The Personal Touch
Editorial
Just over a year after the National Health Service was introduced, it is natural that there should be a phase of stocktaking. Some of the more politically-minded may be concerned to call attention to its successes or shortcomings, and such subjects as the cost of the dental services, or the delays in their products are, fortunately, outside our scope. There is, however, another criticism which has been made often enough to give rise to some disquiet? particularly in view of its author. He is not a politician of either side but an individual whose views are still of some importance even if his influence and interests are implied more tacitly than ever in many negotiations?that is the patient.
First and secondhand accounts of patients’ views met at random in different parts of the country, suggest that they are missing something of the personal touch they had from the medical profession before the Act came in ; their general practitioner ” seems more rushed off his feet than ever before ” ; the specialist at the local hospital ” can’t be seen for some weeks, and even then hasn’t much time” ; the dentist asks if he shall ” spend the appointment by filling the form or filling the cavity All this is very unsatisfactory to the patient, and is obviously damaging to the doctorpatient relationship ; its immediate effects are likely to be a lowering of the confidence in the profession in many and a gross neglect of a few. This neglect will, of course, be more marked in the less obvious and apparently less urgent but more preventable cases, and the ill-effect on the health of the nation in the long run can well be imagined. This is bad enough for all, but it is of particular concern in the field of mental health ; the past has shown us only too clearly that what is not treated early becomes progressively more and more difficult to treat, and it would indeed be tragic if at the very moment that new techniques and new hopes have been given us, and a completely new orientation has become possible, we should be hindered in our task by this lack of time, and manpower.
Moreover, it is not just a question of the treatment of the individual ; the problem is even bigger, and concerns the whole feeling in the country about mental health and illness. If this is unsatisfactory for the individual patient, and dangerous for the nation’s health,, it is no less unsatisfactory and dangerous for the medical profession. The doctor will deplore the loss of a good relationship with the patient as much as the latter ; and he realizes perfectly well that he does not give of his best when he is very rushed. Indeed, he sees the possibility ‘ of being so swept off his feet by the mere pressure of the day that he works automatically and has no time to do the really important work ?sitting and thinking, or sitting and listening. Without it the art of medicine and the vision fade ; and ” where there is no vision, the people perish The doctors then are as disturbed as the patient by the lack of personal touch.
The cause of the trouble is not so easy to find ; to some it seems to be too much time spent in form-filling (” futile quill driving “) ; to some, too much committee work ; to some, a great increase of patients, encouraged by the advent ^ of the National Health Service to seek assistance or appliances ; to some, merely inefficient administration, in the planning of a surgery or out-patient department which has broken down under extra work. Not so often mentioned, but sometimes evident on enquiry, is the habit of ” flitting Time is wasted by never being thorough, never doing more than a patch, always hurrying on to do as little for the next case. The first three of these may be expected to be temporary ; for all should be symptoms of the beginning of the National Health Service, not its constant accompaniments. Forms should be more familiar, committee work less frequent, new patients less eager. This, of course, presupposes (in what some may feel is a pathetic . optimism) that no new forms are designed, no fresh work found for committees, and no more free offers made to patients. We shall see. But anyhow, the latter two deserve attention. Is medical administration adequate ? How much doctor’s time is wasted by doing work his secretary could do ? How much secretarial ) work could be saved by doctors thinking a little ahead ? And for the matter of that, need patients wait as long as they do in hospital outpatients and surgeries ? Secondly, the lack of thoroughness is most insidious ; we can sympathize ; a feeling of rush engenders it, and one must be very strong-minded to settle down methodically and thoroughly to an individual case with a crowd of others waiting. Unfortunately, without it the patient so often goes steadily downhill, never satisfied, never fully investigated, and losing confidence at each visit. The success of early treatment had gone far to remove the prejudice and fear of mental illness among the general public, and they were consequently being encouraged to seek advice earlier. They are likely to slip back where they were, if treatment becomes restricted to the acute forms of disorder.
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