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Imported Malaria 236 26 July 1969 M MEDICALRNrLsHIOURNA-L Correspondence Br Med J: first published as 10.1136/bmj.3.5664.236-a on 26 July 1969. Downloaded from Letters to the Editor should not exceed 500 words. The Consultant's Job Pigmentation in Megaloblasic Anaemia Aetiology of Pre-eclampsia G. A. Medhurst, M.R.C.S., and P. S. A. F. Fleming, M.B., and F. A. Ive, G. J. Sophian, F.R.C.O.G. ........... .......... 241 Andrews, M.D. .................................236 M.R.C.P. .......................... 238 Psychiatry Courses for G.P.s Imported Malaria Hypokalaemia after Treatment with R. I. Muir, M.B . ................................. 241 L. J. Bruce-Chwatt, M.D. ..................... 236 Duogastrone (Carbenoxolone) Adrenal Function and Exogenous A.C.T.H. M. W. Swallow, M.R.C.P. ................... 239 Prospects in Cardiology Susan E. Mitchley, M.R.C.S ................ 241 Sir Max Rosenheim, P.R.C.P., and others 237 Scanning Electronmicroscopy in Annual Representative Meeting Decompression Sickness and Contact Lenses Dermatology R. E. W. Oliver, M.R.C.S. ..................... 242 A. J. P. Carteaud, M.D . ................... 239 J. C. Betts, M.B. ................................. 237 Vocational Training for Medical Teachers Bowel Motility and Colonic Cancer Intermittent Methohexitone A. E. Stuart, PH.D., M.R.C.P.ED. ............ 242 A. R. P. Walker, PH.D., and B. Faith J. S. Robinson, M.D., F.F.A. R.C.S., and B.M.A. Subscription and Salaries Walker ............................................. 238 others .... .............. 240 G. Wiseman, M.D. .............................. 242 The Consultant's Job result of this recently published report.-We are, etc., SIR,-The medical staff of the Kettering great benefit in being fully stretched by the G. A. MEDHURST, and District General Hospital record their exercise of the highest skills and talents, but Chairman disagreement with the report of the working none in being ground down by an ever- Medical Advisory domrrittee. party on the responsibilities of the consultant increasing load of routine chores. P. S. ANDREWS, Chairman, grade' (7 June, p. 588). We insist that in district general hospitals Medical Staff Committee. We realize that the general practitioner's the proper functioning of departments de- Kettering General Hospital, http://www.bmj.com/ first call is to his list patients and not to the pends upon team-work, and that the team Northamptonshire. hospital, and therefore his services cannot be consists of housemen, registrars, and con- REFERENCES The Responsibilities of the Consultant Grade, De- the solution to the present manpower defi- sultants. We dispute the statement in para- partenent of Health and Social Security, De- ciency in the hospital service. We insist that graph 14 that there has been a more than partment of Health for Scotland, 1969. the report is not accepted as it stands, and " H.M. S.0. commensurate" increase in the number of 2 Aledical Staffing Structure in the Hospital Service, that full discussion with widely representative juniors since "Platt "' was implemented. Report of the Doint Working Party, 1961. elements of the profession must take place During these years the junior staff rightly has London, H.M.S.O. before the report is acted upon. been allowed more time to study and their We feel that the working party's composi- hours of duty made realistic and less penal, on 26 September 2021 by guest. Protected copyright. tion was biased in favour of teaching hos- at least in this part of the country. A re- pitals, and therefore the report does not distribution of consultants and junior staff to assess the problem of the staffing structure correspond more evenly and closely with the Imported Malaria within district general hospitals. We realize population served throughout the country SIR,-The comprehensive paper by Mr. that discontent exists among junior staff in would be beneficial to doctors and patients. P. G. Shute and Miss Marjorie Maryon (28 many of the teaching hospitals, but regret We feel that by achieving a free rotation of June, p. 781) is most timely in recalling the that few senior registrars are in rotating posts junior staff between teaching and district past and present records of imported malaria between the teaching hospitals and the dis- general hospitals constant cross-fertilization in the United Kingdom, where the reported trict general hospitals, in which the bulk of of ideas and experience can be realized, with number of 1,036 cases over the past 10 years the N.H.S. hospital work is carried out; great benefits to both types of institution and is probably an underestimate (29 March, therefore they have no experience of the sort the engendering of a genuine partnership, p. 844). of work they will be called upon to perform which we feel to be the way ahead for our The problem is of importance to many when appointed as consultants. Should the National Health Service, which at present other countries and forms one of the aspects report be acted upon, these men will find that is the best of its kind in the world. We of the increased speed and volume of inter- their jobs afs consultants will consist of the would welcome a reshaping of the work-load, national travel. As a result of malaria eradi- work they are at present doing and no more. but do not wish this to be done hastily. cation operations the indigenous disease has To us it is a pointless waste of vocational Finally, lest it be thought that we seek disappeared from Europe, from the U.S.A., training to encourage men to obtain higher housemen and registrars to do the service from most of the U.S.S.R., from South qualifications so that they may do the work work only, we wish to record the achieve- Africa, northern Australia, most of the of juniors during the greater part of their ments of our registrars in obtaining higher islands in the Caribbean, from Chile, Cyprus, working life, from the age of 32 to 65 years. qualifications, and their record is as good as Israel, Japan, Lebanon, Mauritius, Singapore, We expect the Royal Colleges will resent this that of most teaching hospitals. Moreover, and Taiwan. However, the whole of tropical debasement of the consultant's role, and see they return and tell us that their experience Africa, much of Central America, many to it that the standard of the recruits is main- here has made all the difference to their pro- countries of South America (with the excep- tained and the duties of consultants not fessional lives. We do not therefore wish tion of large areas of Venezuela), most of restricted to mere hackwo.rk. There is a to be forced to lower our standards as a the countries of southern Asia and of south- 26 July 1969 Correspondence MEDICAL JOURNAL 237 west Pacific, are still malarious and constitute Prospects in Cardiology will also be needed. Since most of those a reservoir of imported infection. A W.H.O. senior registrars who now hold a post in report' some cases of SIR,-The poor prospects of obtaining a cardiology will ultimately hold Group 1 posts, quoted 1,500 malaria Br Med J: first published as 10.1136/bmj.3.5664.236-a on 26 July 1969. Downloaded from imported into six countries during the past consultant post in cardiology implied in the or in some cases Group 2 or sometimes few years. There were 876 such cases in reports of the Ministry of Health on Medical Group 3 posts, it would appear that the 1963-1965 in the U.S.S.R.' Staffing in Hospitals' 2 are confirmed by the prospects in cardiology implied in the fore- The burden of imported malaria falls now present difficulties experienced by many senior casts by the Department of Health may pre- heavily on the U.S.A., where, since 1966, the registrars trained in cardiology in obtaining sent an unduly gloomy view, and that regis- number of cases rose dramatically from fewer consultant posts. This, together with the trars should not be discouraged from seeking than 100 per annum to 2,855 cases in 1967 evident lack of sufficient consultant appoint- further training as senior registrars in cardio- and to 2,610 cases in 1968, chiefly in the ments in cardiology in the country, suggests logy.-We are, etc., military personnel returning from Vietnam.' the need to investigate and clarify the posi- MAx ROSENHEIM, tion with a view to its improvement. President, Although malaria in the civilians returning Royal College of Physicians. to the U.S.A. from tropical areas was seen Such an investigation has been carried out by the Cardiology Committee of the Royal JOHN MCMICHAEL, only in 123 cases, the fact that most of President, them occurred in students and teachers calls College of Physicians of London and the Cardiac co-operation British Society. for special vigilance when it comes to these British Cardiac Society, with the J. F. GOODWIN, and similar occupational groups and par- of representatives of the Department of Honorary Secretary, Health and Social Security. It soon became Cardiology Committee, ticularly Voluntary Service Overseas volun- Royal College of Physicians. teers returning to this country from service apparent that the true number of consultant London N.W.l1. abroad. To this one might add the increas- cardiologists in the country was not known. REFERENCES ing number of far-ranging tourists, and the Many consultants appointed as general physi- 1 British Medical 7ournal Supplement, 1966, 2, 240. cians, and appearing as such in the official 2 British Medical 7ournal Supplement, 1968, 3, 110. following case may serve as a good illustra- 3 Royal College of Physicians of London, Royal tion of hazards of modern version of returns to the Department of Health, are in College of Surgeons of England, Joint Cardio- Innocents Abroad.
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