PILOT PLANT FOR HEALTH
Friedlich, Ruth K.
Pilot Plant For Health By RUTH EC. FRIEDLICH IT could be your appendix," Peggy said, squinting at the thermometer. "I'm calling a doctor right away." I envisioned an old village practitioner...
...Late one night, a country doctor brought in a lad.desperately in need of the hospital's iron lung...
...The Mary Hitchcock Memorial Hospital is the core of a modern rural health center with a staff of 23 doctors, each expert in one medical or surgical specialty...
...Now you can build fine hospitals and buy top-notch equipment for a system of rural health centers allover this country but people still won't get the kind of care they deserve unless'doctors keep up the quality of the service...
...The specialist in urology was called to a remote White Mountain village to see an old man too sick to move...
...During the next week, I saw the Hitchcock Clinic at work...
...In a year, the 2 specialists on the Hitchcock staff handle over 10,000 calls for the use of X-rays...
...THE doctors in "Hanover see the rural health center as a spur to country practice, now unpopular with ambitious young medicos...
...The lecturers on medical subjects, the staff of the hospital, and Hanover's family doctors were the self-same 5 overworked men...
...The rural health center must offer professional satisfaction to the fellow who loves his work...
...The clinic doctors and the hospital's laboratory staff are also guardians of Hanover's public health...
...The senior surgeon now talking to me was one of the founding fathers...
...She has come to know the problems of most families in the district and avoids putting the burden of debt where it is painful...
...The surgeon was warming up to a pet subject...
...The care of local residents accounts for only one-tenth of the Clinic's group practice...
...I hope that rural health centers like ours will offer them fine opportunities—a good living and a chance for professional growth...
...The 23 doctors whose names now appear in alphabetical order on the letterhead of the Hitchcock Clinic represent many familiar specialties such as child and maternity care and also the comparatively new fields of chest, plastic, and nerve surgery...
...By 9 that Sunday morning an expert in anesthetics had joined the team, and my appendix had become a specimen in a bottle...
...When college was in session, Dartmouth students almost doubled the local population while more and more country practitioners were turning to the hospital and its staff for help on serious cases...
...There aren't any bars and nightclubs around here and there's plenty of Winter...
...The child specialist serves as school physician, the pathologist as coroner, and the bacteriologist as inspector of food, milk, and water...
...THE Business Manager of the Clinic has her quarters just off the entrance hall...
...Obviously, the busy practitioners of the area welcome this assistance...
...The war has placed extra burdens on the staff—six members are with the armed forces—but in peacetime each doctor is expected to be free for one weekday afternoon, also every second weekend, and for an annual 2 weeks vacation...
...It's up to the medical profession to organize these centers so that group practice can benefit both the patient and the doctor...
...Such a unified record as the Clinic puts into the hands of its examining doctors has great scientific value and may shed more light on the case than an hour of interview...
...He may follow penicillin treatments in a Boston hospital, learn a new surgical technique from the master in Los Angeles, or observe endocrine research in Baltimore...
...The relationship between the family doctor and his patient is something very valuable and we're trying hard to keep it...
...It's only a question of time," my doctor told me, "until the staff of a health center is entirely supported through some kind of insurance—but we'll leave the economic problems for the experts to work out...
...Cooperating, this staff serves all hospitalized patients, carries on its group office practice in the Clinic building, makes home visits both in the town and the surrounding country, and attends Dartmouth students in the college infirmary...
...The story starts with the delivery of the mother, notes on infant feeding, weight and measurements, childhood diseases and accidents, immunizations, and physical check-ups during school years...
...The city cynic in me rose to protest at that point...
...Wards, kitchens, laboratories, and X-ray rooms teem with activity...
...We feel that the family physician can't possibly give adequate service in this day and age without top hospital facilities and a staff of specialists to supplement his skills when the need arises...
...Office calls generally cost from $2 to $10, with home visits $3, operations and deliveries $100 to $500...
...I asked...
...Although Hanover itself is a town of about 3000, the services of its hospital and clinic are available to family physicians throughout a large area in New Hampshire and Vermont...
...Often, a number of opinions plus reports from the hospital's laboratory and X-ray departments are brought together before a decision is reached...
...To qualify, each doctor must have a minimum of 3 years' training in his own line...
...The important thing is to understand why the day for solo practice was passing," he emphasized...
...Medical science and its paraphernalia is too much for any individual to master...
...Thirteen fractures once arrived on a single Dartmouth Winter Carnival day...
...I'll phone the Clinic," Peggy went on...
...Ninety per cent of its patients are referred by family doctors in other localities...
...A guest from the city has no right to be jpiek, especially not at 4 o'clock on a Sunday morning...
...Over and over, I was told of the care that went into the selection of the staff...
...You've got to build up teams of specialists who care more about the satisfaction of good medical practice than about their incomes...
...A recent report of Sen...
...Organized as the Hitchcock Clinic, these specialists care for all the hospital's patients, although about half of them cannot afford to pay for medical service...
...A comfortable pine-panelled library in the Clinic building is stocked with the latest technical publications and here the doctors gather when some puzzling case brings them into consultation...
...The selection of personnel is the most important part of the whole set-up in planning for group medicine...
...WHILE I was in the hospital, they operated on a child with an upside-down stomach and delivered a farmer's wife of tiny triplets who might not have lived without the baby specialist, trained nurses, and modern incubators...
...You notice I don't say substitute, but supplement...
...Ordinarily, the doctors neither know nor care what price, if any, has been put upon their services...
...THE 5 doctors decided that the situation called for some broad-gauged planning in terms of human welfare...
...No matter how good the doctor is or how well he knows the family, what he needs is access to reliable X-ray pictures, a laryngoscope, and a specialist, like our throat man, who knows how to go after that safety-pin...
...The family doctor is kept informed and the patient is returned to his care with hospital records, the advice of specialists and complete scientific laboratory reports...
...In addition, each year he is sent, at the expense of the Clinic, for brush-up study in his specialty...
...HANOVER'S doctors have made an 18 years' start toward solving the problem of bringing adequate health service to people in rural communities...
...There's always somebody on call...
...Twenty minutes later my hostess introduced a vigorous and efficient man of 50, who turned out to be a senior surgeon of the Hitchcock Clinic...
...The scale is set by a highly ^intelligent and sympathetic woman who came to Hanover years ago with experience at the Mayo Clinic...
...One Hitchcock doctor states the financial policy in other terms: "If a farmer would have to sell his cow to pay for his wife's operation, we feel he needs the cow more than we need the money...
...Although the patient has an appointment with the doctor of his choice, interview or examination may show that the condition could be more expertly treated by another member of the staff...
...Twenty-four hours of every day in the year, Sundays and holidays included, medical help may be called through their central switchboard, and while the patient may choose his own physician from the staff, he will benefit by the judgment of other specialists if they are needed...
...The Clinic is working out the answer to one of the toughest problems of our time—how to make scientific medical care, 1945 model, available to the people of a non-too-prosperous rural area...
...Its figures show a shocking lack of physicians and hospitals in hundred ; of American counties...
...I envisioned an old village practitioner operating on me in the kitchen of Peggy's New Hampshire farmhouse...
...They have built up a hope for human welfare and a challenge to their profession...
...Today, regardless of means, no one in the upper Connecticut Valley must suffer for want of expert care or up-to-date laboratory and hospital facilities...
...But finally, the men of the Hitchcock Clinic have achieved a success that is compounded of their own personal qualities of hearA and mind—the highest professional skill and integrity, deep concern with their social responsibility, and sympathy and understanding for the needs of their neighbors...
...Pepper's subcommittee on wartime health and education echoes this call for medical statesmanship: "We may expect young doctors to shun the countryside unless they are offered good professional surroundings, modern hospital facilities and an opportunity to earn a good living...
...And so, 18 years ago, the Hitchcock Clinic was set up...
...He had served as surgical resident at the Mayo Clinic and knew that group practice paid in more ways than one...
...The Mary Hitchcock Memorial Hospital, with its 196 beds, is the largest in New Hampshire...
...There fees are discussed...
...AS science opened up new fields, Hanover's 5 doctors invited other specialists to join their group and to become partners in the Hitchcock Clinic...
...Cooperation with the clinic brings professional recognition and comradeship into the life of the doctor in isolated communities while contact with the center can keep him in the mainstream of medical progress...
...Right now the earnings of all Clinic doctors go into a common pool and after aggregate expenses are paid, the income is shared on an agreed percentage basis...
...Doesn't everybody need rewards for good work ?" ' . „ . "Of course the doctor needs incentive—but it isn't all a question of dollars and cents...
...In 1927, my doctor told me, there were 5 doctors in the township and a local hospital...
...Founded in the '90s by Hiram Hitchcock in memory of his wife Mary, the hospital had been built to care for the sick and to provide Dartmouth's small medical school with clinical material...
...This group sees the need for a better way of distributing the risks of illness and emergencies...
...Given a hospital and local cooperation, they've shown that group practice can support a competent, specialized staff...
...We couldn't use the type of fellow who was ambitious for a Park Avenue office...
...Through group practice, with combined offices in the Clinic building attached to the hospital, they are proving that cooperation pays dividends for doctors as well as patients...
...Between these annual excursions, doctors keep up with the scientific times in their staff conferences and monthly medical meetings...
...But you take the case of a child who swallows a safety-pin...
...The charge is based on the ability of the family to meet the cost of current illness rather than on the number of doctors working on the case...
...Practitioners from the surrounding country, as well as hospital interns and residents, are invited to hear guest speakers and to share in the discussion that follows lectures...
...And how do you find doctors willing to work for glory and for the love of humanity...
...We kept on the look-out for well-trained specialists who liked country people and wanted to bring up their own families in a little New England college town," the Surgeon said...
...The doctors of the Hitchcock Clinic practice as a group, pooling their interests and their skills to care for the health needs of their community and its surrounding countryside...
...In another half-hour I was abed in the hospital of Hanover, with a bit of my blood on its way to the laboratory for tests and a specialist in internal medicine listening to my heart...
...They see many victims of ski accidents as Hanover lies in the heart of Winter sports country...
...When the war's over, there will be thousands of doctors coming out of the Armed Services with experience in group medicine...
...With the Clinic partnership in effect for 18 years, practically every young person in the township is represented by a complete life history...
Vol. 9 • August 1945 • No. 34
