DISEASE TREATMENT.

Auckland Star, Volume LIX, Issue 237, 6 October 1928, Page 1 (Supplement)

DISEASE TREATMENT.

THE PRIVATE PRACTITIONER. HIS PKOBABUQ rUXTTBE. ■ INFLUENCE' OF HOSPITALS. 1 :'•■-, .'(By PEEITUS.); ; It is.a curious and regrettable anomaly that a country -with a healthy climate and an . exceptionally ,'low death . rate should . have sucli; excessive hospital accommodation. In Auckland the proportion of . people continually within the walls of. the hospital .is. about three times ' as ■ large as that- .-pi English estimates. .In seeking for a reason for this 'state of affairs one sees that it is chiefly pecuniary. The -nursing home and the private practitioner, do not invite the sick to apply for assistance with the condition that ''payment, is based upon ability to pay, with a reduction, even a complete writing off of fee's,' in cases of necessity. The growth of surgical' treatment, and what a. recent writer (in the "CornhiU Magazine") calls the' "abandonment of medicine," involves the attainment of practical efficiency, and the accumulation of equipment possible only when public and State funds can be drawn upon; yet the routine of a great hospital gives to the sick '.a' more chance-governed: prospect than does private attendance. The private practitioner i has formed- a. habit of transferring his responsibilities to the nearest hospital; with the'inevitable-con-sequence of lowering his standard of knowledge and lessening his.experience.! To be.merely the author of a preliminary diagnosis, -with the feeling that any doubtful or serious case can be immediately transferred to. a convenient institution, destroys the consciousness of competence and weakens the determination tq.be able to meet every medical emergency with, credit and with benefit •to the) patient. The sympathetic and genuinely friendly-conduct of the family physician provides, so strong a' hope of recovery in the mind'of an,invalid that this happy Tiope •.alone' paves the .way for physical improvement; When a, practice is now offered for "sale it, is usual to name as one of attractive advantage's its nearness to a hospital, .yet most patients removed from their homes represent to the doctor a loss of money and of reputation. Certainly the practitioner' is . right in making every possible, use of the Health Department, v the radiologist and the bacteriologist, -whilst ordinary chemical testing aiid microscopic work he'should do for himself, but .he should send a swab for report "rather , , than' send his patient, and use the X-ray (by sending the patient to.the machine), only when the, diagnosis is'beyond his skill. '• . , Setting.by Machinery.

In a recent copy of the "Lancet" there is a description of a new method of "setting fractures, by machinery," and, as mechanical diagnosis has already been made use of, the automatic practitioner cannot be far off. However, it is for the public, who pay in suffering and in cash, to restore the general practitioner to his once honourable position, to see that his training is not mechanical, and that his self-reliance is assured by prolonged practical instruction. Just now the, student's advance in science generally is secured by his loss of really useful knowledge, and the support of the hospital takes the strength and flexibility away from his professional spine. I am not suggesting that any incompetent man should- be foolishly courageous and accept tasks beyond his skill, but that- those who: have knowledge, skill and experience should set their faces against this rush to hospitals, and, with, the aid :6£ .'a consultant when necessary, restore the belief of the public in private advice, diet and.drugs, and in' the private practitioner's willingness to consider the pecuniary circumstances of his patient. There', is ,no doubt but] that, the; general practitioner is losing his grip. He .dashes, at newly, advertised productions of wholesale druggists, only to quickly disregard them for something newer; he fears to cling to old and welltested remedies lest he be deemed "oldfashioned".; but his peace of mind would be far greater if he handled drugs the action of which he could safely predicate] rather, than- prescribe those novelties of I Continental origin which—as far as he is concerned—are experi-mental..-Calomel, opium, quinine, salicy-! late of soda, iron, strychnine, 'zinc, lead and carbolic acid,' with such ' hariiely remedies as may be ,found in inost houses, in-the hands of a good man -will do wonderful things.- All minor surgery aikb emergency major surgery should be within his scope-without" any hurt to! hi?'conscience.. He should make a ri<*id rule to avoid the buckshot prescriptfon in favour .of simple combinations, and to admit he is treating symptoms until'he can safely say the d'isease is revealed, and then act accordingly.' In conclusion, nursing homes should have inclusive' ternis, varied only according to accommodation and refuse to be "bought I in" by any'surgeon or controlled by f D J" j outside prejudice or influence.' -"