5. Skilled nursing must be obtainable for patients needing to be treated at home, though the extent to which this is required will be greatly reduced by increased use of hospital beds.
6. In every district the patient might have the choice between several doctors; but unnecessary change of doctors should be discouraged. Subject to general regulations, however, he should be entitled to demand a consultation when not satisfied as to his treatment.
7. The doctor chosen by the head of the family should be held responsible for supervising the health of the whole family; and should be required at least once in three months to arrange to see each member of it, to ascertain any existing disease, or any habits, manner of life or work tending to cause disease, and to make a concise statement to the medical officer of health or health commissioner embodying his recommendations as to any public health action which may be needed.
8. The scheme at first might be limited to one section of the population, but there is no reason why ultimately it should not embrace all willing to join it.
9. The remuneration of doctors engaging in this public work should be adequate at once to attract junior members of the profession. The remuneration should not be on a capitation basis, but by salary, modified according to the success achieved. The scheme would enable doctors to have ample leisure and holidays and to take part in post-graduate courses. Every inducement should be given to physicians to undertake along with their family work special work in connection with one of the following activities:
- Pathological laboratories,
- Hospitals,
- Health centres for infants and mothers,
- Prenatal and post-natal clinics,
- Consultant obstetric work,
- Pre-school clinics,
- School medical inspection and clinics,
- Industrial inspections and clinics, etc.
10. Medical schemes on the above general lines can only be completely satisfactory to the extent to which every physician taking part in them becomes imbued with an appreciation of the almost unlimited preventive possibilities opened up by the opportunity to treat disease, and by the realization likewise that an essential part of his family work should consist in detecting the beginnings of disease and in detecting and securing the removal of domestic, dietetic, housing, industrial or other factors liable to cause disease.
If these ideals can be even partially realised, we shall have approached the time when every practising physician will become a hygienist, and when any sickness insurance still demanded or required will be on a scale much lower than is necessary at the present time. In short, compulsory sickness insurance under present conditions is a measure of relief. It has almost as little prevention involved in it, as has insurance against the risk of fire. Relief must be given, by insurance or otherwise. How much preferable, however, it would be to precede it by a far-reaching scheme of effective preventive and curative work, or at the least to place it in a strictly subsidiary position to such a scheme in actual operation!
FOOTNOTES:
[11] An address given to the Quiz Medical Society, New York, Feb. 14, 1920.