THE DOCTOR AND HOSPITAL COSTS

It is believed that the doctor's best contribution to reduction of hospital costs is by practising efficient medicine, in close cooperation with all departments of the hospital. It is believed that the time is long overdue for organization of public hospitals In medical departments supervised by full‐time specialists charged with the responsibility for organizing and running the medical services. Hospital departments must be coordinated in an efficient system of medical administration, which brings specialized medical care to all patients and allows continuing consultation between medical and other departments to provide optimum over‐all care. This can be achieved only if many of the doctors, and particularly those in charge of special departments, spend all or most of their time working In the hospital. The restrictions of the National Health Act now make it Impossible for hospitals to offer such specialists financial rewards commensurate with private practice. There should be provision for resident training programmes to educate resident medical officers to utilize hospital services efficiently, to expedite Investigation and treatment, to prescribe drugs only when indicated and for as long as Indicated, and to take their part in arranging consultation and coordination between departments. Excessive investigation may be wasteful, but so can delay in diagnosis due to failure to Initiate appropriate studies. Hospitals should attempt to obtain qualified admitting officers so that the condition of patients can be adequately assessed, and delay in investigation and treatment avoided. Here, inefficiency is both costly and Inhumane. It must be remembered that the hospital treating acute Illness is busy day and night and at weekends, and In very large hospitals, it will be necessary to have qualified admitting officers on duty for two or three shifts a day. Continued cooperation between the technical, medical and nursing staff is necessary, so that proper use, purchase and maintenance of valuable equipment occurs. There should be a medical audit which tells all doctors In the hospital about what they and their colleagues are doing medically, and a financial audit which informs them of what their actions are costing the hospital.