74 little time to assimilate and evaluate the mass of information with which he is currently inundated. Anatomy Department, The Medical School, University of Manchester, Manchester M13 9PT.

PHILIP HARRIS.

social facilities which the hospital provides and are members of the staff. The idea behind this arrangement was to bring about the sort of integration with the community and the hospital which Professor Fendall describes, because as he says, any general hospital in a town or city is in fact the community

hospital. THE DOCTOR IN THE HOSPITAL LABORATORY

SIR,-Professor Griffiths and Dr Mitchell (July 5, p. 27) rightly ask that the non-medical scientists in clinical chemistry are not forgotten in the current concern for chemical pathologists. They ask: " If clinicians with specialised laboratories take over all the interesting biochemical work, where will people good enough to ensure proper standards for the day-to-day routine be found ?" But they miss the point of other letters on the subject.1-a Many of the clinicians referred to should be chemical pathologists, with routine laboratory commitments. Likewise, the staff of these specialised laboratories should have commitments in the general laboratory. Clinically competent chemical pathologists should provide opportunities for non-medical scientists to work on clinical problems. At present, in many departments, such opportunities are absent, and trained scientists too often find themselves frustrated, working as technicians. Only by bringing the scientist in on the cooperative investigation of patients can his expertise in clinical chemistry be fully used. This, in practice, can only be done through clinicians, preferably working alongside him. This is not a plea for an entire volte-face in the profession ; the routine tests must continue to be performed on request, and work on methodology must go on. This is a plea for the profession to broaden its horizons, to seek out clinical problems, to direct the investigation of biochemical aspects of disease rather than passively to await direction. A clinical chemistry department should be more than just an efficient factory. In my opinion a start can be made by encouraging some trainee pathologists to become clinicians. Many clinicians are good scientists; why should not the reverse be true ? At present there is little encouragement to gain a dual qualification, and, for that matter, little encouragement to gain confidence in clinical research for most trainees. And if such experience is not gained during training, all too often the qualified pathologist then finds himself a prisoner of his laboratory, a laboratory manager unable to use what medical skills he has. If he cannot involve the non-medical graduate in challenging biochemical work bearing directly on clinical problems, it is

unlikely

anyone can. Department of Clinical Chemistry, Queen Elizabeth Hospital, Birmingham B15 2TH.

G. D. CALVERT.

AN ASSISTANT IN THE HOUSE ? SIR,-In his letter (June 7, p. 1291), Professor Fendall wrote of the general practitioner becoming the primary-care physician with responsibility for the family " whether at home or in the hospital". We have had here at the Radcliffe Infirmary what we call associate general practitioners who have an honorary contract with the hospital, attend ward rounds, and are encouraged (though they rarely do so) to admit their own patients direct into the hospital’s beds. They have all the Calvert, G. D. Lancet, 1974, ii, 473. Carter, P. M., Davison, A. J., Wickings, H. I., Zilva, J. F. ibid. p. 1555. 3. Cheng, B., Lockey, E. ibid. 1975, i, 920.

1. 2.

The associate G.P.S were welcomed by the consultant staff and by the registrars and the " house ". There is with them an interchange of learning and teaching, and the students also benefit. It is, however, a very small prototype of what Professor Fendall was proposing and one of the major barriers to its expansion is lack of money. Under present regulations it is impossible to make any payment to the G.P.S or even make a contribution to their practice expenses (which increase because of their association). I have been unable to persuade the Department of Health or any Trust to put money into the experiment, and it may die because of that. Now is no time to expect a subsidy but a time to re-deploy existing resources. The problem is to find what resources to deploy. It would be sad if the thing falls apart, because obviously it is fundamental to a proper and natural integration. Ours is a fragile plant much in need of the compost of finance. For four years it has been nurtured only by enthusiasm and good will. Radcliffe Infirmary, E. J. R. BURROUGH. Oxford OX2 6HE.

COST OF TRAVELLING TO SPECIALIST CENTRES with chronically sick adults and children SIR,-Working in a London teaching hospital, I have become aware of the financial burden placed on adults or the parents of young children being treated as outpatients or inpatients at some highly specialised units. Many physicians are ignorant of the scarce statutory allowances available to help with travelling expensespatients and their relatives are also either unaware of the costs that may be involved, or unwilling to admit that their resources may not meet the demands. The regulations under which assistance may be given to people towards their travelling expenses requires that a person or family must be receiving supplementary benefit or family income supplement. Many families’ incomes fall just above this category, and, under the Department of, Health and Social Security’s regulations, they are not entitled to financial assistance. Social services departments both within and outside the hospital are often fully aware of this problem and do all in their power to help, using Samaritan (hospital voluntary) funds and other monies from trusts and charities; however, these funds are often limited and moreover rarely do they see their function as being one of supplementing outpatient or other essential

hospital travelling expenses. The Department of Health should recognise that specialist centres provide a service not only for their own health-care district, and that patients may travel substantial distances for treatment (200 miles is not uncommon). The National Association for the Welfare of Children in Hospital believe that the visiting of children in hospital by parents must almost always be seen as being part of essential treatment. The Department of Health and Social Security and the professions should consider the possibility of changing the regulations to provide financial assistance for travelling arrangements to cover all those patients and relatives who have to travel outside their health-care districts for treatment. Guy’s Hospital, ANDREW BEHR, St. Thomas Street, London SE1 9RT. Senior Social Worker.

Letter: The doctor in the hospital laboratory.

74 little time to assimilate and evaluate the mass of information with which he is currently inundated. Anatomy Department, The Medical School, Univer...
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