clinic

clinic, an organized medical service offering diagnostic, therapeutic, or preventive outpatient services. Often, the term covers an entire medical teaching centre, including the hospital and the outpatient facilities. The medical care offered by a clinic may or may not be connected with a hospital.

The term clinic may be used to designate all the activities of a general clinic or only a particular division of the work— e.g., the psychiatric clinic, neurology clinic, or surgery clinic. The entire activity when connected with a hospital is typically called the outpatient department, and the specific subdivisions may be referred to as clinics.

The first clinic in the English-speaking world, the London Dispensary, was founded in 1696 as a central means of dispensing medicines to the sick poor whom the physicians were treating in the patients’ homes. The New York City, Philadelphia, and Boston dispensaries, founded in 1771, 1786, and 1796, respectively, had the same objective. Later, for the sake of convenience, physicians began to treat their free patients at the dispensary. The number of such clinics did not increase rapidly, and as late as 1890 only 132 were operating in the United States. The impetus for the mushroomlike growth that has occurred since that time came with the rapid growth of hospitals and also from the public health movement.

Hospital clinics

During the late 1800s the modern concept of a hospital began to take shape. During this period some of the hospitals connected with medical schools inaugurated outpatient departments for the purposes of teaching and charity. The advantages of providing ambulatory care close to the facilities of a hospital became apparent, and such hospital clinics multiplied rapidly.

The organization of a hospital clinic in general follows that of the inpatient facilities. Hospital clinics are primarily concerned with acute diseases, and the physicians in the clinics are usually the same physicians who treat inpatients in the hospital.

In many hospital clinics, especially those in countries that do not have national health insurance programs, care is made available only to the medically indigent, and no professional fee is charged. Practically all such clinics, however, charge a small registration fee if the patient is financially able to pay; income from such fees helps pay operating costs. A number of successful attempts have been made to extend hospital clinic care to paying patients. Most of this effort has been in the area of lower income groups although in a few hospitals no limit is placed on income in determining eligibility for care. The hospitals of the University of Chicago, for example, began operating a clinic on such a basis in 1928.

Public health clinics

The public health movement was mainly concerned with preventive medicine, child and maternal health, and other medical problems affecting broad segments of the population. The first public health clinics were established in the late 19th century. In 1890 A. Pinard set up a maternal dispensary or antenatal clinic at the Maternité Baudelocque in Paris. Milk distribution centres were set up in France by J. Comby (1890) and in Britain by F.D. Harris (1899). Infant welfare clinics were established in Barcelona (1890); and clinics for older children were founded in St. Pancras, London, by J.F.J. Sykes (1907).

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Unlike hospital clinics, which have had their greatest growth in the cities, public health clinics are located chiefly in smaller towns and villages. In the United States the first great movement in creating public health clinics resulted in the founding of the National Association for the Study and Prevention of Tuberculosis in 1904. It was the association’s goal to study and prevent tuberculosis by making clinic facilities available for free examination and treatment in every city and county. Other nationwide, private health agencies in specialized medical fields quickly adopted this method to improve the quality and extend the quantity of medical service in their fields. Local governmental health units operate similar clinics for the prevention of communicable disease and long-term illness. Such clinics are generally concerned with one particular medical interest—for example, tuberculosis, sexually transmitted diseases, prenatal care, well-baby care, teeth, tonsils, eyes, children affected by physical disorders, or mental health. There is a tendency toward the establishment of traveling clinics, such as dental clinics for schoolchildren. Often, no charge is made for service in public health clinics, and for many medical conditions no income restrictions are imposed. A few are operated in connection with hospitals, but most such clinics use public buildings or space furnished by welfare and other social agencies. Financial support is received mostly from the same sources.

Private clinics

The advantages of group medical service, with facilities and technical personnel beyond the means of an individual practitioner plus the benefit of group consultation, have encouraged the establishment of pay or private clinics. Such a clinic is essentially a voluntary association of physicians engaged in the practice of medicine on an organized group basis. Common administration and facilities are used, and the resulting expense and income are shared according to a predetermined plan. To be classified as a group clinic the relationship between each physician and the organization must be defined in a legal agreement. The relationship usually takes the form of a partnership. Several of these, such as the Mayo Clinic, in Rochester, Minnesota, have achieved a national reputation and attract patients from a wide area. Most of these organized group clinics are general clinics; i.e., they have several of the different medical specialties represented on their staffs. A number of private clinics, however, limit their work to one medical specialty. An enterprise of special interest is the London Clinic, established in 1932 by a group of prominent consultant surgeons and physicians who wished to make available to their private patients a place where the comforts and privacy of a nursing home could be combined with facilities for diagnosis and therapy such as exist only in the larger general hospitals.

Usually the group is organized independently of any hospital or other agency, but in some instances such clinics own and operate their own hospital facilities. In other instances the clinic is a part of a prepaid health service plan. This latter pattern received impetus as labour unions set up medical clinics supported by welfare benefits contributed by employers. The United Mine Workers, for example, has an established system of such clinics in hospitals constructed by the union in the coal-mining areas of Virginia and West Virginia.

Health centres

In 1910 the first health centres, or multiple clinics, were established in Pittsburgh and Wilkes-Barre, Pennsylvania. Others were opened in 1913 in New York City and in 1916 in Boston and Philadelphia. In 1920 in Britain a consultative council on medical and allied services (Dawson Committee) described a health centre as an institution wherein various medical services, preventive and curative, are brought together. Under Section 21 of the National Health Service Act, 1946, local health authorities provide, equip, maintain, and staff health centres to offer facilities for all or any of the following services: general medical and dental, pharmaceutical, hospital outpatient and health education, and care of expectant and nursing mothers. The prenatal and postnatal clinics include periodic medical and dental examinations, classes in parenthood and relaxation, and welfare foods. Activities in child welfare clinics comprise education in all aspects of motherhood, periodic medical and dental examinations, advice on mental health problems, immunization and vaccination, and distribution of welfare foods.

Polyclinics

In Russia the polyclinic (poliklinika) was created in order to combine the function of a hospital outpatient department with that of a general-practitioner health centre. Factory workers and their families could attend general polyclinics attached to major factories, and many special children’s polyclinics were built in the towns. A typical urban polyclinic, which was usually associated with a hospital, included reception and waiting rooms, registration desk, and consulting and treatment rooms of the following: internist, pediatrician, gynecologist, surgeon, eye specialist, ear, nose, and throat specialist, neurologist, urologist, and dentist. Rooms were often set aside for first aid, reception of infectious cases, and women and children’s welfare, as well as a dental department, drugstore, pathological laboratory, X-ray department, gymnasium, and lecture hall. There were always fairly elaborate physiotherapy departments and usually large and small operating theatres.

Family planning clinics

The main purposes of family planning services are to encourage parents to make responsible decisions about pregnancy that take into account the best interests of the family; to provide guidance to couples who wish to limit the size of their families; and to advise on the technical methods that are available for doing so. There are marked differences in attitude toward the desirability of a reduction in family size between developed and less-developed countries. This difference is dominated by high infant and child mortality in most less-developed countries as compared with developed countries.