This question will probably arise in other directions but, having regard to the form in which it is raised by Deputy Kyne, perhaps it would be just as well to glance at what exactly is involved. Deputy Kyne has given one particular instance showing what the situation is. There are other cases, particularly where a person is living near an urban district, where more than one doctor even in the public service is available. The question arises of the value from a health and medical point of view of a person being able to choose among those around him the person with whom he has greatest affinity and the greatest personal understanding. This is probably as suitable an occasion as any to glance at the report of the inquiry into the health needs of thenation by President Truman's Presidential Commission of the 18th December, 1952.
In connection with the general question of health, ranging over a very wide field, very strong and very definite emphasis is placed upon the patient-doctor relationship. The report is available. I quote from the official text from the introduction, published in the United States News and World Report of the 26th December, 1952. At page 78, we find this paragraph:—
"In considering the rôles of the individual and various elements of Government in securing health services, one must, of course, not lose sight of a most precious relationship for health. Throughout the whole history of civilised man the relationship between patient and physician has been a special thing. In days when scientific knowledge was scanty, this relationship yielded about all the benefits the patient received. Even to-day, all the complex arrangements that exist to provide medical care have not replaced it. The patient's confidence in his physician underlies most successful care. But now the physician needs more than knowledge of human nature and love of mankind. To be effective in the modern sense he must have the help that the modern hospital supplies, the assistance of trained helpers and adequate facilities."
Very strong emphasis is laid there on the basic requirement, that there shall be confidence and an understanding between the patient and the physician.
The commission formulated ten principles and perhaps it is just as well to read them now, to show the particular context in which emphasis is still placed upon the physician-patient relationship:—
"From such considerations the commission has formulated these principles to be used as a guide in approaching our health problem. We believe that:—
1. Access to the means for the attainment and preservation of health is a basic human right.
2. Effort of the individual himself is a vitally important factor in attaining and maintaining health.
3. The physician-patient relationship is so fundamental to health that everyone should have a personal physician.
4. The physician should have access to proper facilities and equipment, affiliation on some basis with a hospital, and the help of trained personnel in order to fulfil his part in providing comprehensive health services.
5. Comprehensive health service includes the positive promotion of health, the prevention of disease, the diagnosis and treatment of disease, the rehabilitation of the disabled— all supported by constantly improving education of personnel and a continuous programme of research.
6. Comprehensive health service is the concern of society and is best ensured when all elements of society participate in providing it.
7. Responsibility for health is a joint one, with the individual citizen and local, State, Federal Governments each having major contributions to make toward its fuller realisation.
8. The American people desire and deserve comprehensive health service of the highest quality and that in our dynamic expanding economy the means can be found to provide it.
9. The same high quality of health service should be available to all people equally.
10. A health programme must take into account the progress and experience of the past, the realities of the present, and must be flexible enough to cope with future changes."
In a very realistic and practical approach to health, over a very wide-flung community, with varying problems and, no doubt, different methods of organising themselves, they place in the forefront the effort of the individual himself, first, and the importance of the physician-patient relationship.The effort of the person himself is very largely involved in confidence in the person to whom he is going for medical attention. So that, where there is the possibility of a personal choice in certain districts and particularly where the circumstances in which the man is working, his natural circumstances, provide him with medical attention from a particular physician in whom he has confidence and with whom he is in touch and with whom he has a tradition of dealing, if that person would be normally entitled to go to the dispensary doctor and to get free medical service through the dispensary organisation, I do not think it disturbs the elements of even the simplest form of administration that such a person, although not calling on the local authority for the services of the dispensary doctor, would, nevertheless, be entitled to make part of his claim, that is, the claim for the cost of medicine.