van Niekerk, JP

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SUID-AFRIKAANSEMEDIESETYDSKRIFSOUTH AFRICANMEDICALJOURNALKaapstad, 21 Augustus 1971VAN DIE REDAKSIEDeel 45 No. 33 Volume 45 Cape Town, 21 August 1971EDITORIALDie Diepte-ondersoekMet toenemende kennis en sofistikasie het onsdiagnostiese en terapeutiese handelinge onver-mydelik baie duur geword. Daarbenewens is diealgemene lewensduurte ook verantwoordelik vir 'nstygende kostepatroon in die geneeskunde. 'nDekade of twee, drie gelede kon ons nog redelikverwag dat iedere pasient sy eie potjie moes krap,met die uitsondering van die werklik armes wat vrymediese dienste moes ontvang. Toenertyd koniedere dokter binne perke sy eie gelde wat viriedere handeling gevra gaan word, bereken. Solankhy nie te rof tekere gegaan het sodat die MedieseRaad hom voor stok kon kry nie, was daar geennodigheid om 'n voorafopgestelde tarief te he nie.Dit is nie vandag meer so nie. Die oorgrotemeerderheid van die bevolking benodig een ofander vorm van vooruitbetaalde mediese diens. Diebeste tipe sodanige reeling is nie hier ter sprakehie. Dit kan deur middel van hulpfondse geskiedof met assuransie op 'n indemniteitsbasis, of nogeen of ander van verskeie moontlikhede. Maarhoe dit ook sy, ten einde so 'n vooruitbetaaldediens te kan aanbied, moet die organiseerders 'ntariefstelsel he waarvolgens hulle hul koste enbegroting kan bereken. Dit is eenvoudig niemoontlik om 'n groot siekefonds, van watter aardookal, te bestuur sonder 'n leidraad te he oor watdaar verwag kan word wat kostestruktuur betrefnie.Selfs die Geneeskundige en TandheelkundigeRaad wat normaalweg volstrek weier om betrekte word in enige bespreking in verband met dok-tersgelde, moes die Vereniging vra om 'n leidraadte verskaf insake redelike gelde vir gebruik gedu-rende tugondersoeke. Dit was die oorsprong vandie Standaardtarief. Ons moet dus aanvaar dat dieopstel van 'n tarief deesdae 'n noodsaaklikheid is.Die Wet op Mediese Skemas bepaal dat daarmet gereelde tussenposes ondersoek gehou moetword om die statutere tarief op datum te bring endie volgende sitting van die Vergoedingskommissieis net om die draai. Ten einde die afvaardigingvan die Mediese Vereniging in die posisie te plaasom feitlike en aanvaarbare getuienis af te le isbesluit om 'n diepte-ondersoek in te stel na dieverskillende groepe in die Vereniging. Met diehulp van 'n statistikus is 'n ewekansige monstervan geneeshere verkry en 'n vraelys is opgestelwat nou reeds aan die betrokke dokters gepos is.Tot dusver is die respons beroerd.Mens wonder waarom? Daar is verskeie moont-likhede. Sommige van die gekose geneeshere sepraktyke is miskien in so 'n haglike toestand datdit vir hulle eenvoudig haas onmoontlik is om diegevraagde inligting te verskaf. Indien dit die gevalis sou ons aanbeveel dat sulke ongelukkige sukke-laars dringend poog om hul praktykshuishoudingsin orde te bring. Chaos is eenvoudig nie meer 'naanvaarbare vorm van praktykvoering nie.Daar is moontlik diegene wat om een of anderrede steeks is om mee te help en ons vermoeddat dit in sommige gevalle te wyte is aan 'n weersinteen sulke sogenaamd onprofessionele uitpluisingvan kostestruktuur. Sulke argumente hou nie meersteek nie. Soos ons hierbo verduidelik het, is diedae van raai-raai rekenings agter die rug. Omvinger te wys na die ander beroepe en te se dathulle nie soortgalyke gegewens hoef te gee nie, isook nie 'n aanvaarbare beswaar nie. Die gemid-delde burger hoef nie sy prokureur of advokaat ofargitek meer as 'n paar keer in sy lewe lastig te valnie, maar iedereen het voortdurend mediese ver-sorging nodig sodat kostestruktuur in die geneas-kunde van veel groter belang is.Miskien berus die swak respons op 'n uitstel-basis. More is nog 'n dag. Diegene wat so redeneermoet hul sokkies optrek, want die tyd word minen as hulle later na die kommissie-ondersoekbedroe uitkom moet hulle nie 'n skouer soek omop te huil nie. Sommige, en ons hoop hulle is in dieminderheid, het moontlik die vorms nie ingevul niebloot weens nalatigheid. Dit is 'n laakbare houding,veral as mens in ag neem die moeite en die kostewat daar met die opstel van die vraelyste geneemis.905906 S.A. MEDICAL JOURNALEarning Too Much21 August 1971I have ventur'dLike little wanton boys that swim on bladders,This many summers in a sea of glory,But far beyond my depth.Shakespeare: King Henry VIIIThere are few things as soul-destroying as theconstant feeling that one is not entirely on top ofone's job. It is normal to be ambitious and mostpeople constantly strive to better their positionswith regard to income as well as status and respon-sibility. Poverty is uncomfortable and lack of secu-rity irksome, but we must not in our ambitiousstrivings lose sight of the fact that to go beyondone's depth is far more dangerous.The man who has to discover for himself dayafter day that he simply has neither the trainingnor the innate intelligence to cope with the de-mands made of him, will gradually but inevitablysink in a quagmire of despair, never to hope again.He may not be able or willing to admit his failingseven to himself, in which case those around himwill be made the scapegoats and he will blameanything and everybody for the myriad of smallthings that will constantly tend to go wrong.Some may be lucky enough to hide their frustra-tions under a cloak of bonhomie and they mighteven build a reputation as the life and soul ofoffice parties, but they bluff nobody, least of allthemselves. Sooner or later the denouement willcome, and it is the day-to-day waiting for thecrash which white-ants their mental reserves stillfurther.The employers and the doctors alike have aheavy responsibility in this regard. The chief whois unaware of the fact that he is expecting servicefrom his underling way beyond his ability runs therisk of landing his firm in a disastrous situation,but in addition he is party to the destruction of apsyche, and that may well be more serious thanthe mere financial problems his staff member'sinefficiency may engender. A management consult-ant can usually save the business, but it requiresprolonged expert psychiatric help to re-establishthe overburdened employee.To climb up the ladder requires drive, abilityand a certain amount of luck, but to climb downrequires herculean courage. To daydream aboutthe better house and the expensive motor car ispleasant and relatively harmless, prOVided it doesnot become an obsession; but to relinquish theseluxuries, not because of a financial setback, per-manent or temporary, but because of the horriblerealization that they were and always will be be-yond reach as a result of inability, is a bitter blowwhich is not easily weathered, even by the stoutestheart.The doctor must give advice and he must beable to spot the first symptoms of the crackingfac;ade. And then he must have the courage andthe intimate contact with his patient to be in aposition to convince him that he must turn backand start again at a rung on the ladder which isbetter tailored to his capabilities. There is moretruth in the old saying 'He is a nice, steady youngman who started at the bottom of the ladder andstayed there' than meets the eye. Although we arethe music-makers, we cannot all call the tune andit is a lucky and an integrated man who, at an earlystage, can define his own operational sphere andcan accept his limitations.The. doctor in his consulting room must makesure that the wailing complaints of his patientabout his lack of income and his frustrations athome are not, in fact, the laments of a man who issecretly aware of his limitations and who hasalready overstepped them. Pills will not cure him,nor will prolonged psychiatry, for he will still haveto face the very core of his problem every morningwhen he reaches the office.Doctors are not exempt. The young surgeonwho overreaches himself may kill a patient, but healso destroys himself.

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