British Medical Journal. Supplement : A general medical service for the nation
1938-04-30 1938 1930s 14 pages 256 APRIL 30, 1938 REPORT OF COUNCIL SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL (4) That the several parts of the complete medical service should be closely co-ordinated and developed by the application of a planned national health policy. 25. The system of medi...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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[London : British Medical Association]
30 April 1938
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| Online Access: | http://hdl.handle.net/10796/0DDF6B80-2B99-4113-95D1-C0D42A325AE4 http://hdl.handle.net/10796/F72030FC-FE43-4582-9024-695F912AD5DD |
| Summary: | 1938-04-30
1938
1930s
14 pages
256 APRIL 30, 1938 REPORT OF COUNCIL SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL (4) That the several parts of the complete medical service should be closely co-ordinated and developed by the application of a planned national health policy. 25. The system of medical service should be directed to the achievement of positive health and the prevention of disease no less than to the relief of sickness. Health is something more than the absence of disease. While provision for the treatment of disease is an essential part of any satisfactory health service, the emphasis should rest on the positive prosecution of measures to maintain and enhance mental and physical health. 26. This first principle not only satisfies the demands of enlightened public opinion but it accords with the spirit and trend of modern medicine. Recent years have been characterized by a reorientation of medical thought and a widening of the basis of medical practice. Whereas, until comparatively recently, medicine found its sanction to a large extent in the sciences of pathology and morbid anatomy, it now approaches the problems of health and disease from the standpoint of applied biology, concentrating not only on the causes and treatment of disease in its individual manifestations but on the promotion and maintenance of positive health. It views the individual not as a vehicle of disease processes but as a living organism adapting itself to its environment. 27. By continuous attention to such factors as housing, water and food supply, the prevention of epidemics, and the prevention or abatement of conditions injurious to health, the services administered by sanitary authorities ensure a standard of environmental circumstances which is vastly superior to anything which existed comparatively few years ago. There is no room for complacency, however, for much remains to be done. The nutritional standards of considerable numbers of our people are too low; such a valuable food as milk is by no means universally safe; facilities for recreation are commonly inadequate; in many parts of the country overcrowding is rife; and preventable infectious disease still occurs all too frequently. 28. There are signs of a new public interest in the more positive aspects of health. The issue by the British Medical Association of a special report on physical education stimulated both interest and activity, culminating in governmental action and a widespread "keep-fit" movement. Recent publications on nutrition, including those of the League of Nations, of the Advisory Committee on Nutrition to the Ministry of Health, and of the British Medical Association, have illustrated a closer contact between the doctor and the problems, economic and nutritional, of the housewife. There are signs of improved technique in health education: it is directed more to healthy living and less to particular diseases. Biology and elementary hygiene are being taught more effectively in the schools, while the Press, the poster, the pamphlet, the film, and — potentially the greatest of all — the radio, are all contributing to health education. 29. But the value of all these contributions can be greatly enhanced by the work of the family doctor. Because of his intimate knowledge of the homes and lives of his patients he has unrivalled opportunities of advising on wise and healthy living. This is made possible, however, only when a family doctor is within easy reach of every citizen and when every citizen avails himself of the advice and help that his doctor can give. On this subject the Departmental Committee on Scottish Health Services, 1936, expressed itself in the following terms: "It will be noted that in the modern conception of medical practice great emphasis is placed on the role of the family doctor as health adviser. Owing to the advances of scientific knowledge many specialisms have developed, and there is nothing to suggest that this movement will be less rapid in the future than it has been in recent times. On the other hand, there has emerged a growing public appreciation of the value of health and of the importance of early attentions to departures from normal and a demand for the services of the general practitioner as health adviser. We think that this movement also is bound to develop rapidly, and that national policy for the promotion of the heaith of the people should be so framed as to encourage it. It appears to us that the role of health adviser by the family doctor is a natural development of ordinary medical practice, and that the training of the student of medicine should be adapted to fit him for it." 30. There should be provided for every individual the services of a general practitioner or a family doctor of his own choice. The view of all branches of the medical profession on the proper role of the general practitioner was admirably stated in the report of the Consultative Council on Medical and Allied Services of the Scottish Board of Health, published in 1920: "We regard it as of primary importance that the organization of the health service of the nation should be based upon the family as the normal unit, and on the family doctor as the normal medical attendant and guardian. It is not for disease or diseases in the abstract that provision has to be made; but for persons liable to or suffering from disease. The first essential for the proper and efficient treatment of individual persons is, therefore, not institutional but personal service, such as can be rendered in their own homes only by a family doctor who has the continuous care of their health; to whom they will naturally turn for advice and help in all matters pertaining thereto; who will afford them such professional services as he can render personally; and who will make it his duty to see that they obtain full advantage of all the further auxiliary services that may be otherwise provided." 31. The general practitioner has undergone the same training before qualification as all other members of the medical profession, usually supplementing it with hospital and other experience before adopting general practice as his chosen branch or department of practice. His services are used to the best advantage only when he is general health adviser as well as medical attendant in sickness. He is in the best position to advise generally on matters relating to health, to take into account domestic circumstances and environment, and to discover as early as possible when departures from the normal have occurred. It is to him that the public should naturally look for advice and help in increasing or maintaining health, for early diagnosis and treatment, and for reference to agencies providing special services. The Departmental Committee on Scottish Health Services summarized its view by stating that "the general practitioner acting normally as family doctor is an indispensable instrument of national health policy, that without his assistance, as health adviser and as principal liaison between the homes of the people and the statutory health services, these services cannot, in modem conditions, function to the full extent as part of a comprehensive policy for promoting and safeguarding the health of the people." 32. It is interesting, too, to note the conclusion on this subject formed by an independent research body, Political and Economic Planning, which issued a comprehensive survey of health services in this country in 1937: "The needs of the individual or family in health matters vary so very much, and call for so much experience and judgment that they can in practice only be intelligently and sympathetically determined by a person inside the health services who is acquainted with the medical record and the environment of the person requiring attention. In other words, only the general practitioner can keep track of the resources of the health services on the one hand and the peculiarities and needs of the individual 'consumer' of health services on the other." 33. The value of a family doctor to his patient is immeasurably increased where complete confidence exists. Few conditions of ill-health are without an underlying psychological factor, and if the relationship between
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