"CHOOSE YOUR OWN DOCTOR"

New Zealand Listener, Volume 17, Issue 425, 15 August 1947, Page 8

"CHOOSE YOUR OWN DOCTOR"

(Written for "The Listener" by

ELSIE

LOCKE

WO little phrases of magical import are familiar to all who read current comment on our health services by the B.M.A, official commissions, newspaper editorials and whatnot. They are "the right of the patient to choose his own medical adviser" and "the personal rélationship between doctor and patient." With minor variations, the refrain has been sung recently in connection with the proposed co-ordinated

medical services of the new housing areas. in the Hutt Valley, and with the Committee of Inquiry’s report on maternity services. I am slightly puzzled as to why my "right of choice" should be so sacred in this particular professional service when no one thinks of grant--ing it to me in certain other services. I am also puzzled as to why I am credited with the skill to make the best possible choice, and why my relationship with the doctor will be "impersonal" if I do not have this righte

Surely it cannot be that brains are of less importance than boils or bunions, since neither I nor my parents had any choice in the class teachers to whom my education was entrusted? We did not even choose my headmaster, though it could not be said that our relations were exactly "impersonal." To be honest, we children regarded him so affectionately that he was never called anything among ourselves but "Old Dick," and he usually referred to me no less intimately as "that awful child." Neither did we, later on, choose professors, lecturers, Plunket nurses, or ward sisters. Nor were any of these "impersonal." On the whole, it is unlikely that our relationships could have been any more friendly and intimate had they been specially selected. It is true that one does choose one’s dentist and one’s lawyers. My own first efforts were singularly unfortunate. Lacking any other criterion, I once patronised a dentist because he reminded me of a Dickens character and _ this actually made my visits enjoyable. About five years later his fillings had to be ploughed out and replaced at the Wellington Public Hospital Dental Department. Some years later again, a dentist in another town asked me if those fillings were the work of Mr. R. at the Wellington Hospital? Maybe he was an impersonal servant of a soulless instjtution-but Mr. R.’s work was esteemed far and wide. The first time I chose a lawyer I relied on his excellent reputation and clientele. He charged me £2/10/- for a brief interview and a scrap of advice that proved to be the exact reverse of correct. ; ; With these unhappy experiences in mind, I ponder: How does the wise layman choose his medical adviser? © Obviously there are many orvantages to a life-long association with a "real

old family doctor’-one who knows the family and its history, and is an everpresent help in time of trouble, even if he is not quite as ubiquitous as "Doctor Mac" of tadio fame. The question in this age of specialisation is, how do you find him? He seems to live mainly in the coun-try--but that is not very helpful to our general difficulty-for in the country we usually have the choice of one doctor or none. He is becoming more rare in the cities. where only an old-ectahliched

family and an old-established practice together can really achieve an ifitimate relationship on a "family" basis. What then does a person do who is not satisfied with the doctor his parents had, or has moved into a new district, or needs medical attention for the first time? He asks his friends, his fellow-hos-pital-patients, or maybe his grocer or the baker’s boy. "Can you recommend a good doctor?" "Whom do you suggest I. should go-to?" The friend, or the baker’s boy, probably says that X did a lot of good with his own great aunt’s asthma, So the inquirer goes off. to Dr. X to have his gastric ulcer cured. | It is a hit and miss method, though superior to the choice of Dr. Y because he is SO charming, or because his wife was Miss Z, you know, her people own acres and acres of land up in the hills and they had eight bridesmaids at their wedding. This might be the beginning of a personal relationship-provided that Dr. X can afford the time for his new friend, among the dozens of others who queue up in his surgery. Whether or not, the choice, it seems, helps to safeguard the standards of the medical profession. For the professors, on the other hand, life must be rather hard. They have no choice-by-students to safeguard their standards. Somehow or other they do Manage to give excellent service, as do’ educationists from probationary teachers. upwards. There is a drawback, however, to the professor’s not accepting individual students with individual fees for himself. His brother, the doctor, may attract enough patients to earn two or three times the fixed salary of the professor. Let it be plain here that I would be the last person to be unappreciative of (continued on next page)

(continued from previous page) what doctors have done for me and my family. There are two in particular whose exceptional consideration I will remember with gratitude till my dying day. Yet there is a curious circumstance here. These two were not "chosen" at all. One found me, and I found the other, by the merest accident in each case. Perhaps what many people look for is not the right of choice, but the right of refusal to be attended by a doctor whom they feel has made a poor show. Parents who strongly object to their children’s teachers often solve a similar problem by sending the children to another school. I should think that a Hutt Valley resident, if the local scheme for health centres is adopted, "vill exercise this right of refusal if he is dissatisfied. What I cannot help wondering is how the patient’s choice is affected by the location of the surgery, whether it is in the doctor’s residence or in the health centre attached to the shopping centre. St. Helens Hospitals Recently the Committee of Inquiry into Maternity Services told us that the "closed" training hospitals were "obviously not offering to the majority of women the type of service they desired." A daily newspaper editorial commented by describing these hospitals as "highly efficient, but largely impersonal." I have been a patient in St. Helens hospitals of both Wellington and Christchurch, and cannot help wondering if the reluctance of women is not due to misunderstandings such as those. shown by the editor. Naturally the expectant other whe has a "real old family doctor" will prefer to have him attend her. In our day not every doctor undertakes maternity work and many a mother has a choice to make. If the report is correct she prefers an individual doctor and a private maternity home. : She is choosing a service in two or more parts, She will visit a doctor for ante-natal advice, and he will be present for the birth, provided that a more urgent case has not claimed him immediately before. She will see little of the home until she is admitted. The St. Helens hospitals provide a complete service. Handicapped by unsuitable buildings-in Christchurch nothing more than an ancient, converted hotel-their staffs do devoted work. The ante-natal clinics are conducted by Sisters whose experience is more wide than that attainable by most doctors. These Sisters are known by name and loved by hundreds of women. The expectant mother has every attentionshe does not compete for the adviser’s time with a queue of assorted patients outside the door. Every aspect of her health is considered. She is given knowledge, confidence, and assistance. There is a series of exercises specially designed for maternity. These she is taught, free of charge, by speciallytrained physiotherapists. They are invaluable both for her health and her figure. I have seen more than one timid oung mother (too often well primed "up with "old wives’ tales") go from these "lasses with a new confidence and happiness in the approaching event. "But you don’t have a doctor at all?" friends have said to me with a sort of horror. There is a doctor, a specialist, for the necessary examinations, and in attendance at the confinement in cases of difficulty. For the rest, it is not clear to me what extra advantage the quite

normal patient would have from the presence of a doctor rather than an experienced midwife. Health and Happiness A healthy young woman having a baby is not an invalid. She needs expert care to guard against the hazards of maternity, which in this country have been reduced to the lowest in the world, to -a considerable extent because of medical supervision. But we look upon our maternity services wrongly if our emphasis is on the actual confinement. It is full preparation and sound aftercare which make for dhe great event being one of joy unmixed with fear. The point of all this is that a "closed" system is not a device for keeping the patient from her _ individually-chosen doctor for the benefit of nurses’ training but a co-ordinated service in which all aspects of the care of the mother are interlocked. Far from being "impersonal" the staff come to know her so well that she enters hospital on the great day as she would a house of friends. This is not a commentary on the decisions of the Committee of Inquiry, nor a criticism of its "compromise" proposals which, from their evidence, appear to be wise. Their submissions may begin a useful experiment. My object has been simply to point out a view of the existing service of training hospitals which is not sufficiently’ recognised — and to refute the suggestion that they are soulless institutions. So long as most doctors and many laymen consider the choice of individual practitioners to be a cornerstone of our medical standards, these preferences cannot be ignored. But increasing numbers of people wish to choose, not a man to cure them, but a many-sided, co-ordinated health service. This is what the Hutt Valley State House tenants are asking for. The conception has been pioneered and experimented with by far-seeing medicos, abroad and in New Zealand. It is another aspect of the trend towards emphasis on the promotion of health rather than the cure of |. disease. In effect, this viewpoint saysgive us the means to be healthy, and we shan’t need to worry about what doctor we might have chosen.