A position paper
For some years it has been obvious that in modern communities the opportunities and responsibility for the study and application of measures of preventive medicine are with the General Practitioner.
The Central Health Authority may attempt the collection of epidemiological information, design and seek to apply effective measures for the prevention of disease but it will succeed only to the extent to which the General Practitioner is able and willing to co-operate.
The field for the General Practitioner’s co-operation includes the enlightened observation of the patient in health and in sickness for the timely detection of premonitory signs of progressive or communicable disease, the identification of contributing familial, social and environmental factors and the prompt application of effectual measures to cure, to retard progress or to prevent the involvement of others.
Instances of the Health Authority’s interest in this field of general practice may be cited:-
- For the control of communicable disease there must be prompt and correct diagnosis, with appropriate therapeutic and prophylactic handling of the case. Enquiry to ascertain the source of infection and the degree of exposure of susceptible contacts should be thorough and must be followed by effective action whether by counselling, treatment, immunization or other, directed towards containing dissemination. All Health Authorities agree that the standard of professional performance in this field in Australia leaves much to be desired. Notification is incomplete, late or neglected; department search for the source of infection and measures for protection of contacts are to that extent ineffectual.
- In the interests of maternal and child health there should be careful observation of the mother during pregnancy, labour and the puerperium for the recording of significant events, the prompt and appropriate treatment of clinical disorder and advice for the removal of malign, social or environmental influences. This routine incorporated in ante natal care of the “booked” obstetric patient is probably more satisfactorily performed than any other preventive routine in General Practice but it does not reach the “unbooked” patient.
- Child Health programmes require the trained observation of the infant during the neo natal period throughout its infancy and in the pre-school years for the prompt detection of developing physical and psychological abnormality which notation and recording of exposure and response to adverse social and environmental influences. The timely application of appropriate measures whether therapeutic or by referral may avert permanent disability.
- For the generality of patients there is obvious need for informed observation and examination for evidence of reaction to adverse environmental or social influences or to hazards of employment and for the application of appropriate measures designed to safeguard the patient and to protect others likely to be exposed.
To encourage and to assist medical practitioners to discharge these responsibilities, State Health Authorities have provided reporting facilities and consulting services. Until these obligations are as routine undertaken and adequately discharged by the General Practitioner the purposes of the Health Authority will be largely frustrated and the services provided will continue largely unused.
In fact, the General Practitioner should become a Government Medical Officer within the scope and area of his Practice but to this end it will be necessary:
(a) to develop in him an attitude of eager and conscientious participation.
(b) to train him in observation and make him familiar with the signs to be observed, their significance and the responsibility for their detection imposes.
It may be said that these basic requirements are lacking in the general practitioner today:-
(a) Many have an attitude of intransigent opposition to unrewarded performance of any duty regarded as a service to the Health Authority, local, State or Federal.
(b) To the extent that discharge of these responsibilities involves expenses which will not be recouped by Government will recognise no obligation, though it is implicit in the medical service to be rendered.
(c) Some Practitioners see unacceptable implications of unethical conduct in a course of action which may present them to the patient as “soliciting” work.
(d) Of the more conscientious and co-operative many are either unaware of the purpose or the value of the services to be rendered – visibly neglected by the generality of their colleagues – or incompletely informed of the wide variety of obligations involved.
Essential ingredients of the remedy for this situation are:
(a) the willing co-operation of the general practitioner and
(b) an infallible and agreeable method of instruction and of sustained communication to keep him apprised of progress and of any change in prophylactic routine and to provide for the free interchange of information required for research for planning and for the control of disease.
Experience suggests that it is unlikely that any significant proportion of general practitioners would welcome any direct attempt by government to “educate” them in new responsibilities attracting no reward. Nor is it likely that any attempt by a Health Department to change the attitude of recalcitrant members be successful. On the other hand, it is possible that the College of General Practitioners would prove both an acceptable and a successful agency, not only in attempting to change professional attitudes, but also in providing the instructional opportunities for individual General Practitioners whether members or not.
(C.E. Cook)