panel and contract practice

971PANEL AND CONTRACT PRACTICE

stated that no Order had been made, and on

March 24th he repeated this statement explicitly :"The circular letter is by way of recommendationto local authorities ; it is not an order." He furtherstated that the local authorities had powers enablingthem to take the action recommended in the circular,but he was silent when questioned for the statutoryreference to such powers. The possession of suchpowers is widely questioned, and it has been stated inthe daily press that the Local Government Officials’Association-a body representative of the officersof local authorities-has obtained opinion of seniorcounsel that no such power resides in the localauthorities. The council of the Irish Free StateMedical Union has advised its members who mightbe adversely affected if the recommendations of thecircular were carried out to take no step towardresigning at present.

MR. HENRY S. MEADE

The French Government has conferred on Mr. HenryS. Meade the rank of Chevalier de la Legion d’Honneur.Mr. Meade, who is one of the surgeons to St. Vincent’sHospital, Dublin, worked as a surgeon for a con-

siderable time in French hospitals during the late war.

FOTHERGILL TESTIMONIAL FUND

THE following is the fifth list of subscribers to thetestimonial to Dr. E. Rowland Fothergill received in

response to the letter published in the British MedicalJournal and The Lancet of Jan. 18th:-Amount previously acknowledged, P1361 12s.R. L. Newell (Manchester), 2 2s.; Carnarvonshire Panel

Committee, .85 5 5s. ; E. R. Sweeney (London), 10s. 6d. ; J. P.Davie (Chesterfield) and H. Downer (Hove), each .81 Is. ; Bed-fordshire Local Medical and Panel Committee, 21 ; Car-marthenshire Panel Committee, .&bgr;5 5 5s. ; ; Portsmouth PanelCommittee, B13 8s. ; Northampton Panel Committee, .82 2 2s. ; ;Glamorgan Panel Committee, 10 10s. ; C. J. Marsh (Yeovil)and A. T. Jones (Mountain Ash), each 91 Is.; J. Macfayden(Newcastle-on-Tyne), .81 ; F. A. L’E. Burges (Birmingham),.82 2 2s. ; Sir Thomas Dunhill (London), k3 3 3s. ; F. H. Alexander(Littlehampton), H. Child (Brighton), -. Marshall, F. Hinds(Worthing), N. E. Chadwick (Hove), D. D. Macintosh (Worth-ing), W. N. Maple (Hove), Nora Crow (Brighton), A. Barnes,Sir Hubert Bond (Brighton), A. E. Cawston (Lewes), J. V.Banner (Brighton), W. A. Wood (Brighton), and RoderickClapham (Hove), 927 9s. 6d. ; W. P. S. Branson (FrimleyGreen), k2 2 2s. ; B. R. Rygate (London), 10s. ; C. F. T. Scott.and W. Paterson (Willesden), each .81 Is. ; Adam Fulton(Harrogate), k2 10s. Total 1466 17s.

It has been decided that the fund will be closed at theend of May and it is hoped, therefore, that any intendingsubscribers will forward before that date their contributionto the treasurer, Fothergill Testimonial Fund, BritishMedical Association, B.M.A. House, Tavistock-square,London, W.C.I.

PANEL AND CONTRACT PRACTICETest Prescriptions

A PRACTITIONER in the Home Counties was askedto write a test prescription and did so, under protest,in such a way as to make it clear to any chemistto whom it might be presented that it was a test

prescription. Approached in turn by the insuranceand the panel committee he relented to the extent ofsaying he would be prepared to issue an amendedprescription, but he was adamant in his intentionto inform the local chemists that he was issuing it.His attitude is accordingly being investigated by themedical service subcommittee. During the discussiona medical member of the committee imputed to thesponsor of the Act the statement that the dispensingof medicines by chemists was designed to secure thatdoctors should not give their patients " bad drugs,"but it now appeared that an elaborate intelligencesystem was necessary to ensure this. If there hadto be a system of tests it should, he thought, be anefficient one. He seems to have been unaware

that the schemes for testing drugs and appliancessupplied to insured persons are designed simply tocheck the accuracy with which they are dispensed.Under their terms of service the drugs and applianceswhich chemists supply must be of a grade or qualitynot lower than that specified in the Drug Tariff,which is almost invariably that of the B.P. or itscodex. If not included in it they must be of a gradeor quality not lower than that ordinarily used formedical purposes. Inspectors under the Food andDrugs Acts see that drugs are of a proper degree ofpurity. In the early days of the testing scheme,before the issue of test prescriptions was made partof the practitioner’s terms of service, the protestantwould prescribe for Mr. B. Ware, Mr. 0. B. Careful,or Mr. A. Test.

Secrecy of RecordsThere has been some concern about the possible

leakage of information on forms of medical record.The instructions to insurance committees lay it downthat the obligation laid on them to maintain strictsecrecy as to the information in their possessionextends generally to all information, of any kindwhatever (including names and addresses), about allclasses of insured persons and their dependants,

which may come into the possession of the com-mittee, its members, and officials in their officialcapacity. Even when application is made by thepolice for information as to the addresses of insuredpersons, the foregoing instructions are sufficientlyexplicit to warrant the refusal of information. Incases where the entries on a record card are likelyto be of assistance to the investigation of a questionby the medical service subcommittee, it is the practiceto secure the consent of the insured person to the

production of the medical record before it is evenexamined by the subcommittee.

Grubby EnvelopesAn insurance doctor had employed a surgery

attendant who for many years had been in the habitof taking the medical records from the file as patientsarrived so that each patient on passing into the

consulting-room could himself hand the F.M.R.to the doctor or his assistant. After surgery hoursthe attendant would restore the records to the cabinet,but naturally over a period of years some of the

envelopes became dirty. Recently the doctorappointed a new surgery attendant who developedpulmonary tuberculosis. The doctor pointed outto the insurance committee that it was difficulteffectively to disinfect and clean the envelope recordsand asked for duplicate envelope records to whichhe might transfer the notes. The committee consultedthe Department, who took the view that, in the

special circumstances, if in the case of such recordsas the doctor considered should be renewed he wouldenter on the back of a new envelope a brief summaryof the essential facts of the medical history, as

indicated by the clinical notes on the ’old envelope,the latter might then be destroyed. No notes otherthan this summary should be made on the fresh

envelope ; particulars of further illnesses, for instance,should be recorded on continuation cards. Medicalrecords have now been in existence since January,1921, and the condition of some of them, especiallywhere handled by the insured persons themselves,is certainly not hygienic. Other practitioners willbe considering the desirability of substituting a cleannew record where the condition of the existing recordis unsatisfactory.