The Insurance Medical Service—Some Conclusions and Criticisms

Although the Royal Commission, so far as the machinery of the Insurance Medical Service is concerned, recommended that insurance committees should be abolished and their powers transferred to the local authorities, the Commission had no criticism to offer with regard to the character of the service given by the general body of insurance practitioners. They find, as indeed they were bound to find, that the service itself was seriously incomplete. It is possible to criticize the service from this point of view— this being a matter in which the doctors have no control— while recognising that within the scope of the existing contract the doctors are giving as reasonably good service as could fairly be expected. I append one or two extracts from the Royal Commission’s report. I have already made an extended reference to what the late Sir Henry Brackenbury had to say on the subject in his book “Patient and Doctor”. (See Ch. 9 ). (R.C. p. 36). “We turn now to a new subject on which there has been, and may still be, a certain amount of public misgiving. We refer to the suggestion frequently made in the early days of the scheme and still heard occasionally, that doctors and chemists deliberately give to insured persons a service inferior to that given to their private patients. We are glad to say that, except for some rather contradictory evidence given by witnesses from the National Conference of Friendly Societies, we have found no support for this allegation. On the contrary, there has been a great body of evidence not only from the interested parties—the doctors and chemists—but from societies and representative bodies showing that no such distinction is made. It is, perhaps, proper to observe that in a service comprising 15,000 doctors it is impossible to postulate that all will, at all times and in all circumstances, maintain a superlative standard of efficiency and care. The medical profession, like every other craft and calling, can claim no immunity from the intrusion of undesirable and unworthy elements. Nor does this imply any disrespect towards an honourable profession; it is merely an acknowledgment of their common humanity. Isolated cases of negligence and carelessness, therefore, prove nothing; such occur in private practice also. Even if it were established statistically that there were proportionately more causes of complaint in insurance practice than in private practice, this, again, would in itself prove nothing. The causes of complaint might be due to the industrial or social peculiarities of certain areas or to the idiosyncrasies of certain doctors, and these might manifest themselves irrespective of the arrangements under which the doctor was giving his service. As against the rather vague suggestions that have been made, it is only right to refer to one other consideration put in evidence before us, namely, that there is a growing tendency among practitioners to be more scrupulous to avoid giving offence in the case of insurance patients than in the case of private patients, since the former are, in a sense, protected by the machinery under the Act for the investigation of complaints.”