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are all dealing with sick people who know they are sick and who
approach them for advice and treatment on account of some physical
or mental disability. I am dealing with those who believe themselves
to be healthy and as a rule have not been to consult a practitioner
for a long time. I have to be on the watch for possible developments
at an early stage. So in the clinic I am not dealing with the very
sick and I am not duplicating any of the practitioner or hospital
services, because I am dealing with so called healthy people who
are not aware that they are suffering from anything.
In the surgery a general practitioner, sick people will get
advice on some specific complaint. In the hospital it may well be
they will be referred to a number of departments for advice by
independent consultants in various specialities, such as geriatric,
cardiology,, metabolism, ophthalmology, endocrinology, surgery, nose,
throat and ear, dermatology. Those patients who have had to do this
in the past tell me they get weary of going round various departments;
of having to wait for an appointment on a certain day; and
then to go and.wait their turn to see the consultant. In my clinic
it is already clfear that an old person will brace herself up for
one examination provided that examination is to be a complete one
done at the same time and place.
In the hospitals consultants are employed to deal with sick
people. In the social and preventive services of a local authority
the medical officer of health is the consultant physician in preventive
medicine. The geriatric clinic requires the services of
only one consultant in preventive medicine whose function is to
determine early signs of departure from normal and to suggest
measures where possible for the prevention of further deterioration.
I hope this makes clear the difference between the two types of,work.
Providing the Service.
Certainly in the hospital the consultants and specialists would
not devote their services to the examination and investigation of
the so-called healthy people for preventive purposes. They would say
that it is not their function. It is the function of the health
authorities. The same argument applies to the general practitioners.
A practitioner will say he is not there to examine fully an apparently
healthy person. The function of providing the preventive medical
service lies with the local authorities.
Delay in Seeking Advice.
The primary function of the clinic is the detection of deterioration
- in other words real preventive medicine - yet in this
short time certain facts have become amazingly clear. The average
old person delays and delays in seeking medical advice, sometimes
from fear of something being found; sometimes from "not wishing
to tempt providence; "but most often from unwillingness to sit
waiting in a doctor's surgery or unwillingness to undertake the
journey to hospital and to hang about various departments, for
lengthy periods. One great attraction of the clinic has been the
desire to be "checked up for everying in one place" and if
possible at one particular time and by appointment promptly kept.
Where serious and urgent conditions have been discovered, the fact
that the examination has been conducted as described has been a
positive;adjunct in persuading the patient that treatment by the
private practitioner or hospital was urgently needed. Because of
the thoroughness of the examination and the experience that the
examination was almost a complete one, it is not surprising that
they were willing to accept advice more readily.
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