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FAMILY DOCTOR AND HEALTH VISITOR
185
Special
atrists received from the health authorities present. The psychiatrists had appealed to them for help in connection with the placing and supervision of patients whom it was desired to send out on licence or on trial from the overcrowded mental hospitals and mental-deficiency institutions. The psychiatrists were promised every help ; and here the health visitor obviously came into the picture. Health visitors assist in allaying the tension and anxiety young mothers so often experience with their first baby or when members of the household are in difficulty, and thus their talks to groups of mothers attending welfare centres are a particularly valuable preventive measure. Recently there has been discussion on the possible need for a psychiatric approach in child-welfare centres as a means of preventing undesirable behaviour patterns developing in the early formative years of a baby’s life, from over-anxiety on the part of the mother or from wrong habits acquired by the child. Some local health authorities now employ a health visitor specially trained in psychiatry, who can act as a consultant, as it were, to her colleagues if they encounter psychological misfits in their family visits. I imagine this is just an extension of the specialised health visitor, as exemplified in the tuberculosis visitor whose work is so highly prized by chest physicians, especially for contact-tracing and in teaching people how to avoid spreading infection.
Articles
FAMILY DOCTOR AND HEALTH VISITOR* Sir SELWYN SELWYN-CLARKE K.B.E., C.M.G., M.C., M.D. Lond., F.R.C.P. A PRINCIPAL MEDICAL
OFFICER,
MINISTRY
OF
HEALTH
SOME general practitioners who fully appreciate the work of domiciliary midwives and district nurses are not, I think, equally well aware of the help they can be given by health visitors. Many others, however, have come to value highly the contribution made by the health visitor, particularly in teaching a mother how to prepare for the birth of her child, and (once the responsibility has been handed over to her by the midwife or the maternity hospital) how to bring up the newborn baby ; how and when to wean ; how to guide the toddler in his first steps; and how to protect baby, toddler, pre-school child, school child, and adolescent from the many dangers of one sort or another which beset his path. Where the general practitioner, the nurse, the midwife, and the health visitor have not yet begun to work together as what the Minister of Health has called " a proper domiciliary team," efforts should be made to break down the barriers between them ; and it has become especially important to establish better contact between the doctor and the health visitor. A short while ago, a family doctor in North West London was telling me how a sherry-party had brought him, more or less accidentally, into contact with the health visitor in his area. He told me what a boon she now was to him with mothers who needed to be encouraged to persevere with breast-feeding, how much time she saved him in teaching his mothers where they could obtain all the various services available under the National Health and Assis-
firmly believe that the health visitor is capable, too, giving a great deal of help in dealing with the aged. It is, I suggest, our duty to do everything within our power to keep elderly folk at home-near their relatives or kindly neighbours, and as closely as possible integrated with the whole community, including children-rather than encourage them to go to a welfare home or hospital. The health visitor going to see old people is in a better position than almost any other domiciliary worker to recognise early signs of deviation from normal and to seek appropriate help. Nothing but good has derived from the extension of her work and responsibilities, since 1949, to the family unit I
of
tance Acts, and from voluntary organisations, and, generally, in steering the mother away from the many pitfalls that face her-especially with her first childin relation to food, clothes, bathing, play, exercise, sleep, teething, infectious diseases, and 101 other matters. The health visitor knows, too, where to get help for patients discharged from hospital and needing aftercare, such as the diabetic and the tuberculous. If she is wise she will give relatively little time to the household which runs smoothly (or only needs a very occasional visit) and, by so doing, will be able to pay rather more frequent visits to the feckless type of mother who requires a good deal of guidance and encouragement and sometimes actual home-help or other services. My friend told me that he has several old folk on his list who live alone ; and when for any reason he is worried about them, and circumstances prevent him from looking in to see how they are faring, he rings up the health visitor and asks if she can call on his patient when she happens to be passing. For her part the health visitor, when in the course of her domiciliary visits she meets a situation where medical help is needed, will naturally telephone to the patient’s doctor. This health visitor now has a standing invitation to call at my friend’s surgery whenever she cares to do so. This sort of friendly spirit is almost always present, I find, where home nurses and midwives are concerned; but, for historical reasons, it still sometimes takes a bit of cultivating in the case of health visitors. Last month, when attending a liaison meeting between hospital and local health authorities, I was very agreeably impressed by the reception which three regional psychi*
Extracts from
County
on
as a whole. On the other hand, the very fact that her burden is greater suggests that the time devoted to mere routine visits at the 10th to 14th day after baby’s birth, weekly during the first month, fortnightly for three months, and monthly up to the first year, and so on, needs modifying. As I have already indicated, visits should be relatively numerous to families where social and medical conditions are clamant and where the mother is not very bright, and should be correspondingly fewer to the happy, healthy, hygienic household with an intelligent mother at the helm.
In some rural areas the work of the health visitor is combined with that of the district nurse and even with domiciliary midwifery : so that many of the points I have tried to make are equally applicable to district nurses and domiciliary midwives. There are places, however, where the health visitor is in a position to relieve the district nurse of some of her social work, and where the heavy burden of purely nursing duties, especially for the aged, might be lightened if the district nurse were to enlist the help of her health visitor colleague when the situation appears to demand the utilisation of other (including voluntary) services. Looking at the problem as a whole, I am convinced that we need a much closer integration of the work of district nurses, domiciliary midwives, health visitors, general medical practitioners, local health and welfare authorities, hospital authorities, and voluntary organisaEach of us individually can do something bring this integration about ; and it can indeed brought about in no other way than by our action
tions.
an address to the health staff of Northampton Dec. 31, 1954. .
individuals.
to be as
Special
atrists received from the health authorities present. The psychiatrists had appealed to them for help in connection with the placing and supervision of patients whom it was desired to send out on licence or on trial from the overcrowded mental hospitals and mental-deficiency institutions. The psychiatrists were promised every help ; and here the health visitor obviously came into the picture. Health visitors assist in allaying the tension and anxiety young mothers so often experience with their first baby or when members of the household are in difficulty, and thus their talks to groups of mothers attending welfare centres are a particularly valuable preventive measure. Recently there has been discussion on the possible need for a psychiatric approach in child-welfare centres as a means of preventing undesirable behaviour patterns developing in the early formative years of a baby’s life, from over-anxiety on the part of the mother or from wrong habits acquired by the child. Some local health authorities now employ a health visitor specially trained in psychiatry, who can act as a consultant, as it were, to her colleagues if they encounter psychological misfits in their family visits. I imagine this is just an extension of the specialised health visitor, as exemplified in the tuberculosis visitor whose work is so highly prized by chest physicians, especially for contact-tracing and in teaching people how to avoid spreading infection.
Articles
FAMILY DOCTOR AND HEALTH VISITOR* Sir SELWYN SELWYN-CLARKE K.B.E., C.M.G., M.C., M.D. Lond., F.R.C.P. A PRINCIPAL MEDICAL
OFFICER,
MINISTRY
OF
HEALTH
SOME general practitioners who fully appreciate the work of domiciliary midwives and district nurses are not, I think, equally well aware of the help they can be given by health visitors. Many others, however, have come to value highly the contribution made by the health visitor, particularly in teaching a mother how to prepare for the birth of her child, and (once the responsibility has been handed over to her by the midwife or the maternity hospital) how to bring up the newborn baby ; how and when to wean ; how to guide the toddler in his first steps; and how to protect baby, toddler, pre-school child, school child, and adolescent from the many dangers of one sort or another which beset his path. Where the general practitioner, the nurse, the midwife, and the health visitor have not yet begun to work together as what the Minister of Health has called " a proper domiciliary team," efforts should be made to break down the barriers between them ; and it has become especially important to establish better contact between the doctor and the health visitor. A short while ago, a family doctor in North West London was telling me how a sherry-party had brought him, more or less accidentally, into contact with the health visitor in his area. He told me what a boon she now was to him with mothers who needed to be encouraged to persevere with breast-feeding, how much time she saved him in teaching his mothers where they could obtain all the various services available under the National Health and Assis-
firmly believe that the health visitor is capable, too, giving a great deal of help in dealing with the aged. It is, I suggest, our duty to do everything within our power to keep elderly folk at home-near their relatives or kindly neighbours, and as closely as possible integrated with the whole community, including children-rather than encourage them to go to a welfare home or hospital. The health visitor going to see old people is in a better position than almost any other domiciliary worker to recognise early signs of deviation from normal and to seek appropriate help. Nothing but good has derived from the extension of her work and responsibilities, since 1949, to the family unit I
of
tance Acts, and from voluntary organisations, and, generally, in steering the mother away from the many pitfalls that face her-especially with her first childin relation to food, clothes, bathing, play, exercise, sleep, teething, infectious diseases, and 101 other matters. The health visitor knows, too, where to get help for patients discharged from hospital and needing aftercare, such as the diabetic and the tuberculous. If she is wise she will give relatively little time to the household which runs smoothly (or only needs a very occasional visit) and, by so doing, will be able to pay rather more frequent visits to the feckless type of mother who requires a good deal of guidance and encouragement and sometimes actual home-help or other services. My friend told me that he has several old folk on his list who live alone ; and when for any reason he is worried about them, and circumstances prevent him from looking in to see how they are faring, he rings up the health visitor and asks if she can call on his patient when she happens to be passing. For her part the health visitor, when in the course of her domiciliary visits she meets a situation where medical help is needed, will naturally telephone to the patient’s doctor. This health visitor now has a standing invitation to call at my friend’s surgery whenever she cares to do so. This sort of friendly spirit is almost always present, I find, where home nurses and midwives are concerned; but, for historical reasons, it still sometimes takes a bit of cultivating in the case of health visitors. Last month, when attending a liaison meeting between hospital and local health authorities, I was very agreeably impressed by the reception which three regional psychi*
Extracts from
County
on
as a whole. On the other hand, the very fact that her burden is greater suggests that the time devoted to mere routine visits at the 10th to 14th day after baby’s birth, weekly during the first month, fortnightly for three months, and monthly up to the first year, and so on, needs modifying. As I have already indicated, visits should be relatively numerous to families where social and medical conditions are clamant and where the mother is not very bright, and should be correspondingly fewer to the happy, healthy, hygienic household with an intelligent mother at the helm.
In some rural areas the work of the health visitor is combined with that of the district nurse and even with domiciliary midwifery : so that many of the points I have tried to make are equally applicable to district nurses and domiciliary midwives. There are places, however, where the health visitor is in a position to relieve the district nurse of some of her social work, and where the heavy burden of purely nursing duties, especially for the aged, might be lightened if the district nurse were to enlist the help of her health visitor colleague when the situation appears to demand the utilisation of other (including voluntary) services. Looking at the problem as a whole, I am convinced that we need a much closer integration of the work of district nurses, domiciliary midwives, health visitors, general medical practitioners, local health and welfare authorities, hospital authorities, and voluntary organisaEach of us individually can do something bring this integration about ; and it can indeed brought about in no other way than by our action
tions.
an address to the health staff of Northampton Dec. 31, 1954. .
individuals.
to be as