outpatient
treatment, however, must be paid for by the patient.

The cornerstone of the health service is the polyclinic, which provides
general and specialized outpatient aid and consultation. Polyclinics may
be attached to a hospital or may be independent units serving a
designated geographic area. A separate network of polyclinics is
attached to industrial mining, transport, and construction enterprises
to serve their workers. Each polyclinic is divided into departments for
the various specialties in medicine, and each department is staffed by
one or more doctors and auxiliary personnel. Not all polyclinics,
however, have departments for all the major fields of medicine; many
have only sections for internal medicine, obstetrics and gynecology,
pediatrics, and surgery. Patients needing consultation or treatment by
other specialists are referred to the nearest hospital.

The health care provided by the polyclinic was under serious attack in
the early 1970s both from the doctors who work there and from the
patients. The main problem seemed to be overburdening and inefficiency
imposed by the system of health care. One polyclinic in Sofia, for
example, was responsible for the health care of 70,000 inhabitants of
its area. Its physicians gave routine examinations to prospective
students and job applicants, certified the legitimacy of claims for sick
leave, and diagnosed and treated all complaints from the common cold to
the most serious illness. During four hours each day, patients were seen
on a first-come-first-served basis, except in emergencies. Waiting rooms
were jammed, and people often waited for hours without seeing a doctor
because the allotted time for office consultations had expired before
their turn came.

Studies have indicated that one physician sees an average of thirty to
forty patients in the four-hour period of office consultations, and then
one-half again as many in a three-hour period of house calls, which
often cover a wide geographic area. The average consultation between
doctor and patient is six minutes, a time much too short for proper
diagnosis. The result has been frequently wrong diagnosis and wrong or
inadequate treatment.

A survey of polyclinic physicians conducted in 1970 revealed that over
50 percent of those surveyed considered the outpatient treatment
provided by the polyclinic to be ineffective. They blamed poor
organization and procedure in handling patients' needs, which resulted