FAMILY DOCTORS

Poverty Bay Herald, Volume LXV, Issue 19758, 12 October 1938, Page 11

FAMILY DOCTORS

BRITISH HEALTH PROPOSAL A PERSONAL SERVICE TWO VITAL I'KIN'CIN.K.S FREE CHOICK & INSURANCE "I want you 10 look on medicine as a great industry, an industry whose product is the health, both physical and mental, of the community which it serves.

"As I sec it this industry is one which is provided with a plant that is excellent, efficient, and up to date it. practically every way. Ido not think, however, thai the best use is made of this plant. It has grown up haphazardly and piecemeal. There is great want of correlation, great duplication of effort." said Dr. Colin D. Lindsay in his presidential address to the British Medical Association. He went on to say:—

-First look at what we may call the selling end of the industry. If you want to buy some unusual article you go to a retail shop and make use of their experience, with wholesalers and the like, to get what you want from the most, appropriate source. Some such arrangement is necessary in medicine, and as things are at present this arrangement is not working smoothly.

"The fault is perhaps largely an administrative one, but I believe clear thinking on the exact nature and function of the medical practitioner is also lacking. The matter of health and its maintenance ; .-

so essentially a personal thing that the personnel of this (retail) division of our health industry must have a close personal relationship with the public as individuals. A Tendency To Sink Lower 'This relationship is only possible in a family doctor, cither in his present form or in some altered, but essentially similar, form. At present there is a tendency for this branch of the profession to sink lower in the estimation both of the public and of the student body from which the profession itself is recruited. "But a reaction from this attitude is inevitable. The more the public is educated and the more the health services extend and intrude into the lives of the people, the more will there be required an active and an intelligent family doctor service. "It will be no corps of clerks. It will require a wide professional training to ensure the early recognition of diseased states and the 'proper co-ordination of the specialist services, becoming daily more abundant. A good general education will bo essential, also personality and mental agility, so as effectively to inspire confidence and assist in the education of a public which is rapidly becoming more enlightened. "Again, it is in this sphere thai the Cinderella of the medical sciences. medical psychology, may well come into its own. The amount oi ininoi and major functional nervous diseases in the community is admittedly very large. The earlier it is recognised and treated, the more, hopeful is the outlook, and owing to the lack of any obvious disability except in the later stages, it is only the general practitioner who can lead the attack. "His position as trusted counsellor and family friend lends itself admirably to the purpose, and it is true even now that all general practitioners are, to a greater or less extent. psychotherapists. They would be much more effectively so if their training included some instructions in the principles of medical psychology.

Family Doctor us Connecting Link

"The family doctor is the obvious connecting link for our medical industry. All direct contact with the public as individuals should be in the first instance through the family doctor. There should be no shortcircuiting or duplication of bis services.

"At the back of this family doctor service there must be a specialist ser-

vice. Medicine has grown so enormously that it is quite impossible foi any one person to bo proficient in every branch. The specialist is concerned more with one branch of disease, but in these days of specialism where the tendency is to dis-sever lite various organs of the body it. is wise to bear in mind the truth of the

ancient saying 'if one member suffer all the members suffer with it.'

"That, great surgeon, the late Lord Moynihan, is reported to have said that he liked to consider himself a physician who had sometimes to employ surgery to cure some of his cases. There is, moreover, a lot of mistakenly loose thinking on the subject of specialism. The family doctor, when all is said and done, kalso a specialist, a specialist in the recognition of disease in its early stages and in the helping of his fellow men in the many little ills and troubles that beset them; and these may be important as a serious breakdown in health in later life may have its origin in trilling and unrecognised ailments of 20-30 years before. The So-Called Minor Ailments "1 would like to see mote attention paid to the treatment of the so-called minor ailments. It has been estimated that -ID per ecu: of till sickness is due to tin- palieiu': own action.'

"If tins lie tin.- land from my own personal experience I have found it soi think what a vast amount of sickness and ill health might be avoided; but this requires a willingness on the paid of the patient to talk over his minor ailments with his doctor instead of going in for selfmedication assisted by the chemist.

"Remember it. is the general practitioner who sees the beginning of disease, the specialist mainly the end. There is no real reason why one branch should be from its nature more eminent than the other. They arc essentially complementary and each requires for its proper performance attainments of the highest order.

"We as an association have just prepared a revised version of our proposals for a. general medical service for the nation, in which the two vital principles of free choice of doctor and of payment on ;m insurance basis tire reaffirmed and their wide extension advocated.

"The first great extension we propose is the inclusion in the system of all members of all families within an income limit of £250 a year. We tire seeking to double—no less —the number of individuals who receive medical service through N.H.I. The second extension we propose is that the service given should be medically complete—that is to say that it should include all forms of specialist, consultant, and auxiliary service as

well as that provided by the general practitioner. I should not like to say which of those changes can do most for the public health.

"Such is our official policy, farreaching in scope and well suttee to secure the full co-ordination ol each and all of the country's health services. Our proposals would bring three-quarters of the community within an official system of medical service.

"Illness is not a steady event from season to season or from year to year, and for this reason it lends itself particularly to treatment on an insurance basis. Both patient and doctor must surely prefer regular to irregular outgoings and incomings. "Within the last six months the association has been instrumental in forming a National Federation of Provident Associations, which extends the insurance method up to a maximum income of £SOO according to the number of individuals in the family, or to a maximum of £550 in the case of London, also taking into account the family income. 1 suggest to you that the principle adopted is one which, in the future, may well be much more widely applied. Blind Trust. "Taken as individuals and in times of sickness and stress, we all knowthat there can be nothing quite so touching as the almost blind trust which tne public impose in the science of medicine and in the particular practitioners that happen to be giving them the benefits of that science.

"That is true of the public as sick individuals, but the public taken in the mass and in health does, not trust either medicine or the medical profession. Their attitude is an extraordinary blend of ignorance and superstition, in which they have unbounded confidence. Everybody thinks he knows all about medicine without training or instruction.

"What opportunity is there at present for the public to outgrow this ignorance and superstition? In the long run I suggest that education oi the people must be Ihe basis of any effective remedy. 1 think that this theme of public education in health is particularly apt at the moment. Tne health of the nation is very much m the public eye. and unless we guide the enormous enthusiasm that lies behind this campaign, there is a real danger that it may do more harm than good.

"1 think we should go further than that. I think that teaching in elementary biology, anatomy, and physiology should be ;m essential and important part of till education, however elementary. Surely it is up to us and to no one else to see that it is included in the curricula of our

schools. Similarly, courses of popular lectures could lie arranged, if not officially, possibly by branches and divisions of our own association. 1 have very little doubt that were they provided there would be no difficulty in finding audiences for litem. . . . Only Through Education "I feel sure thai d is only through education of the public thai Ihe public credulity in regard to advertised remedies can be removed. You all know what I. mean when 1 speak of the evil of patent medicines. There. are good proprietary medicines as well ;ts bad. Some we make use of ourselves, others we could on no account condone or recommend. "What matters is that because of Ihe superstitious ignorance of ihe public there lias, grown up an enormous mass of advertisement literature for remedies thai are famed lo cure not only oxcry disease known lo the profession bill also many diseases invented purely for (he sake of being cured by some particular remedy. "The trade as il is now conducted could only llourisli in a public which knows little or nothing of the Iruo