Læknablaðið - 01.06.1972, Blaðsíða 62

42
LÆKNABLAÐIÐ
It is a continuing requirement throughout a professional career, and
the man who has ceased to learn will soon cease to be worthy of
whatever position of responsibility in a professional sense he holds.
A comprehensive health service must therefore provide a framework
within which that education can go on, together with the resources
that the process requires. This offers a great temptation to interfere
in what are essentially professional responsibilities. If the profession
itself faces its responsibilities, then the govemment will be able to
hold back from intervention. It can be an uneasy equilibrium, especial-
ly when some parts of the service fall sadly behind others. The
special problems of providing for long-stay care, particularly of the
chronic sick and mentally handicapped, have been such as to com-
plicate the burden on the relevant clinical teams as a consequence
of their success. Restoration of the less severely mentally handicapped
to life in the community has taken place at a time when the capacity
to treat infections has preserved from earlier death large numbers of
the more severely handicapped patients who then fill places intended
for those with less defects. The rehabilitation and discharge home of
the elderly person with chronic illness or disability means only that
more people live to be very old and to require an even greater
amount of care at that later age.
One of the salient features of the development of hospital medicine
in the last 20 years has been its increasing subdivision into specialties.
In Britain the amount of medical time now required for hospital
work is roughly double what was needed 20 years ago. There are
not more people in hospital at any one time — rather there are
nearly 10% less — but on average each requires more medical at-
tention and the attention of more of the allied professions and
technologies. The diagnostic and treatment facilities are far more
complex, precision in the diagnosis and in the monitoring of progress
of disease has greatly increased. The drugs that are available now
are more powerful and therefore more dangerous in many cases and
require greater knowledge and closer control in their use. The life-
time in general use of any new drug now is seldom likely to exceed
five years. It follows that the doctor in practice either in hospital or
outside it must be constantly re-learning the possibilities of clinical
and laboratory measurement and the effects both favourable and un-
favourable of the drugs he has to use. The margins of error can be
small indeed and combinations of different drugs or of drugs with
other things in the human environment carry their own dangers, as
for instance with the mono-amine oxidase inhibitors. It follows that
new specialties must be further developed, for instance clinical
pharmacology in assistance to clinical medicine in hospital or in
general practice or clinical physiology in the diagnosis and control
of conditions requiring major surgical intervention or perhaps arti-
ficial ventilation or cardiac reactivation. The detail that could be
presented is endless, perhaps I have said enough to emphasise the
general point that a continuing educational programme for all doctors
is a necessity and the time required for it will increase. If a doctor