The Evolution of British General Practice 1850-1948

By Anne Digby | Go to book overview

9
Patients

DISCUSSION of the dynamics of the patient-doctor encounter is a feature of the recent past. For the period covered by this volume, the nature of such meetings has to be teased out from a variety of records. Gaps and silences are conspicuous, and testimony on key topics tantalizingly elusive, so that inability to advance far with certain issues, but availability of evidence on others, has shaped the discussion. This chapter selectively explores aspects of doctor-patient encounters including patient choices and expectations, the financial implications of the patient-doctor encounter, and the doctor's evolving patient constituencies. The general practitioner's developing role -- as a gatekeeper who controlled access to benefits of various types -- is highlighted. The chapter begins with a discussion of the likely options facing sufferers in what was an unusually open market for health care. Professional survival in a situation where registered doctors had little, if any intrinsic competitive advantage in recruiting patients, meant that doctors needed to work at improving their accessibility to potential patients, whilst at the same time broadening their social appeal through effective communication, or a good 'bedside manner'.


Choices

In response to their aches, ailments, and afflictions sufferers had a range of choices: those within easy reach (such as household remedies), local ones (folk remedies from neighbours or patent medicines from the local shop); as well as possibly more distant encounters with practitioners, including herbalists, homeopaths, and registered doctors. We still know relatively little about sickness behaviour in the distant past -- the characterizations of illness, the preferences of sufferers, and the conventions governing behaviour.1 In the recent past, however, two out of three ailments were not taken by sufferers to the registered doctor, and nearly 30 per cent of the money spent on medicines in

____________________
1
R. Porter, "The Patient's View. Doing Medical History from Below", Theory and Society, 14 ( 1987), 167-74.

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The Evolution of British General Practice 1850-1948
Table of contents

Table of contents

  • Title Page iii
  • Acknowledgements vii
  • Contents ix
  • List of Plates, Maps, and Figures xi
  • List of Tables xiii
  • Abbreviations xiv
  • 1 - Constructing General Practice 1
  • PART I - Careers 21
  • 3 - Recruitment, Education, and Training 40
  • 4 - Reinventing Roles 66
  • PART II - In Practice 91
  • The Medical Market 93
  • 6 - Organizing A Practice 126
  • 7 - Women Practitioners 154
  • 8 - Medical Investigation and Treatment 187
  • 9 - Patients 224
  • PART III - A Wider World 257
  • 10 - Public Duties and Private Lives 259
  • 11 - Generalists, Specialists, and Others 287
  • 12 - National Health Insurance 306
  • 13 - The National Health Service 325
  • Select Bibliography 343
  • Index of Medical Names 365
  • General Index 369
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