Cancer of Breast

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Abstract

Sm,-The article " Youth Looks at General Practice," by Dr. C. P. D. Grant (Journal, April 30, p. 1049), should be read by every medical practitioner and senior medical student, for it expresses the views of the majority of young general practitioners. In a short space Dr. Grant reviews comprehensively the fears, problems, hopes, and subsequent thrill of success that result from the efforts of the general practitioner. I should like to stress several of his points and elaborate them. It is true that many of us on qualifying set as our ideal a specialty and rather unwillingly later turn to general practice as the permanent sphere of our work. Having arrived in general practice it is found that we are lacking in many of the essentials which are necessary to make a success of the job. We do not know what measles is like, and have never seen a patient suffering from diphtheria. In fact, many of us have never even seen a sore throat; and we certainly have never tried to treat one before. Neither do we appreciate the differences in approach which are necessary in the surgery and home, as compared to the hospital. We have not access to white cell counts and endless x-rays to aid our diagnosis. We have to diagnose perforated ulcers immediately after perforation and not six hours later, as the hospital staff can do. These defects show a grave lack of foresight in our medical education which is partly administrative and partly due to the teaching clinician. Those who arrange our curriculum and timetables have not yet fully appreciated the everwidening gulf between hospital practice and general practice, which has become so pronounced since the end of the war. Our teaching clinicians are composed more and more of younger men who, though brilliant in their own sphere, have little, if any, personal experience of general practice. As a result, they do not know what the medical student needs to be taught. The uses of cortisone and intravenous terramycin are of no great importance to the general practitioner; but which student has been taught how to treat influenza ? Learning the job takes time, but if we are willing and humble a great deal can be learnt quickly. Like Dr. Grant, I have had to learn to try to control a temper which I had not realized existed. But we must learn to endure fools; and also eccentric hospital consultants. There are consultants who will only do domiciliary visits on a Sunday afternoon, and those who will not do them outside a town except under pressure. These are in a minority, granted, but one cannot always do without their services. The majority fortunately are on extremely good terms with the general practitioner and are only too willing to help at any time. TIhe greatest satisfaction comes from being accepted as a family doctor, and as such I consider it is my duty to provide full maternity services to all my patients who request such services; and the majority prefer their own doctor to the clinics. I am glad we have no regulation in force in this part of the world like there is in Glasgow controlling admission to maternity beds. Here the general practitioner has equal access to beds as do the local authority clinics and those who attend the hospital clinics entirely. It seems to me that the local authority clinics for maternity care have largely outworn their usefulness in many areas, and could be dispensed with or curtailed. As Dr. Grant says, it is the general practitioner who has to deal with the antenatal emergencies, and not the clinic. Finally, let us realize that the patients themselves are mostly considerate and appreciative, often out of all proportion to the services rendered to them. But a word of advice to those who have not yet settled in practice-get out of the seaside resorts and wealthy residential areas, and practise in an honest-to-goodness working-class area, where there is more work, more appreciation, and more satisfaction to be gained.-I am, etc.,