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NEED FOR MEDICAL SUPERINTENDENTS
648 number of doctors from outside, most of them from underdeveloped countries; and we in this country have only just managed to stave off, and perhaps only for a short time, the collapse of our much-vaunted National Health Service. That our particular plight is not unique is obvious from a reading of a recent publication1 from one of the central pillars of the Western establishment, McKinsey and Co. Medicine does need a new, profound analysis. And then, on a yet broader but relevant tack, there is no moonshine about the problems of pollution, resource depletion, overpopulation, mycotoxins, nuclear power stations, the poor 1974 harvest, the beef mountain, the sugar molehill-and inflation. Ivan Illich has been described as the 20th-century Karl Marx. Even by the end of the last century how many English businessmen had accepted the Marxist analysis of capitalism ? This was then the leading capitalist country in the world. Was there a single such businessman ? And yet to how many hundreds of millions of people is the Marxist dialectic not divine’writ today ? We doctors should ponder the fact. Let us, like Montaigne, cultivate our cabbages for a while: we shall need them this winter, and the 21st century is not many winters away. Garraway House How Caple,
S. BRADSHAW.
Hereford.
MEETING THE NEED FOR DOCTORS
SIR,—Attention is drawn intermittently to the situation in Britain where we have fewer doctors than we need, so that we have to fill the gap by importing doctors from developing countries whose need is already greater than our own. The situation becomes tragically absurd when we realise that at the same time our universities will have just rejected over 6000 students who achieved adequate A-level results and whose wish was to start studying medicine this September. Existing medical schools have increased their intake to the limit (with little or inadequate improvement of facilities) and new medical schools are being suggested to bridge the gap between our needs and our own " production". Nottingham and Southampton exist, Hull and Reading are hoping to be approved. But new medical schools require years of planning, they are prodigiously expensive to build and maintain, and they represent a substantial internal brain-drain of practising specialists into teaching. In 1965, 26 consultants in Bath devised a scheme2 which is even more valid today and could train an extra 1500 doctors a year, starting very rapidly-the equivalent of at least 10 new medical schools. The saving in general finance actually covers the cost! First, it requires courses in human biology outside the preclinical sections of present medical schools; space for these (a problem in 1965) could now be found in the spare capacity in present science and engineering departments.3 Secondly, it requires that all existing teaching hospitals should use non-teaching hospitals as clinical training departments, with students spending up to a year in these satellite units. This could start slowly, so that by the time graduates were emerging from the human-biology course, a 50% increase in clinical students could be achieved, with minimum increase in teaching staff and with little building All medical costs except residential accommodation. schools have, in fact, adopted this idea on a piecemeal basis and the trend is increasing. Properly organised it could make an immense impact. The clinical experience in district general hospitals is at least as wide and varied ’
1.
Maxwell,
R. Health Care: the
Growing Dilemma. New York and
London, 1974. 2. Lancet, 1966, i, 201. 3. Scott, F. W. Headmasters’ Conference. See Times, Nov. 6, 1973.
in teaching centres (most students who come to us now admit that it is more varied) and virtually all of the senior medical staff have done their share of teaching in the past and would happily do it again. The Royal Commission on Medical Education, to whom our original detailed proposals were submitted, considered such a rapid expansion was not necessary. However, technological developments are increasing the need for doctors faster than the rise in intake of our medical schools. We submit that a scheme such as ours is urgently required. Ultimately, of course, the decision is political and depends largely on finance. We believe that our proposals could enable us to train as many doctors as we need-quickly, cheaply, and without loss of quality. They would also relieve the sixth-form blues, suffered by thousands of gifted young people who have proved they are academically up to standard, know their country needs them as doctors, but cannot get places in medical schools.3 Linden, S. D. V. WELLER as
Weston Road, Bath BA1 2XU.
T. STUART-BLACK KELLY.
NEED FOR MEDICAL SUPERINTENDENTS SIR,—I very strongly support the views of Dr Bowers (Aug. 31, p. 513). At the end of the 1939-45 war I came to this area with the defined duty of starting a pathology service from scratch for the municipal hospitals, each of which was in charge of a medical superintendent. With their help and cooperation a reasonably efficient and comprehensive service was soon at work. In 1948 the organisational decline was not immediately dramatic, thanks to the survival of certain traditions, and the continuance in office of a small nucleus of administrative officers of the old school. But the seeds of decay were inherent in the Act, the hospital structure failed to respond fully to the changing needs of the times, and now it is an antiquated rotting skeleton encrusted with an expensive proliferating mass of non-productive non-medical officials, cumbersome procedures, and futile committees. Junior doctors are pathetically lost and sadly lack a proper guide and mentor. For years I have not attended meetings. The mere reading of their minutes is a source of sadness. So many knowledgeable and otherwise able doctors have to fritter away their time arguing the toss over some of the very same problems which were faced and solved by a small designated (and largely dedicated) group more than a quarter of a century ago. In the present state of the national economy, medical superintendents or similar officers are a financial necessity. 95 Wolfreton Lane,
Willerby, Hull HU10 6PS.
A.
J. SHILLITOE.
SELF-TESTING REAGENTS FOR DIABETICS
SIR,—Last year 4 I expressed the opinion that the Department of Health and Social Security did not give a fair deal to diabetics. I have seen further examples of this. E.c.10 prescriptions for ’Dextrostix’ and ’Keto-Diastix’ have been disallowed without explanation or local inquiry. Had the Central Pricing Bureau made any check, they would have found that these prescriptions were for a doctor-diabetic and his wife, both of whom are unstable in control and who require vitamin C in large doses. It will be appreciated that the reagents required for selftesting in such cases undoubtedly save money, and lessen 4. Lancet, 1973, ii, 456.
S. BRADSHAW.
Hereford.
MEETING THE NEED FOR DOCTORS
SIR,—Attention is drawn intermittently to the situation in Britain where we have fewer doctors than we need, so that we have to fill the gap by importing doctors from developing countries whose need is already greater than our own. The situation becomes tragically absurd when we realise that at the same time our universities will have just rejected over 6000 students who achieved adequate A-level results and whose wish was to start studying medicine this September. Existing medical schools have increased their intake to the limit (with little or inadequate improvement of facilities) and new medical schools are being suggested to bridge the gap between our needs and our own " production". Nottingham and Southampton exist, Hull and Reading are hoping to be approved. But new medical schools require years of planning, they are prodigiously expensive to build and maintain, and they represent a substantial internal brain-drain of practising specialists into teaching. In 1965, 26 consultants in Bath devised a scheme2 which is even more valid today and could train an extra 1500 doctors a year, starting very rapidly-the equivalent of at least 10 new medical schools. The saving in general finance actually covers the cost! First, it requires courses in human biology outside the preclinical sections of present medical schools; space for these (a problem in 1965) could now be found in the spare capacity in present science and engineering departments.3 Secondly, it requires that all existing teaching hospitals should use non-teaching hospitals as clinical training departments, with students spending up to a year in these satellite units. This could start slowly, so that by the time graduates were emerging from the human-biology course, a 50% increase in clinical students could be achieved, with minimum increase in teaching staff and with little building All medical costs except residential accommodation. schools have, in fact, adopted this idea on a piecemeal basis and the trend is increasing. Properly organised it could make an immense impact. The clinical experience in district general hospitals is at least as wide and varied ’
1.
Maxwell,
R. Health Care: the
Growing Dilemma. New York and
London, 1974. 2. Lancet, 1966, i, 201. 3. Scott, F. W. Headmasters’ Conference. See Times, Nov. 6, 1973.
in teaching centres (most students who come to us now admit that it is more varied) and virtually all of the senior medical staff have done their share of teaching in the past and would happily do it again. The Royal Commission on Medical Education, to whom our original detailed proposals were submitted, considered such a rapid expansion was not necessary. However, technological developments are increasing the need for doctors faster than the rise in intake of our medical schools. We submit that a scheme such as ours is urgently required. Ultimately, of course, the decision is political and depends largely on finance. We believe that our proposals could enable us to train as many doctors as we need-quickly, cheaply, and without loss of quality. They would also relieve the sixth-form blues, suffered by thousands of gifted young people who have proved they are academically up to standard, know their country needs them as doctors, but cannot get places in medical schools.3 Linden, S. D. V. WELLER as
Weston Road, Bath BA1 2XU.
T. STUART-BLACK KELLY.
NEED FOR MEDICAL SUPERINTENDENTS SIR,—I very strongly support the views of Dr Bowers (Aug. 31, p. 513). At the end of the 1939-45 war I came to this area with the defined duty of starting a pathology service from scratch for the municipal hospitals, each of which was in charge of a medical superintendent. With their help and cooperation a reasonably efficient and comprehensive service was soon at work. In 1948 the organisational decline was not immediately dramatic, thanks to the survival of certain traditions, and the continuance in office of a small nucleus of administrative officers of the old school. But the seeds of decay were inherent in the Act, the hospital structure failed to respond fully to the changing needs of the times, and now it is an antiquated rotting skeleton encrusted with an expensive proliferating mass of non-productive non-medical officials, cumbersome procedures, and futile committees. Junior doctors are pathetically lost and sadly lack a proper guide and mentor. For years I have not attended meetings. The mere reading of their minutes is a source of sadness. So many knowledgeable and otherwise able doctors have to fritter away their time arguing the toss over some of the very same problems which were faced and solved by a small designated (and largely dedicated) group more than a quarter of a century ago. In the present state of the national economy, medical superintendents or similar officers are a financial necessity. 95 Wolfreton Lane,
Willerby, Hull HU10 6PS.
A.
J. SHILLITOE.
SELF-TESTING REAGENTS FOR DIABETICS
SIR,—Last year 4 I expressed the opinion that the Department of Health and Social Security did not give a fair deal to diabetics. I have seen further examples of this. E.c.10 prescriptions for ’Dextrostix’ and ’Keto-Diastix’ have been disallowed without explanation or local inquiry. Had the Central Pricing Bureau made any check, they would have found that these prescriptions were for a doctor-diabetic and his wife, both of whom are unstable in control and who require vitamin C in large doses. It will be appreciated that the reagents required for selftesting in such cases undoubtedly save money, and lessen 4. Lancet, 1973, ii, 456.