Develop. Med. Child Neurol. 1971, 13,419-420

EDITORIAL

WHERE WE DO GO FROM HERE?

MEDICINE is changing in many ways. Whether it is advancing is more difficult to decide. Whether the practitioner is in an academic post or is giving clinical service he can look at the changes in medicine and consider whether he is bringing the better parts of these changes to his task of helping people.

He may choose to keep up with the advances which will help him to be better and better at the type of medicine he was introduced to ten or twenty years ago. This is the pattern today in some of the most famous medical schools where better and better diagnosis of the presenting symptom in terms of anatomic or biochemical disorder still reigns supreme.

The physician may be impressed by the current emphasis on com- prehensive diagnosis of a person who has the symptom, trying to answer J. L. Halliday’s three-prong question ‘Why did this patient get this symptom at this time?’ (or in relation to chronic disorder, ‘at the time when it started ?).

If he starts asking such questions he may come to accept that the origins of many symptoms lie, partly it is true, in the person affected but IargeIy in the culture and environment he lives in.

He may then begin to wonder about the general state of health among the children of the community and to see that early identification of acute and chronic physical, mental and psychosocial disorder is desirable for the benefit of the individual child. The population screenings and assess- ments designed to help individuals can also give us the epidemiological information which alone can give a rational basis for deciding how best to deploy our apparently scanty resources for delivery of medical care.

By this time he may have come to feel that much hospital medicine is challenging to the curiosity but comes under the heading of more and more about less and less. He may feel that, while our knowledge is often inadequate, we know about common disorders quite a lot which is not yet being put into use for the benefit of many children. In many ‘advanced’ countries there are areas where tuberculosis is still common but no attempt made to prevent it with BCG; where epilepsy is inadequately treated and asthma thought of as a symptom to be treated solely by drugs.

Children with chronic neurological deficits have been neglected in the past and their care is improving. It seems worth underlining that the only

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way in which early help can be brought is by universal periodic develop- mental assessment of all the children in the community and that this is a programme which can be instituted within our current resources; it may be better to plan early ‘physiotherapy’ of all children than much more intensive treatment of a few of them, using the physiotherapists to help the parents to develop their child’s motor abilities to the full. For many families with handicapped children there are great dividends to be derived from time given to informing and supporting anxious parents. Research must continue and so must better care. It may be wise to stop awhile to consider the best deployment and direction of research and habilitative care.

RONALD MAC KEITH

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