CHAPTER XIII.INTERFERENCE WITH PHYSICIANS.
Great latitude is allowed by the community in interfering with the practice of physicians. It is the object of this chapter to point out some of the ways in which this interference is exercised, and some of the injurious consequences which result from it.
Sometimes the confidence which one feels in his own physician leads him to put a low estimate upon the merits of other physicians and to attempt to destroy the hold which they have upon the confidence of their employers. Though this is very common, it is a most unjustifiable interference. While it is right that every one should be attached to the physician who has done well for him and his family in their sickness, this furnishes no ground for disparaging the physician to whom another is attached, perhaps for just as good reasons. He may sincerely believe that his friend has misplaced his confidence. But let him ask himself, am I sure—do Iknow, that it is so? Have I the data on which I can properly base such an opinion? Am I competent to judge of the comparative merits of the two physicians from observing their practice? If every one, who is tempted by a mere preference, or by pride ofopinion to practice the interference referred to, should put to himself such questions as these, he would at least be less positive in his opinions, and less zealous in his efforts to unsettle the confidence of others in the physicians whom they employ.
Let me not be understood to mean that interference is proper in no case whatever. There are cases, in which it is not only allowable, but it is even an imperative duty. If you see a friend confiding in a quack, or an unskilful and ignorant practitioner, it is your duty to persuade him to relinquish such a misplaced confidence. But you must remember that the evidence upon which you act should be clear and satisfactory, and that no mere preference can justify such an interference, however strong that preference may be. So also, if you have a friend, who trusts his own life and that of his family in the hands of an intemperate practitioner, it is a case which calls loudly for the warnings of friendship. But in this case, you must have better evidence of the fact, upon which your advice is based, than mere suspicion, or vague reports.
Some of those, who are fond of practising the interference under consideration, hesitate not to make the most severe and reckless attacks upon the professional reputation of physicians. Indeed, such attacks are quite common in all circles. Though the non-professional observer, as you have seen, is not capable of estimating correctly the results of medical practice, many are in the habit of expressing their opinions upon this subject freely, and sometimes very harshly, especially when any case comes to a fatal issue. In such a case the busy partizans of other physicians are ready to cast blame upon the practitioner who has attended upon it, though all they may know in relation to it may be the idle rumors which come from gossiping tongues. Theinterests of the physician are often seriously injured by the reckless opinions thus expressed by men, who, though wholly incompetent to judge in such matters, from their wealth and standing have considerable influence.
The professional reputation of medical men seems to be considered by common consent as fair game for the shafts of all, whether high or low, learned or unlearned. Although the charge of mal-practice is a serious charge, especially when it has relation to the death of a patient, it is exceedingly common to hear this charge put forth without any hesitation, and in the most positive manner. So common is it, that it awakens but little feeling; and, though it be a shameful enormity, it seldom meets with any rebuke. A very severe rebuke was once administered by a judge in Massachusetts to a lawyer, for hinting at the charge of mal-practice against a physician, who was one of the parties in a case before the Court. The insinuation was intended as a sort of make-weight for the advantage of his client. The judge at once inquired of the lawyer, if he intended to make that a point, giving him to understand, that if he did, he would be expected to produce evidence bearing upon it. The lawyer said that he did not. ‘You will withdraw that point then,’ said the judge, ‘and indulge in no farther remarks upon it.’ Very soon, however, he made the same insinuation again. The judge interrupted him, and remarked, that, as a professional man’s reputation was of the highest value to him, and was even the means of his livelihood, he would not suffer it to be wantonly attacked in any case; and he told the lawyer, that, as he had twice brought the charge of mal-practice against this physician, he should not permit him to go on with his plea, till he had withdrawn it inwriting. It would be well if the same regard for the value of professional reputation werefelt by all our judges, and by all the wise and influential in the community.
Let me not be understood to claim, that the merits of physicians should not be canvassed at all by the community. There should be freedom of opinion upon this subject; and, when it will accomplish any good purpose, there should be freedom also in expressing that opinion. But the opinions of those who are ignorant of the subjects to which they relate, and who are not in possession of the facts in the case, ought at least to be uttered with some degree of modesty, and a mere blind preference is no justification of the bold opinionating, and the busy interference, which are so common with the train of zealous partizans, which some physicians draw after them.
Some in their zeal carry their interference even into the chamber of the sick, and disturb its quiet with debates in regard to the propriety of the practice which is pursued. To say nothing of the evil resulting from the excitement thus produced, the influence of the physician over the mind of the patient, which, as you will see in another chapter, is sometimes of great importance, is often destroyed in this way. Hope is as real a cordial to the sick as any restorative medicine that can be given. And the meddler, who attempts to destroy the confidence of a patient in his physician, and thus take from him the hope that he will be relieved by his skill, does as cruel an act as if he entered the sick room and snatched from the very lips of the enfeebled, languishing, and perhaps dying man, the cordial draught which was to revive him.
Some are zealous in their recommendation of medicines to the sick, and perhaps even urge the patient to take them without the knowledge of the attending physician. Such meddlers have no scruples in regard to this interferencewith the physician’s course, so long as the responsibility of the case remains upon his hands; but the moment that it is proposed to them to take the responsibility upon themselves, they shrink from it, notwithstanding the confidence and earnestness with which they urge the use of their favorite remedies.
It is amusing to see what various, and even opposite measures are recommended by different persons in the same case. The friends of a patient, who are anxious that everything should be done to save a life so valuable and dear to them, are often perplexed and troubled by the great variety of remedies urged upon them, and the plausible reasons, and the asserted cures, upon which these recommendations are based. And not a little firmness is required to resist the importunity of these meddlers, especially as it is often prompted by undoubted kindness. But the welfare of the patient demands it, and no fear of giving offence should hinder from pursuing the proper course. The adequate remedy in such circumstances is to thank such meddlers for their kindness, and tell them that the measures which they recommend shall be mentioned to the physician, and, if he thinks proper, they shall be used.
Some are disposed to restrict physicians in regard to the medicines which they shall give. While the practitioner should avoid a useless war with the notions and caprices of his employers, and should sometimes even yield to them in unessential matters, it is ordinarily not only compromising his own dignity and independence, but is doing an absolute injury to the patient, to make any concessions on this point. The omission of some remedy or measure, in obedience to prejudice, may prove very injurious, and even in some cases fatal. As a general rule, therefore, the physician should claim his right to pursue his own course, independentand untrammeled. He, and he alone, is responsible for the proper management of the case before him, and his rights are certainly commensurate with his responsibility, and should not be interfered with. But those who make medicine a trade, and who care more for popularity and patronage than they do for the interests of science, or the welfare of the sick, often submit, as a matter of policy, to this interference with their rights. They will do anything to satisfy their employers. They will, for example, pursue the homœopathic mode of practice, if it be desired, and stoop to the farce of infinitesimal globules. They must despise themselves for so doing, and deserve to be despised by others.
The frequency of a physician’s visits[37]should for the most part be left to his own judgment; for if he is not to be trusted in relation to this matter, he had better be dismissed, and another employed in his place. The conscientious physician is often much embarrassed by the complaints of his patients on this point. Some complain that his visits are too frequent, and others that they are not enough so. The attendance of the physician is sometimes discontinued too soon for the welfare of the patient, from motives of delicacy, where this fault-finding is practised. And, on the other hand, the extreme frequency of visits, which is sometimesrequired of the practitioner, especially by the wealthy, is in many cases injurious. For example, it may impair the mental influence, which it is important that the physician should maintain over his patient, or it may impose upon him almost a necessity to use too much medication, or to make too frequent changes in his course of practice in the case.
I trust that it is now clear to the reader, that all interferences with the practice of the physician are inconsistent with the best management of the sick. They repress that freedom of thought and action, which is an essential element of success in the treatment of disease, as well as in everything else. Even when no interference is intended, the anxiety of friends is sometimes the cause of so much embarrassment to the physician, as to be detrimental to the welfare of the patient. And there is no doubt, that, in spite of all the care that is lavished by numerous friends upon the sick in the higher walks of life, they are often, from the cause above alluded to, treated with less skill and judgment than the miserably attended sick in the cheerless habitations of the poor. This may appear at first though rather paradoxical to the reader; but let us examine this point, and you will easily see the reasonableness of the assertion.
I will suppose a case. A lady is sick under the care of her physician. Her husband and friends are exceedingly anxious in regard to the result of the case. They have many inquiries to make of the physician about her symptoms, his fears and hopes, the operation of medicines, &c. They ask him, perhaps, if he is not afraid that such a remedy will produce such an effect, and such an one such an effect; and they may even go so far as to attribute some unfavorable symptom to some medicine that has been administered. There are few physicians who are so independent,that they will not feel themselves embarrassed under such circumstances. The responsibility of an important case in itself occasions sufficient embarrassment, without adding to it by such a course. Napoleon, that shrewd observer of men, saw this in the case of his wife, and governed himself accordingly. He saw that there was danger, and that the physician was in a measure paralyzed by his sense of his responsibility. Instead of talking with him about the difficulties of the case, and expressing his apprehensions, he immediately said to him, “she is but a woman: forget that she is an empress, and treat her as you would the wife of a citizen of the Rue St. Denis.” This restored confidence to the physician; and his treatment of his royal patient was successful, when perhaps a timid course would have been fatal to her.
Let me not be understood, that I would have the friends of a patient make no inquiries at all of the physician in relation to the case. His intercourse with them should be candid and free, and the intelligent and honorable physician wishes it to be so. All that I claim is, that the practitioner should not beharrassedwith inquiries, and especially with such scrutiny, and such expressions of doubt as to the effect of remedies, as shall indicate their lack of confidence in the treatment, and therefore tend to destroy his own confidence in it. The physician knows, and for the most part should be left to judge, how much ought to be communicated to the friends of a patient in relation to his case.
Neither let me be understood to mean, that physicians are afraid to have their practice watched and scanned. Every honorable and intelligent practitioner is willing that his treatment of any case be scanned most thoroughly, but he would prefer that it should be done byskilfuleyes.The friends of the patient should always remember, that they have not sufficient knowledge of the human system, and of the effects of agents upon it, to appreciate properly the workings of disease, and the operation of remedies; and they should therefore be careful not to put themselves in the attitude ofclinicalcritics—a station for which none but a physician is really fitted. The physician himself is in constant danger of making wrong inferences, on account of the complicated character of the system, and the various circumstances which therefore modify the operation of agents brought to bear upon it—even he, prepared as he is by study and well-weighed experience to observe accurately, is obliged to sift well the evidence in regard to the effects of remedies, in order to avoid mistake in his conclusions. How much more then shouldtheybe cautious in the inferences which they draw, who have never studied the human frame, and who have had but little experience of the treatment of disease. And yet many make no scruple in forming the most decided opinions of the practice of physicians, in every case of which they have any knowledge, however limited, and in proclaiming those opinions with all the authority of an oracle. The practitioner is sometimes so much harrassed by these meddlers that he is in danger of mixing up with the measures of his practice expedients to satisfy or foil their officiousness—a compound which brings no benefit to the patient. The attention and the skill of the physician should beconcentratedupon one object—the proper treatment of the case before him. And the expenditure of his ingenuity, in using feints and practising concealments, to avoid a collision with the whims and prejudices of by-standers, impairs this concentration to the injury of the patient, and that sometimes afatalinjury.
The influence of scrutiny in impairing the skilfulness ofaction is seen on other subjects, as well as in the practice of medicine. The eloquent clergyman, who would ordinarily carry his audience along with him, while he is aiming with clear mind and zealous heart to attain theonegreat object of his preaching, the impression of the truth upon the conscience would fail to produce the same effect upon an audience ofcritics. For, to say nothing of the embarrassment which the very idea of criticism occasions, his attention would be distracted by supposed criticisms, which would suggest themselves to his mind while he is speaking; and that concentration of mental and moral energies upon one object, which is essential to true eloquence, would be wanting. To be eloquent before such an audience, he must either disarm their criticism, or he must forget that they are critics, and look upon them only as men whose minds are to be impressed and whose feelings are to be moved by the truth.
Take another illustration of quite a different character. A noted juggler perceived, at the commencement of his performance, that he was very narrowly watched by a gentleman whom he knew at once to be a very acute observer. He was embarrassed, as I have seen a practicer of the juggleries of animal magnetism embarrassed by a similar cause, and he felt that he could not practice his deceptions with so free and easy a hand, as he could if he were not watched by so an intelligent an eye. The consciousness of being thus watched distracted his mind, and prevented him from concentrating its energies upon one object. The juggler immediately gave this gentleman a piece of money, telling him that he must look out or he would get it away from him in the course of the evening. At the conclusion of the exhibition the gentleman said to the juggler, ‘well, sir, here is your money—you see that I have kept it safely.’ ‘Yes,’replied he, ‘and I meant that you should, for I chose that you should have something else to watch besides me.’
The case of the physician, whose practice is scrutinized by by-standers, is worse even than that of the criticized clergyman, or the watched juggler. For the criticism to which he is subjected is not skilful, and is therefore not capable of appreciating the merit of the measures which he employs. In the case of the clergyman, the analogy would be more correct if his audience were illiterate, and his subject were one of an abstruse and metaphysical character. Their criticism would then bear a strong resemblance to that to which the practice of the physician is often made to submit. If the physician investigate the case before him, thoroughly and scientifically, the reasonings upon which his treatment is based are often as much beyond the knowledge of those who have not been instructed in the science of medicine, as a strictly metaphysical argument is beyond the knowledge, and therefore the criticism, of a plain unlearned audience.
A similar defect can be pointed out in the analogy of the case of the juggler. However much he felt embarrassed by the keen eye which he was conscious was watching him, he knew that if the way in which his feats were performed was discovered, his skill would nevertheless be appreciated and admired. The physician, as you have seen, has no consolation of this kind. He knows that those who watch him have generally so little knowledge of disease, and of its treatment, that they cannot estimate with any correctness the skill with which he meets the various phases presented by disease, with its numerous and changing complications; and yet they are quite confident that they are exactly right in their judgment on such points. He iswatched by ignorance, and ignorance, too, believing itself to be wise.
And farther, as the clergyman, if he be one, who, instead of possessing true eloquence, is skilled in the mere tricks of oratory, would prefer an ignorant and indiscriminating audience, and fears one of an opposite character; and as a bungling juggler had rather be watched by unskilful than skilful eyes; so the ignorant and dishonorable physician is more at home, when the eyes of the multitude are fixed upon him, than when he is under the scrutiny of his medical brethren. And as many, who are incapable of being real orators, study most faithfully the tricks of oratory, and so far succeed as to deceive the superficial and the ignorant, so there is many a physician, who, instead of bestowing all his energies upon the management of disease, wastes them in learning the tricks of the charlatan, which will enable him, like the mock orator, to make a show of skill and acquire the reputation of possessing it with the multitude. This he can do with more certainty than the pretender in oratory, because he deals with subjects on which most men are profoundly ignorant, and yet think themselves to be very wise. It is for this reason, that the quackish physician, in common with the open quack, addresses all his appeals to the multitude, and brings all his arts to bear upon the one point of making such false displays as will impress upon their minds the idea that he has uncommon knowledge and skill. He therefore loves their credulous gaze, while he hates the intelligent scrutiny of his brethren. There is no one thing, in which the difference between the empirical and dishonorable physician and the high-minded and truly skilful practitioner is more strongly marked than in this.
The practice, then, of interfering with physicians in theperformance of their duties, which is so common in every community, impairs their usefulness, not only directly, by embarrassing them in their treatment of the sick, but also indirectly, by encouraging the intrigues and manœuvres of the dishonorable in our profession. We have no hope of persuading busy-bodies to abandon a practice of which they are so fond; but we have a right to expect, that the wise and good, who are so often betrayed into it by zeal for some favorite physician, or remedy, or by a generous kindness, or an urgent anxiety for the patient, will, upon seeing their error, renounce it, and pursue in future such a course as will secure to the sick the best efforts of the physician in their behalf.
FOOTNOTES:[37]Though the plan of charging so much a visit, so universally adopted by the profession, is on the whole the best general plan of regulating the prices of the physician’s services, it is liable to some abuses. Some variations from it must of course be allowed; and in making these a door is opened for manœuvering on the part of dishonorable practitioners. It is a very common ‘trick of the trade’ to make more visits than are necessary, perhaps quite short ones, and then charge less per visit than is usually charged by medical men in the same neighborhood. In this way the credit of being both a very cheap and a very attentive physician is most unjustly obtained.
[37]Though the plan of charging so much a visit, so universally adopted by the profession, is on the whole the best general plan of regulating the prices of the physician’s services, it is liable to some abuses. Some variations from it must of course be allowed; and in making these a door is opened for manœuvering on the part of dishonorable practitioners. It is a very common ‘trick of the trade’ to make more visits than are necessary, perhaps quite short ones, and then charge less per visit than is usually charged by medical men in the same neighborhood. In this way the credit of being both a very cheap and a very attentive physician is most unjustly obtained.
[37]Though the plan of charging so much a visit, so universally adopted by the profession, is on the whole the best general plan of regulating the prices of the physician’s services, it is liable to some abuses. Some variations from it must of course be allowed; and in making these a door is opened for manœuvering on the part of dishonorable practitioners. It is a very common ‘trick of the trade’ to make more visits than are necessary, perhaps quite short ones, and then charge less per visit than is usually charged by medical men in the same neighborhood. In this way the credit of being both a very cheap and a very attentive physician is most unjustly obtained.