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opticians and other agenpies. Very little of this falls within the
province of a family doctor, in every case I send a full report to
the family doctor saying what has been done and found. If the practitioners
are to have confidence in these reports they must be
accurate and reliable. The patients are given advice on diet, food
preparation, dietary supplements and other matters, especially
comfort and reassurance when I can tell them they are not suffering
from something they imagined they had.
If the work was skimped and slipshod, then the information
about all the disabilities would be incomplete, and important
things would be missed. It takes time and patience to listen to the
patient's story, to gain his confidence, and to give the full advice,
comfort and interest which he needs.
The Purpose of the Clinic,
As I have already said, in the geriatric clinic I am testing
the fitness or otherwise of so-called healthy persons. In so far
as these people have not recently attended a practitioner for some
specific complaint they believe themselves to be well. Often they
say to me "You won't find anything wrong with me doctor." I have
to investigate the functional efficiency of these people without
any specific medical complaints and to see if they are healthy. For
this purpose I need the appropriate instruments and apparatus. I
have to answer the question in every case "Am I all right, doctor."
It so happens that the instruments needed for testing the functional
efficiency of the various systems of the body and for detecting
early departures from normal are almost exactly the same
instruments as are used for the investigation of established disease.
This is not surprising, but it has lead to much misunderstanding.
To detect an early cataract before even the patient knows it is
there requires a slit lamp microscope; to detect restriction of
the fields of vision - an early sign of glaucoma and threatened
blindness - requires a perimeter; to test the breathing capacity
requires a spirometer; to test the function of the heart requires
an electrocardiograph. It is ridiculous to rely on guess work when
accurate readings are possible with the correct instruments. It is
like asking a scientist to do modern experiments without instruments.
If the medical instruments reveal that all is well the patient is
so much better pleased. But if the instruments show abnormality, it
is far better to send accurate information to the practitioner than
rely on guess work.
Poor Equipment.
In The Lancet for 29th November, 1958, the leader is talking
about doctors emigrating and states that one reason is "dissatisfaction
with the circumstances of practice or the opportunities
for research in Britain. Too often the British clinician of the
mid-20th century has to work with 19th-century tools; the general
practitioner may lack proper ancillaries and may not even have
access to hospital diagnostic departments; while the specialist may
have to divide his time wastefully between three or four different
hospitals, and be denied such needs as routine virology service
or a biochemistry department equipped for modern tests. Compared
with the United States, research here is being starved; and a keen
worker with an idea, who in North America could be sure of a warm
welcome and unstinted support, may have a battle to extract even
from a well-stocked hospital endowment fund a few hundred pounds
for essential equipment. The potential emigrant, gazing across the
Atlantic, sees practice pursued with vigour and vitality (although,
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