THE COLONIST. TUESDAY-, JULY 29,1919. THE STATE AND THE MEDICAL PROFESSION.

Colonist, Volume LXI, Issue 151035, 29 July 1919, Page 4

THE COLONIST. TUESDAY-, JULY 29,1919. THE STATE AND THE MEDICAL PROFESSION.

Some time ago an English medical man who visited New Zealand propounded an interesting scheme for revolutionising the relation of the State and the community to the medical profession, and also the accepted view of the function of the doctor. This plan comprehended a national medical service in which every practising doctor would be a servant of the State, but it went a good deal further than the State medical service, of which we have been hearing a good deal of late. It aimed at making the medical profession a preventive rather than or as well as a curative service. That is to say, the doctor's duty would not begin when his patient became ill, but- each doctor would be responsible for the maintenr anee of the normal health of those members of the community entrusted to his guardianship as far as skilled Dversiglit could ward off attacks of illness. The scheme was elaborated in considerable detail, which it is not necessary to recount. We have indicated the fundamental idea. It did not attract a great deal of attention, and still less support, either from the profession .or the public, for the reason that such a plan was a little too revolutionary when a change from the existing practice—supposing a change to be desirable—must be sought along other lines if it is to be successful. »n the last number of the "New Zealand Medical Journal," the organ of the New Zealand branch of the British Medical Association, there is a thoughtful leading article on the agitation for the nationalisation of the profession in which the subject is dispassionately and on the whole sympathetically discussed. The article says that a change from the traditional standpoint of the profession, which is. individualistic rather than socialistic, is being forced up on it both from within and without; from within by those who have studied social service, who have seen the advantage in the Army medical service of division of labour and reasonable hours of work and by others who have observed in private medical practice a waste pi effort and duplication of work in every district; from without by the whole trend of public events, which has made it impossible for anyone to pursue i purely individualistic course. It believes that it is inevitable that a State medical service will be established, oi what already exists will be largely increased in some shape or form, anid every doctor will either become a sincere convert or adopt the attitude of the Duke of Wellington in politics, whe opposed changes the wisdom of whicfc he doubted, until opposition was futile, when he tried to mould the changes into their least objectionable form. Th( "Journal" quotes from the Cavendist Lectures by Sir Bertrand Dawson or the future relations of the State anc the profession. " Ho favours a progression on the following lines: (1) StaU aid and central control; (2) co-ordin-ated effort—team work; (3) development of institutions specially designec for diagnosis and treatment; (4) curative and preventive medicine shoult be no longer separated. Under thi: scheme hospitals as we know then now would be valuable as teaching anc training centres, and the medical ataf would be full time and on salary. Ii addition there would be a large number of local clinics built out of State fundi and staffed by the medical men of th< district on the basis of a part-time service paid by salary. This would noi exclude private practice, which woulc remove the main objection to a whol^ time State service, and offer reward: in conformity with ability and industry Sir Bertrand Dawson believes that th< suggested plan would bring mor; ! interest and stimulus into the life o: a doctor; he would continue to de velop; he would have the inspiratior and opportunities of good work, coulc j follow up his cases and exchange idea! | with his colleagues in ' the "settle ment," which would become a centr< of intellectual life.. He would do hi work in less time, with less fatigue I and at less expense, because more oi it would be localised. The "Journal' says it is convinced that the profession for weal or woe is at the parting of the ways. It must take a broac view and understand that its members; J are not only practitioners of medicine ! but engaged in social service. Thej must be prepared to conserve what iessentially good in the experience oi centuries, and also to make radical changes. In opening his pages for the discussion of the question, the edito: of the "Journal" records his view that the case for a State medical service n at present not proven, but presents many attractive features and some very dangerous possibilities. With this guarded expression of opinion most people who have devoted any thought to the subject will be prepared to agree, whatever their personal attitude, and much useful light will probably bo thrown upon this complex problem by tho argument on both sides of those who are most intimately concerned, to which the "Journal" has given such >. fair start.