioners, into the ambit of bis Health Centre. His scheme implies lhal a. large part of every doctor’s financial rewards should come in the form of a salary rather than as fees from individual patients. While most senior practitioners would look with horror on such a. change, there are many already among the younger ones who would welcome ' t- “IDEAL DOCTOR-PATIENT RELATIONSHIP’’ “The ideal doctor-patient relationship is sometimes marred by the making of

a direct payment irom patient to doctor, and most doctors in their hearts would sympathise vitli the paediatrician who said, T. am at my best in dealing with the children ot’iny colleagues where no question of fee!arises.’ This aspect of the problem nefds fuller consideration. The disadvantages of an entirely salaried service are obvious.

“If the stimulus of economic competition among doctor is to be diminished, it, must lie repined in part by such things as ail assminee of economic security, possibilities' of economic betterment within the new scheme, and—more important—tje joy of interesting work in good compnv midi of loyally to an institution with high ideals. CniJRAHKOfS THINKING “A nationally organised medical service is too largo! and too impersonal to evoke that lofalty, but a service organised in eompjet and reasonably independent local lints may easily do so. 'That is an essentid feature of Sir Earqiiliar Buzzard's biggest ion. His whole address is a pioO of courageous and constructive thiuimg, which should command the cael'ul consideration of the medical proh-simi, the Stale, and t.lie public at larg.”