New Orientations in Epilepsy
Authors: D. Williams
Journal: BMJ (1950)

ONAL685 MEDICAL 685NAof yesterday, and may be the discarded fallacy of to-morrow.Methods, like men, must establish their own grading.Above all things it is important that the relation of confidence between the doctor and his patient should not be disturbed.The patient should look on his doctor as an individual whom he has chosen to help his own individual needs, as a man of power who can invoke State assistance and command State resources, never as an official at the end of an office string.For this relationship to be maintained it is essential that private practice should be encouraged rather than driven into the hands of the small group of charlatans who would still exist to prey on the stragglers of a society in which all reputable doctors were perforce full-time employees of the State.In matters of decisive concern to the individual-his health, his house, his legal affairs, his money-it is essential that each man should be free, if he so desires, to seek advice from an expert of acknowledged position and integrity, chosen by himself.Only when such a body of experts is available, as a standard for comparison and as a Court of Appeal in doubt or difficulty, can a Government service be wholly efficient or command complete confidence.It is clearly in the interests of a State medical service that the men who work within it, and the men whose wisdom or whose contributions to science have earned them a position in which they are sought as second opinions, should be the same.At the Cross-roads American medicine is at the cross-roads, and American doctors would be wise to face that fact.They can see, if they will look, other nations proceeding along, or being dragged along, some of the many paths that lead from the crossing.They are still free to choose their own.They can pick the good and reject the bad from other systems if they will study them, and from these pickings they have to-day an unparalleled opportunity, one that will never come again, to produce their own system and make it work.They can then go to their Government and say, " Here is a plan that we, the doctors of America, have devised and tested.We claim that it will keep our scientific research in the forefront of world progress, that it will allow every man who enters medicine to find that work to which he is most suited by inclination and ability, and that it will enable every citizen of our great country to get the treatment that his disability demands.We can prove that the cost of this system to the country is less than that of the National Health Service in Great Britain, that the benefits it confers are greater, and that it is more readily adaptable to changing needs.We ask you to take it over as a going concern.We will run it for you."The organization of medical services must come, all over the world, and the best people to initiate and develop such a public service are the doctors themselves.They alone have a clear and consistent grasp of the true relation of those services to the people, which is essentially that of servant and master-meaning that the true centre of interest and action is not in the authority but in the patient.And that patient is not a number in an office, but a unique person, a living soul.It is because doctors, and especially that most responsible of doctors the general practitioner, can never forget that all-important fact, so easily mislaid in offices and ignored by Governments, that I hope the American profession itself will take the first steps in its own development on a modern nation-wide scale.Will it do this ?Not if it goes on worrying over Granny.