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Laboratory Services for the General Practitioner
579
of hospital planners, will be the answer to a good many prayers. Often architects have claimed that hospital users do not know what they want and, even when they have decided what they want, they do not know how to brief the architects. Though this situation has lately shown some improvement, there are still enormous and disgraceful delays between the decision to build and the cutting of the first sod. This model hospital could, by the simplification and standardisation of design, substantially reduce delay. As CASHELL remarked,29 " boards and hospitals must be prepared to accept greater standardisation of design and components so long as they can be assured that adequate research and technical knowledge has gone into the formulation of these standards." As more work comes off the boards of this design group, so could more projects be speeded up. Incidentally, two hospital authorities concerned with current building projects in the South Western region (each project being well advanced in the planning stage) have accepted and applied the design of the standard acute ward. Significant reductions in cost have been achieved compared with the duplex ward and race-track ward which were formerly being considered. The design group is working fast and hopes to produce its geriatric ward in the autumn and its accident and emergency department by the end of the year. Well though the group is progressing, a standard hospital could be designed more quickly if other regions took on the planning of various types of ward and department, working with the team in Bristol. Certainly, similar work has been undertaken elsewhere-for example, a study on operating-theatres in the Newcastle region. But it seems a heavy burden for one region, or a handful of regions, to do this long-awaited work alone.
Laboratory Services for
the General
Practitioner FOR many years general practitioners have been pressing for open access to the laboratory service of their local hospitals. Hospitals throughout the country have responded fairly well to the demand, and there are few places today where a general practitioner cannot get a report on a pathological specimen (although this may mean some inconvenience for himself or his patient). But the results of a survey 30 of the use of such facilities in the pathology department of the teaching hospital in Cardiff, which has offered open access since 1942, suggest that general practitioners are not taking full advantage of the services offered. Between 1955 and 1964 the number of investigations carried out for the hospital itself more than doubled: the number of requests from general practitioners quadrupled during this time, but the increased demand still accounted for an annual referral-rate of only 187 per 1000 patients on their lists. About 9 out of 10 episodes of illness medically 29. 30
Cashell, G. T. W. Lancet, Aug. 20, 1966, p. 432. Hitchens, R A. N., Lowe, C. R. Medical Care, Lond. 1966, 3, 142.
treated are handled throughout by family doctors, but only about 11% of the total laboratory work at the Cardiff Royal Infirmary is the result of direct reference from general practitioners. The authors of the survey, Dr. R. A. N. HiTCHENS and Prof. C. R. LOWE, of the department of social medicine of the Welsh National School of Medicine, think that many general practitioners do not fully appreciate the role of the laboratory services: certainly they do not always make the best use of the help at their disposal. In the hospital, demand for biochemical investigations has been rising year by year and is now heavier than for any other type of investigation. The demand by general practitioners for biochemical tests has also risen, but haematological investigations still account for more than half of their requests, while bacteriological and pregnancy tests make up the greater part of the remainder. Most investigations are for ansemia and infections; and surprisingly little use is made of the laboratory service in diagnosing the diseases characteristic of middle and late life (in 1960 neoplasms accounted for only 1% of the requests, and cardiovascular disease for
3-6%). In 1960 there
general practitioners in Cardiff, with a total of 310,961 patients on their lists. Of these doctors, 7 referred no specimens at all, and a further 50 made fewer than 10 referrals per 1000 patients. were
134
At the other end of the scale 9 doctors referred 50 or more specimens per 1000 patients-a difference which, it is held, bears little relation to their respective patients’ needs. Referral-rates were highest for doctors with lists of between 2000 and 3000 and on the whole tended to increase with partnership size. There was a sharp decline in referral-rate from 29 per 1000 patients for doctors who qualified less than 10 years ago to 14 per 1000 for those who qualified 20 or more years ago. This discrepancy HiTCHENs and LowE ascribe to differences in training experience: the hospital laboratory services have grown rapidly in the past few years, and the younger doctors, who have witnessed the expansion during their student years, naturally tend to make more use of these facilities when they move into general practice. It is far more difficult and inconvenient for a general practitioner to have a test carried out than it is for a hospital doctor-especially if his patient is bedridden and he has to take the specimen himself (and probably provide his own dry, sterile syringe for the purpose).
laboratory services by general practitioners will continue to vary according to training, experience, work-load, and inclination,3132 but with the growth of group practice and the introduction of health centres - especially if responsibility for screening services comes to be accepted as part of the general practitioner’s routine work-the demand for diagnostic aid is bound to increase. HITCHENS and LowE believe it could easily rise by 25% per annum; and the need to plan for this expansion is urgent. The use of
31. 32.
Macaulay, H. M. C. Lancet, 1962, i, Eimerl, T. S. ibid. p. 851.
791.
of hospital planners, will be the answer to a good many prayers. Often architects have claimed that hospital users do not know what they want and, even when they have decided what they want, they do not know how to brief the architects. Though this situation has lately shown some improvement, there are still enormous and disgraceful delays between the decision to build and the cutting of the first sod. This model hospital could, by the simplification and standardisation of design, substantially reduce delay. As CASHELL remarked,29 " boards and hospitals must be prepared to accept greater standardisation of design and components so long as they can be assured that adequate research and technical knowledge has gone into the formulation of these standards." As more work comes off the boards of this design group, so could more projects be speeded up. Incidentally, two hospital authorities concerned with current building projects in the South Western region (each project being well advanced in the planning stage) have accepted and applied the design of the standard acute ward. Significant reductions in cost have been achieved compared with the duplex ward and race-track ward which were formerly being considered. The design group is working fast and hopes to produce its geriatric ward in the autumn and its accident and emergency department by the end of the year. Well though the group is progressing, a standard hospital could be designed more quickly if other regions took on the planning of various types of ward and department, working with the team in Bristol. Certainly, similar work has been undertaken elsewhere-for example, a study on operating-theatres in the Newcastle region. But it seems a heavy burden for one region, or a handful of regions, to do this long-awaited work alone.
Laboratory Services for
the General
Practitioner FOR many years general practitioners have been pressing for open access to the laboratory service of their local hospitals. Hospitals throughout the country have responded fairly well to the demand, and there are few places today where a general practitioner cannot get a report on a pathological specimen (although this may mean some inconvenience for himself or his patient). But the results of a survey 30 of the use of such facilities in the pathology department of the teaching hospital in Cardiff, which has offered open access since 1942, suggest that general practitioners are not taking full advantage of the services offered. Between 1955 and 1964 the number of investigations carried out for the hospital itself more than doubled: the number of requests from general practitioners quadrupled during this time, but the increased demand still accounted for an annual referral-rate of only 187 per 1000 patients on their lists. About 9 out of 10 episodes of illness medically 29. 30
Cashell, G. T. W. Lancet, Aug. 20, 1966, p. 432. Hitchens, R A. N., Lowe, C. R. Medical Care, Lond. 1966, 3, 142.
treated are handled throughout by family doctors, but only about 11% of the total laboratory work at the Cardiff Royal Infirmary is the result of direct reference from general practitioners. The authors of the survey, Dr. R. A. N. HiTCHENS and Prof. C. R. LOWE, of the department of social medicine of the Welsh National School of Medicine, think that many general practitioners do not fully appreciate the role of the laboratory services: certainly they do not always make the best use of the help at their disposal. In the hospital, demand for biochemical investigations has been rising year by year and is now heavier than for any other type of investigation. The demand by general practitioners for biochemical tests has also risen, but haematological investigations still account for more than half of their requests, while bacteriological and pregnancy tests make up the greater part of the remainder. Most investigations are for ansemia and infections; and surprisingly little use is made of the laboratory service in diagnosing the diseases characteristic of middle and late life (in 1960 neoplasms accounted for only 1% of the requests, and cardiovascular disease for
3-6%). In 1960 there
general practitioners in Cardiff, with a total of 310,961 patients on their lists. Of these doctors, 7 referred no specimens at all, and a further 50 made fewer than 10 referrals per 1000 patients. were
134
At the other end of the scale 9 doctors referred 50 or more specimens per 1000 patients-a difference which, it is held, bears little relation to their respective patients’ needs. Referral-rates were highest for doctors with lists of between 2000 and 3000 and on the whole tended to increase with partnership size. There was a sharp decline in referral-rate from 29 per 1000 patients for doctors who qualified less than 10 years ago to 14 per 1000 for those who qualified 20 or more years ago. This discrepancy HiTCHENs and LowE ascribe to differences in training experience: the hospital laboratory services have grown rapidly in the past few years, and the younger doctors, who have witnessed the expansion during their student years, naturally tend to make more use of these facilities when they move into general practice. It is far more difficult and inconvenient for a general practitioner to have a test carried out than it is for a hospital doctor-especially if his patient is bedridden and he has to take the specimen himself (and probably provide his own dry, sterile syringe for the purpose).
laboratory services by general practitioners will continue to vary according to training, experience, work-load, and inclination,3132 but with the growth of group practice and the introduction of health centres - especially if responsibility for screening services comes to be accepted as part of the general practitioner’s routine work-the demand for diagnostic aid is bound to increase. HITCHENS and LowE believe it could easily rise by 25% per annum; and the need to plan for this expansion is urgent. The use of
31. 32.
Macaulay, H. M. C. Lancet, 1962, i, Eimerl, T. S. ibid. p. 851.
791.