More findings of the periodic overhaul

1 DISEASE

In considering this category, we cannot do better than quote from our previous Report (Biologist in Search of Material): - "The word 'disease' is used very loosely, not only by the public but also in most medical text-books. 'Disease' may mean (1) the subjective state of the patient, (2) the objective findings of the professional diagnostician, or (3) both the objective findings and the subjective state as though they were interchangeable or one and the same thing. To avoid this confusion here we shall use the word 'dis-ease' to mean only the subjective state of the sufferer. The objective facts discovered by the professional diagnostician we shall term 'disorder'

The condition of disease, the, arises from a disorder or disorders that have led to pain, to discomfort, to disability, or to limitation of action in the occupational, family or social life of the individual. One or other of these states is always present before the sufferer becomes aware of this 'disease'. Though all disorder is not accompanied by disease, all disease has, of course, its underlying disorder. The sufferer's appreciation of his disease, however, may give him no indication of the nature, nor gauge of the severity of the disorder. He may suffer what to him is serious disease from a trivial disorder, e.g. nettle rash, fissure in ano; or the slightest symptom from the most serious disorder such as cancer.

What then is the value of the distinction we make between these two states, dis-ease and dis-order? Its importance lies in the fact that it is upon the degree of the patient's disease that hangs his decision to take action for the removal of his disorder. It is disease, in fact, that converts the individual into a 'patient'; not disorder. The patient gives little or no consideration to the disorder underlying his disease; it is disability and interference with his actions that leads him to recognise that something is amiss, and that consequently leads him to decide that treatment is necessary. So under the existing regime, it is inevitable that the ignorant patient is the primary diagnostician of the existence of his sickness.

The medical services of the Nation (with the possible exception of the School Medical Service and the Child Welfare and Maternity Services) are designed for this 'patient': that is to say for those in the subjective category of disease. That the doctor has no means of coming into contact with the man in the street until by seeking advice the man constitutes himself a patient, makes this clear.

In our survey, we find some 25% of individuals in disease. In the face of the great advance in medical science, we must presume that these individuals in disease could derive benefit from skilled diagnosis and treatment, and, in view of the ever increasing facilities for treatment, it would be reasonable to suppose that they were doing so. In fact, however, less than one-half of t hose in the category of disease were receiving medical care. The remainder, though conscious of disease, were not in contact with any diagnostic or therapeutic agency, not were they receiving any medical attention. Without going into the reasons for this situation…let us look at it from the point of view of national sickness and of medical administration in general.

The first point that would seem clear it that what purport to be the statistics of national sickness do not, in fact, represent the total incidence even of self-acknowledged sickness in the population, for the statistics are gathered from the number of patients encountered by the medical profession. These national statistics of sickness represent, in fact, only the incidence of medically diagnosed and treated sickness. Where the statistics are being used purely as a measure of the relative incidence of sickness, in one year as compared with another, or one nation as compared with another, this is of course a small point. As long as Medicine is conducted on much the same lines throughout this country and in all other countries, the old methods may well continue to serve this purpose; but directly any one country begins systematically to apply periodic medical overhaul to its individuals, the figures will immediately take on an entirely different aspect. They will no longer be comparable with the old ones nor with those of other countries.

Much more important, however, is the fact that if less than half those conscious of disease are seeking treatment, there must inevitably be occurring a considerable and unnecessary time lag between the recognition of his disease by the patient and the date at which he obtains treatment for it. This is confirmed by the average length of history of symptoms given by the patient when he does finally seek medical advice. So many conditions easily curable in their initial stages are, by delay in obtaining treatment, unwittingly but irrevocable being converted into chronic and incurable conditions, thereby adding quite unnecessarily to the length and extent of the treatment required when the patient does eventually reach the doctor.

The Centre's contact with the ordinary citizen discloses neatly for our attention this unnecessary source of chronicity of sickness. It is chronicity more than any other factor that piles up the cost of medical services of the Nation; creates a cumulative loss of working hours and diminution of efficiency in industry; wears down the natural reserves of the individual and continuously robs the family - and therefore the Nation - of its heritage of health."

The authors point out that delays to seeking treatment can influence the nature and results, possibly adversely.

"Although…we found less than half of those suffering from disease to be under medical care at the time of examination, after overhaul…all, without difficulty, were brought to seek treatment. Thus the Centre's approach - which is not through clinical medicine - is a completely satisfactory for bringing all individuals suffering form disease to treatment. It is in fact the only efficient method that has been found the curtailment of chronicity.

Hence we must conclude that although the provisions necessary for dealing with sickness cannot produce health, the organisation necessary for the cultivation of health automatically leads to the rational treatment of all those in disease.