View report page

rely for much of his clinical knowledge on the capacity for communication by the Pharmaceutical Industry
through their "reps" or numerous news magazines. Much of the minor illness treated is readily remediable or self
limiting.
The public attitudes and expectations in regard to medical treatment have changed remarkably and people happily
take risks with their bodies and when they are unlucky they expect the doctor to restore their functions to order.
I refer to minor disasters which often pass unrecorded - the septic ear lobe which can follow unskilled surgery by
an ear piercing jeweller, the face rash in an allergic subject who has been given a hair dye by her hairdresser or the
allergic rash which can follow the application of an adhesive plaster by a chiropodist or again a rash which follows
a bubble bath. These conditions are usually mild and remediable but there is perhaps a need for more communication
between the different professions and some redirection of health education by the future area health
authorities.
There is scope, too, for more effective links with the present school health service and the care of the school
child - asthma in children may call for an environmental report and the relationship between dampness and the
house dust mite directed towards the elimination of the latter. Ear infections are frequent and usually treated
with success but one feels that the effective and well tried follow up organisation of the School Health Service
could be applied by subsequent audiometry to exclude and deal with any residual hearing defect.
Nowhere is the change in public attitude more readily seen than in the field of minor throat infections. Here
rapid cure is expected and if the child's mother is in full employment she does not wish the child to remain at
home a moment longer than necessary. The possibility of ambulant treatment from the earliest date possible
may in future have to be considered jointly by general practitioner and school medical officer so that the child
may return to school without risk of the spread of infection, with the minimal delay.
2. The doctor and the chronic sick
In these circumstances the patient looks for support from the most effective agencies and here one can see the
value of a generic social worker to assess the Local Authority contribution by way of services, i.e. home help,
meals on wheels, mental health and welfare support together with advice on rehousing or re-adaptation of
present home. The excessive demands made by the staircase on so many physically handicapped people become
apparent and the question arises should retired people not be given more encouragement to live in the spacious
environment of a rural or seaside area as is a fairly common practice in Social Classes I and II.
There is scope for difficulty in communication between doctors and social workers and for misunderstanding
because of their different approach. The doctor is generally prompt in his attendance and brief with his visit and
the social worker commonly reverses this pattern of action to take his more comprehensive case history. A doctor
may see sixty cases a day in contrast with the social worker's six and both parties will have to accept the
difference in approach which is a consequence of their different working patterns.
3. The accident and emergency service
The patient needs to have competent professional help instantly available at any hour of the day or night and as
can be seen from frequent press criticisms of hospital casualty departments such provision is not always easy to
arrange. The services of the Ambulance and Casualty Departments are required both in a supportive capacity for
the general practitioner and as an agency of primary medical care. The general practitioner is by tradition "busy"
and an important reason for this attitude is that he must constantly be prepared for emergency action and so the
well-prepared doctor is constantly "clearing his decks for action".
There is always scope for improvement in this kind of service by the professional staff responsible, but other
authorities could help by insisting on well-maintained public telephone boxes and on an efficient system of
address finding, i.e. streets named and numbered so that they can be seen by a vehicle driver. I was appalled at the
contrasting standards of numbering and naming in many blocks of modern flats in different London boroughs.
The experience so far gained has been valuable not so much in obtaining new knowledge as in confirming views
and ideas. There is no doubt that the assessment of local health requirements is most necessary to the efficient
deployment of resources. The assessment of need can only be gained by better links between the community
physician and doctors engaged in various forms of medical care in general practice and in the various specialities.
In my opinion the future should see more direction and guidance of preventive action from other medical
disciplines and direction of this type will have to be sought by a continuous series of exploratory projects
between now and 1974.
41