Prescriptive medicine
From Dr J. P. T. Link later
Sir: When I read the letter by Mr Brian, the Principal of The chotherapy Centre in Uppper Berke',Jj Street (June 30) I listed his errors tr misrepresentations intending to swer each in detail. I reached the u" tom of my second page when,e realised that Mr Brian could only le written to tease or to provoke :51 cussion, since my psychotheraPlog could have equated the act of haollat out a rubber sheath with the ne`lit. prescribing lithium carbonate a P
nelzine where an error in the instructions given to the patient, or a failure to monitor the blood lithium levels could easily lead to death. Three serious points raised by Mr Brian must be answered to put the record straight, however, for the benefit of your lay readers. First. Under the proposed free contraception bill, it would be a patient's absolute right to demand a prescription for the goods required, thus breaking across the tradition of clinical freedom. No doctor worthy of his Professional integrity ever hands out Prescriptions on demand unless that demand happens to coincide with his OW n clinical judgement. Under this Proposed bill, the doctor would no longer have his ancient and traditional right to refuse. He would not be able to produce a medical reason for noncompliance because the whole matter is non-medical. I am quite sure that Mr Brian realises the absurdity of such a situation, just as well as he realises that the general practitioner depends. for his income upon not entering too l'requently into pointless disputes with n's patients. The suggestion that we should grudgingly sign a script for a single sheath would be as inexpedient and pointless as it is undignified. In any event, majority opinion in ParliaMent recently seems to be favouring a relaxation even of the prescription charge for this service.
Second. Most of my colleagues certainly do not adopt a moralising attitude towards contraception and, like me, are quite prepared to prescribe nral contraceptives. These alter the delicate hormonal homeostatic feedback, leading to side effects, and thus occasionally demand of us consider le Medical skill. We also concede that fitting an intra-uterine device requires anatomical knowledge and a thorough understanding of aseptic technique. Therefore this too falls
t,hin our sphere. The objection is "Illy to wasting our time when no Medical skills are required.
b Third, I would recommend to Mr Ilan that he glances through the 'atest handbook of the Royal College of General Practitioners, published for the College by the British Medical sociation and entitled The Future . `Ienenal Practitioner From this he will see that the essential difference beteen the the general practitioner or athilY doctor and any other doctor is precisely that the general practitioner Specifically trained during his postgraduate vocational training years to exPress his findings not only in physical but also in psychological and soci°logical terms. This triad of body, _Mind and environment, is therefore constantly in the thoughts of any general practitioner. He is already trained and competent to deal adeIlbately with problems in these terms. t is indeed sad that the Psy ,ehotherapy Centre is so far removed irbirl reality that it does not under
Stand that when the general prac tioner speaks of disease, he considers koth Physical and mental disease in
Le context of the whole patient as se:en within that patient's family or sogroup. This is the essence of general practice.
J. P. T. Linklater
Ribgsland, Fingringhoe, Essex.
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