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entrance of soul into an ovum at the instant the sperm enters. This is an occasionalism that mocks the grander mysteries. But all the passion and evangelistic potential that inflamed the Gnostics 18 centuries ago invests this new materialism . Our academic and apostolic bureaucrats may have had no choice. Such comments are less a book review than a line of musings instigated by the book. But I mean it as a tribute. There are few enough histories and biographies that engender subsequent thought. The palpable presence of Cannon, the immediacy of his work, and the influences that played on him are so well rendered that it is the most natural thing to lapse into reverie and overlay the past with the present. License that the authors have scrupulously avoided can be enjoyed by a reader. Jerome Lettvin Department ofBiomedical Engineering Rutgers—The State University of NewJersey Pücataway, NewJersey 08855-0909 A New Kind ofDoctor: The General Practitioner's Part in the Health ofthe Community. By Julian Tudor Hart. London: The Merlin Press, Ltd., 1988. Pp. 362. £12.95 (cloth); £7.95 (paper). What can we learn from Britain's 40-year-old experience with a national plan for providing free medical care for all? From the very outset, external critics of the National Health Service (particularly the medical establishment in the United States) pointed to Britain as a frightening example of what happens to the quality of medical care when government wrests control from the medical profession. The fact that British physicians never did lose their "clinical freedom " when fee for service was abandoned did not silence the doomsayers. Now, after 40 years, the "experiment" cannot be dismissed easily: Britain spends roughly one-quarter the average per capita expenditure of the United Stated on medical care, but there is no difference in age-standardized mortality rates in the two countries. Julian Tudor Hart is an articulate and particularly knowledgeable inside critic of the NHS: "Having worked a lifetime in general practice (beginning in 1952, and from 1960 to the present in a small coal mining community, Glyncorrwg, South Wales), that is the point from which I see the NHS as a whole, and the people it serves; a close underview from where the action begins. . . ." Early in his career, Hart recognized the operation of what he dubbed the "inverse care law": the quality of medical care was lowest where the needs of the population were highest. In this very important book, Hart provides a masterful review ofthe social and political conditions in Britain that led to the launching of the NHS in 1948, and an extensively referenced, clearly written account of the development and operation of the health service to the present. His hands-on experience leads him to a thoughtful examination of "the way that doctors, and particularly doctors in 310 Book Reviews primary care, have come to regard their relation to society, and how society has come to regard the function of doctors." Hart concludes that the "Osier model of Medical Professionalism" ("in which the social content of doctoring was ignored, minimized or sentimentalized into charity for the sick poor") has kept doctors from acknowledging the full extent of their social responsibility. For example, he points out that with the arrival of the NHS there was a revolutionary upgrading in "the distribution, staffing, equipment, planning and administration of hospitals." Consultants, who provided specialized care in hospitals, thrived. General practitioners, on the other hand, were demoralized: "GPs were defined not by what they were, but what they were not." "Blinkered by the customs and assumptions of the Osier paradigm ," Hart notes, the general practitioner was unable to see "a huge, largely unmapped field for effective medical care requiring skills unknown to hospital specialism, but badly needed by his patient." Hart has been exploring ways and means to develop "a new kind of doctor": one who recognizes medical care as a human right and not as a marketed commodity , a general practitioner who would attempt to fuse epidemiology with primary care. The challenge, he points out, is to provide accountable, anticipatory care for total populations at risk, not the traditional effort prompted only by patient demand. Hart presents cogent...

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