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PANEL AND CONTRACT PRACTICE

A Modern Jeremiad.

A GENERAL practitioner, writing in the JledicalPress of Feb. 4th, who does not disclose his identity,remarks that the panel system has for the most partruined the feeling between patient and doctor. Thatis, he says, an outstanding fact. A very largeproportion of patients hate the panel and every thingto do with it, while many feel it to be definitelydegrading; any extension of the system would dostill further harm to the medical profession. It is a

system that breeds annoyance such as unnecessarynight calls, for it makes no difference to the patientwhether he sends for the doctor at 9 a.m. or 11 p.m. ;a private patient who pays one and a. half to twicethe normal fee knows better than to do it withoutreason. The panel surgery is packed with patientssuffering from trivial ailments such as colds and gnatbites, none of which the sufferer would regard asworth a fee of 5s. The system allows of the employ-ment of assistants whereby a patient is forced to

put up with treatment by a medical man not of hisown choice. The panel doctor is called upon to issueand sign without fee large numbers of forms, certi-ficates and chits, while the panel is used by many as a rest cure and as a change from work.Whatever justice there may be in this compre-

hensive complaint, it has at all events been set outbefore with equal pungency. Some of the items donot deal with things as they are. It is not unusualfor a busy practitioner with a big list of insured patients to remark on the fewness of his night calls ;if he has given up midwifery he may get none at all.The assistant only comes on the scene if the practi-tioner’s list exceeds 2500, and then only with thesanction of the insurance committee. But thenovelty is the suggestion for the avoidance of thesedrawbacks in the future. The writer believes that, ,were panel work to be paid in the same way as the National Deposit Friendly Society pays for its

members, the great bulk of the ill-feeling to the presentsystem would disappear. The doctor would then bepaid for work actually done. There would be absolute ifreedom of choice of doctor and patient ; the service

might then become a complete one, includinganaesthetics, X rays, massage, dental, and ophthalmictreatment. At the same time he would restrictmedical officers of health and school medical officersto their proper sphere of inspection and reference.

He would arrange with some local authority to savethe practitioner a large part of his clerical work, andas for old-age pension papers, where his signatureis essential the doctor would be paid a fee for eachsignature. To avoid over-pressure of work he would

create a category of chronic patients who could bedeflected down some other channel, either to adeputy regional medical officer or to the out-patientdepartment of the local hospital. Finally he wouldremodel the national health insurance scheme tobecome of a contributory and genuinely insurancenature and entirely self-supporting. If no retainingfee were introduced into the revised panel system theline of cleavage between insurance and non-insurancepractitioners would disappear and their relationswould, he thinks, return to those which existed sohappily before 1909.

But, as the chairman of the Coventry InsuranceCommittee remarked the other day, the existinghealth insurance scheme is actuarially sound, in happycontrast with certain other insurance schemes; andthis in spite of the withdrawal of the exchequergrant. If contributions became voluntary whatwould be the income of the approved societies and,incidentally, how many practitioners in industrialareas would escape bankruptcy ? Professionalincomes, instead of growing with the diminution ofsickness and the improvement in the general healthof the community, would be entirely dependent onthe volume of sickness, on epidemics and similarcatastrophes. There may be defaulters in panelpractice; no scheme, however Utopian, will entirelyexclude commercialism. But is not the anonymouspractitioner trying to put back the clock ?

Cost of Drugs.At a recent quarterly meeting of an insurance

committee the chairman gave some figures intendejto illustrate the fact that there is no limitationon the supply of drugs and appliances to insuredpersons as far as these are required for efficienttreatment. In three recent cases oxygen was, hesaid, supplied for treatment on the following basis:(1) 24 prescriptions in 26 consecutive days, coveringa total quantity of 940 cubic feet of oxygen at acost of £11 is. 3d. ; (2) 22 prescriptions of oxygenin 28 days at a cost of E32 5s. 4d. ; (3) 12 prescriptionsof oxygen in 20 days at a cost of £3 6s. 4d.

NATIONAL COUNCIL FOR MENTAL HYGIENE.—Ameeting of this Society was held at the rooms of theMedical Society of London on Thursday, Feb. 12th, SirSquire Sprigge in the chair, when Mrs. Neville-Rolfe,secretary-general of the British Social Hygiene Council,delivered a thoughtful address on modern marriage and itsproblems. Regarding these problems, as they affected therace, social order, and the individual, she analysed thereasons for many of the prevalent problems and anomaliesassociated with marriage to-day among civilised peoples,and found that their solution or removal would follow awider acceptance of biological tenets. This view shereconciled with the advocacy of monogamy as the basisof that family life, on which progressive society shouldrely.At the conclusion of the address Dr. Doris Odlum, hon.

secretary for propaganda, brought the work and the needsof the National Council for Mental Hygiene to the attention iof a crowded room. She said that the Council acted as a liaison body between the general public and the medical profession and provided a common meeting ground for thoseinterested in the questions of mental hygiene, especially j in its sociological aspects. The human factor was coming,

more and more to he appreciated as the essential determinantof conditions in education, industry, politics, and above allin marriage and the home. Propaganda was, however,still greatly needed. This was carried out by means oflectures and public meetings ; by conferences such as thatheld most successfully in November, 1929, which was tobe followed up by another conference from May 27th to29th this year ; and by the work of expert sub-committees. One of the directions in which there was anurgent need for public education was that of the extensionof facilities for preventive and early treatment of nervousbreakdown and allied emotional and minor mental disorders.The annual economic loss caused by illness of this nature,to say nothing of the human suffering involved, made thisproblem one that urgently needed constructive measures.She therefore urged all those present to take their share inpromoting activities of such vital importance both to theindividual and to the nation, by joining the National Councilfor Mental Hygiene.

NURSES AT ST. BARTHOLOMEW’S HOSPITAL.-The League of St. Bartholomew’s Hospital Nurses hasraised over £1000 to name and endow a bed in the newsurgical block of the hospital.