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Old people don't like a lot of lights shining in their eyes at a
medical examination and you have to be quick. Therefore it is best
to use every piece of apparatus you can so as to reduce the inconvenience
to the patient, and to save the time of the doctor. A
refractometer for measuring refraction and a refraction unit for
ease of subjective testing are very desirable. These machines are
expensive but they are worth it in the long run. I have had people
come into the clinic with most of the common eye disabilities of
the elderly, beginning often before the age of 60, and some have
been nearly blind. I have had people come in who imagine their
vision to be perfect and said they could see quite well; and yet
they were walking about the streets with vision not better than
6/36, and obviously gravely defective. No wonder they are knocked
down in the traffic - they cannot see vehicles coming. And yet I
have been able with the correct glasses to restore their vision to
6/6.
It is no use saying these people have plenty of opticians to
go to. In a sense that is true, but they do not know that they
ought to go. They do not know that these disabilities slowly creep
on them, and because they have no means of comparing themselves
with others are quite unaware that things can be righted. That is
why I need first class equipment to test them properly.
After the eye test comes the examination of the ears. Mr. &
Mrs. F. could knock up 160 years between them. Mr. p. was pretty
fit but his wife was thin and deaf. They said they would not
wish to come to the clinic separately but would come if they could
be examined together. Mr. p. did all the talking and answered all
my questions, both for himself and Mrs. P. Every now and again he
spoke to her in a loud voice and she was obviously deaf. The briefest
glance in her ears showed they were completely stopped up with
hard, solid wax. She had been like this for years and had never
thought of seeking medical advice She just accepted it as one of
these things which you get as you get older and resigned herself
to her disability with fortitude. Mrs. P. was frail and could not
walk very far and it had taken some effort to get her to the clinic
at all. After her ears were syringed the result was amazing. Her
drums were perfectly normal and her hearing quite good. Her
husband was astonished, he said "Doctor, here have I been yelling
at her all these years when I needn't have done. I will tell her
a few extra things when I get home."
When I was examining the heart of one woman she said to me
"Doctor, aren't you going to do an electrocardiograph?" I had to
confess that I hadn't got the instrument. I have had a number of
people with diseases of the heart and I do wish I had the electrocardiograph
to provide further evidence for this part of the examination.
You might say that it needs a cardiologist to interpret
the findings. If this is conceded you might argue it needs an eye
specialist to examine the eyes, an ear specialist to examine the
ears, an endocrinologist to check up on the glands, a chest
physician to examine the chest and so on. This sort of argument
leads us nowhere. Its not too difficult to detect the abnormal;
the finer points can be checked up later.
No Duplication
There are doctors, hospital consultants, opticians and medical
auxiliaries everywhere. Why then start a clinic when people can
have all these things through the National Health Service? Are we
not duplicating these services? Is this not a waste of public
money? The answer is that these doctors, consultants and auxiliaries
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