The response of the hospital doctor to the health requirements of a changing society.

Before the advent of the National Health Service in 1948 most hospital doctors were in close contact with the primary care of, at least, a section of the community both by their continuing close contacts with general practitioners and as a result of often having spent some part of their careers as general practitioners. Since 1948 this awareness of the health aspirations of the community has weakened as a result of advances in the care of disease which have made the hospital doctor increasingly dependent on sophisticated facilities and, thus, focused his attention on hospital care rather than on the community. Hospital staff must re-establish their link with primary care and must perceive clearly the ways in which they contribute to the health of their community. They must be conscious of the proportion of available resources that are used in hospital and be prepared to regulate demands so that there is equality in the distribution of resources in the health field. Hospitals are not only expensive but have become extravagant; it is the responsibility of the hospital doctor to curb extravagance. If private practice is to continue, it must be integrated into the health service, not excluded from it. Finally, the patient must be recognized as a member of a family and of a community that is both curious and concerned about health. The hospital doctor must communicate with patience, understanding and clarity. In this relationship he also has a part to play in health education and prevention of disease. He must remove the mystery from his art and enter into useful discussions with government and community.