JAN. 7, 1961 CORRESPONDENCE MEDICALBRIISHJOURNAL 49 gations carried out is quite capable of co-ordinating the cases quoted could, of course, be paralleled in any closed results. In a letter in the Lancet (December 24, p. 1399) department as well. Dr. J. A. C. Terry has a very logical approach.-I am, On the second count it seems that "Anonymous" etc., would, by implication, attempt to limit the free practice Department of Diagnostic Radiology, J. G. DUNcAN. of specialist medicine by those qualified to do so. Royal Infirmary, Clinical acumen is not the sole prerogative of those Edinburgh 3. practising medicine or surgery, and radiology is no more ancillary to the practice of medicine than these other SIR,-In your issue of December 24, p. 1881, you two specialties. Any attempt to dictate the manner in publish a very unhelpful letter under the above heading. which any specialist shall practise his own specialty is It is not surprising that the writer wishes to remain indicative of an illiberal outlook which can only act to anonymous. He argues that the practice by which the detriment of the progress and development of general practitioners can refer patients direct to the medicine as a whole, and, although this is a tendency radiologist leads to unnecessary radiation exposure and amongst some modern consultants, it should be resisted quotes two cases in proof. Anyone with any experience as a violation of those basic principles which have thus of medicine can find two cases to prove almost anything, far governed our professional relationships in specialist and it seems to me that your correspondent knows practice. It is depressing to think, Sir, that even 20 years. little about the open system or how it works. I have ago such a letter would have been inconceivable in its had the direction for a number of years of two depart- subject, content, and signature.-I am, etc., ments which are open to local doctors and I have yet to Coombe-in-Teignhead, A. ROBINSON THOMAS. find any suggestion of a general misuse of the facility. Devon. Some of the cases referred are not in need of help from any of the out-patient clinics and when an abnormality SIR,-I was dismayed to read the letter from comes to light the family doctor can be advised at once "Anonymous" (December 24, p. 1881) regarding the as to which clinical department will be most likely to radiological hazards to patients. So it would appear serve him. In all such cases hospital time can be saved that general practitioners should not be allowed direct and in many of them radiation exposure also. access to x-ray departments. Some of the consultants. Great exception will also be taken to the statement would also deny to them the use of certain drugs. As. that " the radiologist, when asked by the general practi- a result of these curtailments, how effective would a tioner to act as a direct consultant, feels that he must general practitioner be in his work ? In fact, he would make the diagnosis, disregarding completely the limita- be reduced to the status of a medical warden, directing tions of the technique etc." Take it how you will, this is the traffic to the various departments of the hospitals. about as offensive and damaging a statement as it would I feel that I am indeed fortunate to practise as a be possible for any doctor, under a cloak of anonymity, general practitioner in an area where we receive to make about his colleagues. It clearly implies that the enthusiastic support and encouragement from clinical writer, in his mind, is lumping together general pathologist and radiologist, both departments being practitioners and radiologists alike as people of no open to us. This enables us to take a more active part training, no experience, no judgment, and no honesty. in the treatment of our patients, and adds greatly to To express such a view cannot be in any sense to the the interest of our work. As a result, I consider that credit of your anonymous clinician.-I am, etc., the.general-practitioner service is very much enhanced. I realize that x-ray investigations should be used with, Beckenham, Kent. A. C. GLENDINNING. discretion, but, their diagnostic limitations being recognized, I feel that this argument is not valid in SIR,-I had hoped that some more authoritative pen denying their use to general practitioners. than mine would have answered, in last week's Journal, Most out-patient departments of general hospitals seem to be fully employed with the present number the letter from " Anonymous " (December 24, 1960, " p. 1881) regarding radiological hazards to patients. That of patients attending. It is a pity that Anonymous" letter was lamentable on two counts. Firstly, in that did not give his geographical location, so that all the it is not, generally, true, and, secondly, in that it illness that might be missed could be referred for his. apparently seeks to limit the right of his colleagues blessing. I am certain that, instead of the occasional to practise their profession in whatever way seems condition being passed over, many would have died appropriate and best to them. before they received the out-patient appointment.-I; I have had the opportunity in working at a number am, etc., of hospitals where there are open x-ray departments, Donemana, Co. Tyrone. ARCHIE A. FULLERTON. and I am quite certain that there is no increase in the amount of radiation to which patients are subjected Salary Crisis at Cambridge because the x-ray department is used by general practi- SIR,-A few remarks may perhaps put some of the- tioners, over the amount of-radiation the patients would comments in these columns on medical teachers' salaries receive if they were referred by the hospital staff only. into their proper perspective. The monastic ideal of a, My experience is that G.P.s are much more conservative university and the desirable conditions of life of its in ordering x-ray examinations than are the registrars community, as expressed in the Report of the General and house-officers who so frequently see patients referred Board of Cambridge University, do not stand up well to hospltal out-patient departments. It is also nny to the economic facts of present-day life. Thus the experience that where G.P.s have had access to both limited concessions made in 1949 in respect of the pathological and radiological departments the general recommendations on salaries by the University Grants standard of practice has been very much higher than in Committee were followed by an exodus of lecturers those districts where they have not these facilities. The from some preclinical departments at Cambridge, much