British Medical Journal. Supplement : A general medical service for the nation
1938-04-30 1938 1930s 14 pages APRIL 30, 1938 GENERAL MEDICAL SERVICE FOR THE NATION SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 257 doctor and patient is impaired by suspicion or lack of confidence the doctor is less capable of fulfilling his role of adviser and healer, and the patient is le...
| 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/10796/5BC57ADE-9146-416E-A307-9DE1A86FF3ED http://hdl.handle.net/10796/D2E5FC94-7796-46F8-B7D0-7E27153DADB9 |
| Summary: | 1938-04-30
1938
1930s
14 pages
APRIL 30, 1938 GENERAL MEDICAL SERVICE FOR THE NATION SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 257 doctor and patient is impaired by suspicion or lack of confidence the doctor is less capable of fulfilling his role of adviser and healer, and the patient is less likely to enjoy the full benefit of his doctor's capacity and desire to help him. For this reason the interest of the public demands that free choice of doctor should be the right of every citizen, whatever his social position or medical need. 34. The specialist in medicine is the complement of the family doctor and not a substitute for him. To short-circuit the family doctor is uneconomic, bad for the patient, and bad for the medical profession. The average member of the public is not fully competent to choose the specialist he ought to consult — assuming that he needs to consult one at all. Selection without such guidance is uneconomic. Even if the patient happens to be right in thinking he needs the services of a specialist, and is doubly fortunate in choosing the right one, he cannot obtain full value for his expenditure of time and money if he goes to the specialist unprovided with the valuable information the family doctor could have given — information as to physical and mental characteristics, family history, and previous personal history, and as to what methods of treatment have already been adopted. These considerations apply whether the individual patient seeks treatment at a clinic, a hospital, or privately. 35. Consultants and specialists, laboratory services, and all necessary auxiliary services, together with institutional provision when required, should be available for the individual patient, normally through the agency of the family doctor. The work of the family doctor must be supplemented by the provision of specialist aids for diagnosis and treatment with regard to specific points, or in special circumstances. The increasing complexity of medical science has been accompanied by the development of a considerable number of special methods and techniques, both in diagnosis and in treatment, the successful employment of which involves specialized knowledge and experience and, in many cases, complex and expensive apparatus. 36. The second opinion or consultation, with or without treatment, must be available. It may be sought from the general physician, the general surgeon, the obstetrician and gynaecologist, or from a specialist in a more restricted field. Again, the help of a practitioner specializing in a particular method or group of methods of diagnosis or treatment, such as a pathologist, a radiologist, or a practitioner concentrating on physical or on psychological methods, may be desired. These, too, should be available. Such consultant and specialist provision should be available in the home, the consulting-room, the clinic, or the hospital, according to the circumstances. In short, all classes of special knowledge and specialized technique should be available when the circumstances require them for every member of the community. 37. The work of the medical practitioner, whether he be general practitioner or specialist, often needs to be supplemented by contributions from those not medically qualified. In a special class come the services of the dental surgeon, whose work constitutes one of the most important departments of preventive and curative medicine. Whether he acts as an independent practitioner, or in conjunction with the medical profession, he is a necessary part of a complete medical service. It is essential to the completeness of the scheme here proposed that arrangements be made by the community with the dental profession for a comprehensive dental service. 38. The principal auxiliary services are those provided by pharmacists, nurses, midwives, masseurs, radiographers, dispensing opticians, and medical electricians. The conditions of employment are, first, that all persons so employed shall have been properly trained and found capable of giving the required treatment; and secondly, that no treatment shall be undertaken by such auxiliaries except on the recommendation of, and under the responsible care of a qualified medical practitioner. It is necessary that the medical profession and the public should know that persons to whom important, though auxiliary, methods of treatment are entrusted are competent; and it is equally important that it should be clearly understood that no person without a complete medical training (however well trained he or she may be in the particular service which he or she provides) is competent to assess the bearing of the special line of treatment on the case as a whole. The essential preliminary to any rational form of treatment is a thorough examination of the patient by one properly and completely trained in medical science. Diagnosis is an art sufficiently difficult even to those prepared by this training. Half-knowledge is often misleading and sometimes dangerous. 39. The State registers of nurses, midwives, and pharmacists and the recently established National Register of Medical Auxiliaries provide the necessary machinery for making available to the medical profession the services of those who are satisfactorily trained in a branch of medical auxiliary work. 40. The several parts of the complete medical service should be closely co-ordinated and developed by the application of a planned national health policy. Two of the more important criticisms which are directed at modern health services are, first, that, with certain striking exceptions, there is little evidence of co-operation between the various health agencies, and secondly, that their development has been piecemeal, sporadic, and fragmentary. In many areas local authorities have developed their services without adequate regard for those provided by private practice and without even discussing their problems of medical interest and importance with those well qualified to advise them. The meagre consultation enjoined upon local authorities by the Local Government Act, 1929, has been the limit of co-operation which many county and county borough councils have reached. The domiciliary public assistance medical services of local authorities have been allowed, for the most part, to remain separate and distinct from normal general practice, and to deny to one section of the community what the State in another national service demands, the right of free choice of doctor. In few areas do there exist what were described in Circular 1000 of the Ministry of Health, issued in 1930, as "wider arrangements for the fullest consultation between the local authority and the medical profession." 41. An immediate remedy is the development of adequate consultative and advisory machinery and, in particular, of machinery to ensure consultation between local authorities and the practising profession of their areas. A permanent solution, however, can be reached only by making complete the medical provision available to the people, by including in the arrangements statutory provision for consultation between the administrative authority and the medical profession, and by basing subsequent developments upon a systematic and co-ordinated plan. III. THE PLAN 42. If the foregoing principles of a general medical service be accepted, as, in fact, they have been by such authoritative bodies as the Royal Commission on National Health Insurance, the Departmental Committee on Scottish Health Services, and Political and Economic Planning (P E P), as well as by the British Medical Association, the necessary practical steps to implement these principles should now be considered. (a) General Practitioner Services 43. All the bodies named in the preceding paragraph recommend the extension of the existing national health insurance service. Despite its defects, this service has been an undoubted success. An extract from the Report of the Chief Medical Officer of the Ministry of Health for 1933 expresses the generally accepted view of the existing service:
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