Good health care is the type of medicine practiced and taught by recognized leaders of the medical profession at a certain period of the social, cultural, and professional development of a particular community or population group.
The criteria on which the basic procedures of medical care are based as regards both the prevention and diagnosis of diseases as well as their treatment are not, however, definitive standards. Medical practice is an art, and as such cannot be standardized, just as the art of writing cannot be standardized. Every writer obeys certain rules of grammar, but each maintains the individuality of its expression; similarly, some basic aspects of up-to-date medical practice are generally accepted, although each physician develops his or her own methods and procedures. Therefore, in the description of services essential to good medical care, only the most widely accepted requirements have been used. Such a definition does not include technical details, which should be sought from appropriate sources: textbooks and journals specializing in medicine, dentistry, nursing and public health.
The concept of good medical care used in this study is based on certain articles of faith, which can be formulated as follows:
- Correct medical care is limited to the rational practice of medicine, supported by the medical sciences. In modern medicine there is no place for charlatans, healers or magicians: any system of prevention, diagnosis or treatment that is not based on rational observation and deduction acquires a random character that is incompatible with good medical care, and confers a very unsound basis for the acquisition of health.
“The advances in medicine and the advantages that have resulted from them are the exclusive result of the application of the rational method of observation and experimentation. To control nature we must first of all understand it. And the conception of nature as a kind old wet nurse is no longer sustainable, as is the notion of a wild nature with its tusks and claws dyed red. Still less can we tolerate the painting that paints nature as a generous and abundant mother. If we go to her asking for something in exchange for nothing, far from being generous she will give us as much as we have given her, and to the one who extends the hand of a beggar, she will give him a small alms. Thus, this conception has served for the magician and the sorcerer to think that they can make nature give them everything for their simple charms.1
- Good medical care emphasizes prevention. Preventive medicine is by no means confined to “public health activities. Ideas of prevention and health promotion must reach all branches of medicine. In fact, in a strict sense all medicine is preventive. There are a few specific remedies for the treatment of disease; the purpose of this treatment is to assist the body and mind in the recovery of health, interfering with the progress of the condition, preventing complications, and ultimately postponing death. Prevention, diagnosis and treatment are inseparable aspects of the science and art of medicine. They have a common goal – the promotion and maintenance of health – and share a common body of knowledge.
- Good health care requires intelligent cooperation between the general public and scientific medical professionals. Medical care does not depend solely on the medical profession; little can the best of doctors do with a patient who does not follow their indications. The cooperation of patients is as important as the efficiency of physicians and the availability and excellence of services.
- Good medical care treats the individual as a whole. “Diseases are not individual, but diverse states of individuals. “2 Each sick person presents a unique problem, which each physician attacks in his or her own way. In order for care to be adequate, it is essential that the patient be seen as a person, a member of a specific family living in a particular environment. All factors relating to his or her mental and emotional health – as well as physiological – must be taken into account for prevention, diagnosis and treatment. The sick or injured person should be treated, not the pathological condition that afflicts him or her. Thus, for example, it may happen that although in strict medical terms a patient should be hospitalized, it is discovered that specialized in-hospital care is more harmful than beneficial due to the apprehension caused by the mere idea of leaving home. In such a case, good medical care may well prescribe a home stay.
- Good medical care maintains a close and continuous personal relationship between doctor and patient. The complex nature of the human being and the intricacies of the relationship between body and mind and between people and the whole determine that the first basic premise of good medical care consists of a deep familiarity with the personality and customs of the patient. The family physician is the person best qualified to supervise the health of family members, diagnose their illnesses and manage their treatment. No degree of technical specialty, nor any combination of laboratory devices is as useful in the diagnosis of many ailments as personal knowledge of the patient’s medical history, family situation, and physical and mental idiosyncrasies.
- Good medical care works in coordination with social work. “Where there is love for man, there is also love for this art. But love of man must be illuminated by understanding and must take into account the social environment in which he lives and his economic needs. The relationship between poverty and disease has long been recognized. Poor living conditions weaken the body’s resistance to infection, and inadequate ventilation, overcrowding and malnutrition are proverbial allies of disease. The value of medical care among the poorer classes becomes relative in that after a certain treatment the patient is sent back to the same environment that led to his or her suffering. While medicine cannot cure unemployment or abolish misery, much can be done in cooperation with social welfare institutions to improve the health of the poorest sections of society.
- Good medical care coordinates different types of medical services. The practice of medicine includes a wide range of services, from the eradication of unhealthy agents to the puncture of subcutaneous abscesses. These services are necessarily provided by a wide variety of agencies and institutions, and involve different methods and types of organization. Many of the services are only provided at the community level, such as the collection of vital statistics and the inspection of milk and other foods, for example. Others, such as tonsillectomies, can only be provided at the individual level. And others, although in technical terms they could be provided individually, for social or economic reasons they have no effect if they are not channelled through collective organisations and public services.
Adequate medical care requires close coordination among the agencies and institutions responsible for providing medical services. The type of organization required can be illustrated by the case of diphtheria. If immunization against diphtheria is given by a private physician, the physician must report it to the health department for immediate registration. Cases of diphtheria are diagnosed by the physician with the help of the public health laboratory, which in turn provides the serum with which the physician will treat patients. Cases are isolated by the public health department, which also initiates an investigation to discover the source of the infection.