plete unit and it is extravagant of space. A dis- advantage of the double unit system is that if a patient goes into the examination room and gets undressed, and ...
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22 January 1966
Correspondence
occasionally aid administration, but I should think more often introduces a neurosis which is of far greater significance.-I am, etc.,
room itself contains a couch and whether the examination room contains a desk. If not, then the two rooms together only constitute one complete unit and it is extravagant of space. A disadvantage of the double unit system is that if a patient goes into the examination room and gets undressed, and the next patient needs to be examined, there will be a temptation for the doctor not to examine the second patient when he should, because no couch is available. Another disadvantage is that having taken the history of the first patient the doctor then breaks off consideration of that patient and takes the history of a second before going in to examine the first. I personally prefer to remain in contact with the problem until I have finished with itin other words, to take the history and proceed to the examination without confusing the issue with another case history. Furthermore, by remaining in contact with the patient until the consultation is finished it gives the patient an opportunity to produce afterthoughts which are sometimes of vital importance. It may even be a question of the patient summoning up the courage to give the doctor some vital information he might otherwise have concealed. If it is a question of providing a patient with privacy, a wall and a door are very expensive substitutes for a curtain. It also leads to the production of two rooms, both of which are rather cramped unless there is to be an extravagant use of space. Where examination rooms are required, I believe they should be fully equipped rooms, with couch and desk-that is, a spare consulting room. The question then arises of the proportion of these spare rooms that are required. I am in favour of having one spare consulting room, fully equipped, for every three doctors who are working simultaneously. These are the conclusions I came to after doing a study of purpose-built group practice
Norwich.
B. E. JERWOOD.
Medical Laboratory Technicians SIR,-May I trespass upon your space to draw attention to the implications of State registration for medical laboratory technicians and of the recent increases by the Institute of Medical Laboratory Technology in its standards for admission and in the syllabus for the intermediate examination. It is beyond dispute that technicians' work is absolutely essential for the proper functioning of hospital laboratory services. However, after many years' experience of organizing technicians in a research department of a teaching hospital, I do feel that the true qualities which make a good technician are being overlooked in the present clamour for higher academic standards, paper qualifications, and State registration. I submit that a good technician should primarily have common sense, a critical mind, conscientiousness, reliability, and ability to use his or her hands. Such qualities do not necessarily go with ability to pass examinations. Some of the best technicians I have known have either been entirely unqualified or have failed their examinations. Is it the intention of those responsible for the new regulations to exclude from the profession persons who would make excellent technicians but who do not have the appropriate qualifications for entry, or who for some reason cannot pass examinations ? If not, how is it suggested that such people be catered for ? Since the new intermediate syllabus must involve day release for classes, do the Ministry or the universities propose to allot additional funds for extra staff to stand in for technicians who are away at classes ? Should not qualifications, other than those of the Institute of Medical Laboratory Technology, which may be acceptable to the State Registration Board, be more clearly defined so that courses best suited to their talents, their work, and their employers can be chosen for technicians ? These and similar problems must be worrying many of those responsible for running hospital laboratories. Some guidance about the answers and the official attitude would be most helpful.I am, etc., G. H. SPRAY. Nuffield Department of Clinical Medicine, Radcliffe Infirmary, Oxford.
Value of Examination Rooms SIR,-Dr. R. A. Murray Scott's letter (1 January, P. 52) tends to confirm a growing suspicion I have that " examination rooms " are becoming a status symbol in general practice. He castigates us for not building " examination rooms " in our new group practice premises, but appears to overlook the fact that we are building two spare fully equipped consulting rooms, and the equivalent of two rooms for nurses. Why should a partly equipped examination room be preferable to a fully equipped consulting room ? When considering examination rooms, it is necessary to bear in mind whether the consulting
premises, a report on which will be found in the 7ournal of the College of General Practitioners.1-I am, etc., Guildford, Surrey.
ALLEN J. WHITAKER. REFERENCE
Whitaker, A. J., 7. Coll. gen. Practit., 1965, 10 265.
Practice Premises SIR,-After careful consideration of the second report of the joint discussions between general-practitioner representatives and the Minister of Health (Supplement, 16 October 1965, p. 153) the Exeter Division has instructed us to express the grave concern felt by many members at the following features of this report. Paragraph 7 of Appendix A (Reimbursement of Expenditure on Rents and Rates) states: "The allowances otherwise payable under the scheme may need to be abated in accordance with a scale where the premises are used to a significant extent for the purposes of private practice or other work outside the general medical services." The idea that a general practitioner's private earnings should reduce his N.H.S. practice earnings is quite new. We see no reason why a general practitioner who is looking after the same number of N.H.S. patients and carrying the same N.H.S. responsibilities as a colleague should be fined (that is, have his N.H.S. allowances abated) because he does some private medical work. If this paragraph is allowed to stand there will presumably be a duty on executive councils to determine whether a general practitioner's private practice constitutes " a significant amount." This may, in our view, lead to considerable intrusion into general practitioners' privacy.
MEDICAL JOURNAL Are general practitioners to be made to declare to executive councils every private certificate, insurance report, private patient, or every private examination for factory, school, or college > Are executive councils going to require general practitioners to submit their practice accounts ? It seems to us that any phrase such as " a significant amount," which involves the idea of a general practitioner's private practice being either measured or expressed as a proportion of his N.H.S. practice, will lead to difficulties. The simplest and fairest method is surely to tie these N.H.S. allowances to an agreed minimum number of N.H.S. patients. In the following section the Government proposes a basic practice allowance paid to all general practitioners with more than 1,000 patients, and we are unable to see why this same criterion should not apply to eligibility for the reimbursement of rent and rates. We do not understand why the words " or other work" are present, or what exactly they mean in this context. We advise all general practitioners to reread the second report, and this paragraph in particular, with great care, and hope that those who share our misgivings will join us in expressing them.-We are, etc., J. R. EDWARDS, Hon. Chairman, Exeter Division, B.M.A.
F. E. GRAHAM-BONNALIE, Hon. Secretary, Exeter Division, B.M.A.
D. J. PEREIRA GRAY, Hon. Secretary, Exeter Division, British Medical Guild. Exeter, Devon.
Distinction Awards SIR,-Lord Brain's statement on merit awards (11 December, p. 1430) should not go unchallenged. Until accurate and complete details are published nobody but a select few can know the true facts. Secrecy has always been the strength of the medical establishment, the muzzle to stifle criticism. But why keep up the pretence that these awards have anything to do with merit ? The two main criteria which have come to light as a result of discussions at various B.M.A. conferences are: (1) First and foremost-being on the staff of a teaching hospital. This may well mean previous athletic prowess or being a Mason, or bland conformism. (2) Age-apparently until a person approaches the age of 60 he will not get a top award. The present Minister of Health when in opposition was very critical of these awards. Let him now be of good courage and ignore the unctuous persuasions of the medical establishment. I appeal to him to abolish these secret handouts of public moneys and thus save over £4m. per year.-I am, etc., M. H. PAPPWORTH. London W.1.
Hospital Junior Staff SIR,-I view with grave concern the present attempts to form an independent hospital junior staff group outside the B.M.A., and I would ask the 90% of doctors who Dr. M. Hession claims are supporting this venture to think again before taking what I am sure is a retrograde step. Now
