Monday, November 28, 2011

What is Community Medicine?

Many doctors outside the newly formed specialty of community

medicine are still far from certain what is meant by the term:

what are the 2,000 or so Fellows and members of the newly formed 

Faculty of Community Medicine going to do? At

first sight it seems difficult to see what common ground exists

for medical administrators, public health doctors, and academics

from departments of social medicine. Too often those asking for 

explanations have been fobbed off with talk about

management expertise and coordination-a word-salad of

jargon, incomprehensible to those not in the business; so the

straight-talking at the recent Annual General Meeting of the

Faculty was welcome.

The scientific part of the meeting was concerned with the

contribution of community medicine to health, and the

opening session was concerned with the effects of changes in

the environment on health. Sir Richard Doll was reasonably

optimistic, despite our ignorance of much of the environmental 

causes of disease. He thought the community had

learnt to control most infectious diseases and to avoid the

effects of malnutrition and of occupational exposure to industrial 

hazards, and it would probably be able to contain the

effects of industrial pollution. Something akin to the American

Environmental Pollution Agency might be needed to monitor

the environment; but given this and other watchdog bodies

he saw no reason to be anxious about the direct effect on

health of the future growth of industrialization.

Where Sir Richard was more pessimistic was in human

ability to control the social environment made for itself.

Society still had to learn how to control its appetite 

for concentrated food reduced in bulk by industrial

processing and its

need for mental stimulation-whether by tobacco, marijuana,

alcohol, coffee, or aggressive driving. Dr. Griffith Edwards,

giving a psychiatrist's view, had much the same message:

people shied away from a serious consideration of the social

determinants of health. The social organization of a housing

estate was as important as the purity of its water supply. More

concern was needed with value judgements and more 

understanding of the effects of social isolation; and to achieve this

understanding more objective measurement was needed but 

community and social psychiatrists had to take care not to

fall too easily into the trap of confusing correlation with causation.

With the greater emphasis now given to planning-at last community 

medicine will have a difficult course to chart. Mr.

George Teeling Smith, though speaking particularly ofchronic

disease, gave a message that applies equally well to all health

service planning. He suggested that the specialist in community

health will have to steer the health service ship between the

Scylla of overdiagnosis (and over-enthusiastic treatment) on

the one hand and the Charybdis of underprovision of resources.

Further specific comment on the work of a community

medicine specialist was given by Dr. Henry Yellowlees, the

Chief Medical Officer of the Department of Health and Social

Security, who saw the key role in community medicine played

by the specialist at district level. He would have to make the

system work, with one of his most important tasks being to

bring the general practitioner and hospital doctor together. He

would have to be an interpreter of his own role and of the

roles of different parts of the medical profession, and it would

probably also fall largely to him to weld together the other

professions concerned in the planning and delivery of health

services. He would also have the role of interpreter in the

explanation of priorities and of statistical and epidemiological information.

Sunday, November 27, 2011

defining a physician

"A physician is a person who, having been regularly admitted to a medical school, duly recognized in the country in which it is located, has successfully completed the prescribed courses of studies in medicine and has acquired the requisite qualification to be legally licensed to practise medicine (comprising prevention, diagnosis, treatment and rehabilitation) using independent judgement to promote community and individual health".