The TABLET March 2nd, 1957. VOL. 209, N o . 6093

THE TABL ET

Published as a Newspaper

A WEEKLY NEWSPAPER & REVIEW

Pro Ecclesia Dei, Pro Regina et Patria

FOUNDED IN 1840

MARCH 2nd, 1957

NINEPENCE

How to Lose the Middle East: Short Memories in the West

The Land and the People of Ghana : The New state. By Antony Aiiott

A Century of Divorce : The Royal Commission of 1909-12

The Mass in France: The New Directory. By Lancelot C. Sheppard

Bucklast Abbey : New Evidences on its Original Foundation. By Dom John Stéphan

Education in Poland : The New Dispensation

Critics’ Columns : Notebook : Book Reviews : Letters : Chess

THE DOCTORS’ CASE

r PH E doctors represent part of that professional and middle class to which, the Conservative Party leaders are realising, they will have to devote a little more thought and attention. Mr. Macmillan has now given them an intimation that they may be able to look for some interim relief, because the news of a Royal Commission on their pay under the Health Service has struck a chill and may well have tempted many a medical man to a far from Hippocratic oath, since Royal Commissions have great reputation for being very leisurely affairs. The more important their membership, the rarer their meetings, and the more years do they take to report.

The crisis that has arisen over the status and pay of general practitioners is a very good illustration how, in politics as in business, it is a mistake to drive too hard a bargain, of a kind that does not leave the other party genuinely satisfied. When Mr. Bevan introduced the Health Service, there were great misgivings in the medical profession. But the doctors were not resolutely or skilfully led, and the Labour Government pursued the line of dividing the specialists from the general practitioners, and treating the specialists very well.

There was in the immediate post-war period a feeling of expectation in the air, and those who spoke for the doctors were very anxious that a profession with a great tradition of public service should not seem to be hanging back, or thinking too much of its own interests. They were asked tft give the new system a fair trial, and they agreed to do so. The immediate cause of the present trouble is the loss in the purchasing power of the pound in the ten years since the remuneration was fixed. But even if that had not happened, general practitioners have found much that is unsatisfactory: a loss of their old position, a change in the character of their work. Many of them complain of having to see too many patients, passing on all the more important cases to specialists, handing out endless prescriptions after exceedingly brief interviews with the majority of those who throng their consulting rooms. They argue with much force that there is a great loss in this. Specialists are very necessary people, but so are family doctors, physicians who deal with individuals. This role, they say, has become much more important with the growth of the kind of illness which is largely nervous; not severe enough to call in the psychiatrist, but in large measure psychological.

On the actual issue of pay, the country ought to recognise how every year it becomes necessary for doctors to know more ; that almost every branch of medicine is very much more elaborate and advanced than it was fifty years ago, and that if ever there was a case for adequate differentials for the highly skilled, it is in the medical profession. It will be a salutary thing for the world of trade unionism to realise that there are other organised bodies which can apply pressure in defence of their own members. Doctors cannot, of course, strike against the community, or refuse to relieve pain and cure illness. There has never been any question of their doing that. What they can do is to make a mass withdrawal from the Health Service, while still keeping their skill and energies available for the public, but in the direct relationship which used to prevail.

Probably the settlement will be found by a change in the range of what is provided in return for National Health contributions and out of taxes. Certain of these services are invaluable, where they encourage people to go to the doctor in time, and to take a periodical check-up. This in the past has so often been left until too late, particularly by wives and mothers declaring they have neither the time nor the money to be ill. On the other hand, excessive delays have developed, and Health Service doctors are often driven to talk as though diseases would stand still and wait two months or more, until facilities for treating the case become available. These delays have offset a good deal of the good that the right to a check-up has brought with it. What doctors need is more authority to discriminate between their patients, so that they can concentrate upon