The appointed factory doctor service: just a face-lift or a new breed?

The practice of medicine is more resistant to change than even industry or education when it is presented with advances in science or technology. Until the discovery of the sulphonamides in the late I930s, when clinical scienc{e did not exist even as a name, there was no need for change in the institutions delivering the static medical knowledge in general practice, in hospital, or in public health. Although advances in clinical science have been taking place over the last 30 years, three decades is too short a time for the second oldest profession to adjust its practice because it deals with human beings and not with machines. Even now, in facing the main killers of arterial disease and cancer, it has to rely on its art. Thus, today, general,practice is still a cottage industry served from a corner shop rather than from a supermarket. Hospital practice carries on at the tempo of the buildings which it inherited from the last century, and public health, after its successes in the primary prevention of infection, has mixed feelings about secondary prevention by pre-symptomatic detection of latent morbidity. The tertiary prevention of handicap and invalidity by rehabilitation and adjustment of the family to chronic disease, is not being faced by any sector of medicine. Yet the final test of any modern system of delivering medical skills is not the acute episode requiring care in bed but the ambulant and recurring degenerative diseases in middle and later life, including mental handicap, as they progress with age into 'geriatrics'. This changed pattern of disease, in which the contrast between curative and preventive medicine is meaningless, may remain with every developed country for the rest of the century. It is against this setting of sickness today that this important report (The Appointed Factory Doctor Service, I966)-an outline sketch if not a hopeful blue print-of a viable national scheme of comprehensive industrial medicine for the future has to be judged.