MAJORITY REPORT. 
133 
PROVISION OF CONSULTANT SERVICES AT PATIENT'S HOME. 
989. As a result of recent inquiries by the Regional Medical 
Officers, the Ministry have found that a large number of prac- 
titioners thought it very desirable that the services of a specialist 
should be available for consultation at the patient’s home in 
the case of persons who are unfit to travel. Some of these men- 
tioned cases of acute illnesses, such as pneumonia or °° acute 
abdomen,’ as cases in which such help was specially needed. 
290. Of the value of second opinions in such cases, there can 
be no doubt, not only on account of the assistance given to the 
doctor in cases in which he needs expert advice as to diagnosis, 
or as to the best course of treatment to adopt, but also on account 
of the relief thus given to the mind of the patient, or of his 
relatives, in cases of dangerous illness, even although the general 
practitioner in attendance may have no doubt as to the diagnosis 
or the proper course of treatment. In the cases of the latter 
group, however, what is wanted is not necessarily the opinion of 
an expert. The second opinion of any general practitioner of 
wide experience and good standing will usually serve the purpose 
equally well. Moreover, in acute illnesses of patients residing 
at some distance from the nearest centre at which experts are 
available, considerations of time may make it more advisable to 
get the opinion of a general practitioner, who is more quickly 
available. These latter considerations obviously must affect 
materially the estimate of cost. 
991. The appropriate method of administering such a provision 
would be to draw up lists of approved experts and approved 
general practitioners in different parts of the country who might 
be called in when required, and to supply such lists to the prac- 
titioners concerned. In the large cities and towns, it might 
be possible to allow an expert to be called in wherever 
a second opinion was desired by the practitioner in attend- 
ance. In other places, the practitioner might be allowed to 
call in an expert in a case in which he thought expert advice 
really necessary and otherwise to call in an approved general 
practitioner from the neighbourhood. It would, however, 
probably be desirable that the proposal to call in an expert should 
first be submitted for approval by a medical officer appointed for 
the purpose (who might be one of the Regional Medical Officers 
of the Ministry) except where the practitioner certified that the 
case was one of urgency. That, however, is a matter of detail 
which we think should be left over for negotiation between the 
Ministry and the profession when the general outlines of this 
part of the scheme have been settled. 
EsTiMATE oF CosT oF HOME SERVICE. 
292. On the basis of such information as is at present avail 
able the Ministry have estimated that the cost of domiciliary 
consultant services would probably not exceed £250,000; but