Physician and patient

by Worthington Hooker

And for all this generally the medical man gets comparatively a small compensation. Though some physicians acquire wealth, especially in our large cities, still as a body of men they are in moderate circumstances, and the practice of medicine may be truly said to be far from being a money-making business. A large proportion of those whom they serve are too poor to give them any compensation, and very many of those who are able to pay them do not without reluctance and delay. This, it is true, is in part to be attributed to the remissness of physicians in presenting their claims. But why this remissness? If I mistake not, it arises from the unwillingness to pay, which they so often meet with, even in quarters where they have no reason to expect it. The consequent dislike to the business of collecting begets a habit of neglecting it. A large proportion of their patients feel a less urgent obligation to pay them, than they do to pay others. I know not any other reason for this than the intangibility of the favor which is bestowed by the physician. If a man buy a coat of the tailor, or a barrel of flour of the grocer, he has a tangible memento of his obligation; for the coat is seen, and is felt upon his back, and the flour is eaten, and makes its sensible impression on the palate and stomach. But health restored is a thing of air, and the visits of the physician, as they have left no memorial behind them that addresses the senses, are easily forgotten. For the same reason a man will not so easily forget his obligations to his physician if he has amputated a limb for him, as he would if he had attended him through a course of fever. His crutch or his wooden leg, is ever present to remind him of them. And for the same reason also, as the tailor and grocer can get their pay more readily before the coat is worn out, and the flour is eaten up, than they could a long time afterward, so the physician is more cheerfully paid immediately after returning health, than he can be at any future period.

While the physician is ordinarily but poorly compensated for all his toil and anxiety, he is obliged often to see the quack and hobby-rider amassing wealth by their gross impostures. Often does the scientific and laborious practitioner, who is adding from his daily observations rich treasures to the recorded experience of the profession, suffer from the res angusta domi, while he sees some proprietor of a patent medicine, the recipe for which he purchased of some recreant physician, or filched from some medical book, acquiring a fortune almost in a day, or some ignorant pretender, adopting some system just then high in the popular favor, as Homœopathy for example, making in a brief year or two all the display of a wealthy citizen. And the offensiveness of such cases is enhanced by the fact, that many of the well-informed and the learned unite with the multitude in casting contempt upon the labors of science, by upholding the pretensions and filling the coffers of sheer imposture.

The facility, with which the public are imposed upon in regard to medicine, is a prolific source of vexation and trial to the scientific and high-minded physician. He is subjected to a constant encounter with false opinions, unfounded prejudices, unreasonable caprices, and gross misapprehensions. He hears ignorance in high places, as well as in low, putting forth its oracular opinions, as it sits in judgment upon his practice, and that of his brethren. The most reckless criticisms are made upon his mode of treatment in individual cases, and the most inconsiderate and wanton aspersions are cast upon his professional character.

If the practice of imposition were confined to those who are without the pale of the profession, it would be a trial which could be borne with comparative ease. But when the physician sees his own brethren stooping to an occasional use of the arts of the charlatan, and obtaining success thereby, even among the better portion of the community, while they do it so covertly that they do not lose caste with the profession, it is a sore trial to his spirit. He cannot but regard such men as the chief enemies of the honor of his profession, though they may talk loudly of their attachment to it, and as real opposers of the advancement of medical science, though they may make a great show of zeal in its pursuit. And yet so adroitly do they manœuvre, that they generally escape exposure. This sly quackery, which is practised by so many medical men, provoking an indignation, to which it will do no good to give utterance, is one of the prominent trials of the truly honorable physician.

It is a severe trial to the feelings of the humane physician to see valuable lives sacrificed to a blind trust in ignorance and unskilfulness. He is occasionally obliged to witness such a sacrifice, and ordinarily under such circumstances that any interference on his part would do no good, however strangely he may be urged to it by the dictates of humanity. If he utter the warning voice, however clear the case may be, it will be ascribed to interested and unworthy motives. He may feel deeply for the poor sufferer who is to be sacrificed, and for the family who are to be thus bereaved by the ruthless hand of unskilful ignorance; but hard as it is to hold his peace, he in most cases feels that he must do it, because if he do otherwise, he will not only spend his breath in vain, but will add to the evil by his ineffectual opposition.

The many sad scenes in which the physician is obliged to mingle must often make him sorrowful, if he has not suffered his feelings and sympathies to be destroyed by a total dereliction of principle. As he watches with earnestness the struggle which occurs in severe cases between life and death for the mastery, and does what he can to give it a favorable issue, how deep is his anxiety, how painful the sense of his responsibility, what balancings of hope and fear does he experience; and then when the dread moment comes, when after all this pressure and conflict of feeling, the physician becomes persuaded that the issue is certain to be fatal, how is his spirit borne down with the burden of his grief! And then, too, there are cases, in which, though he has from the first had strong hopes of a favorable termination, all at once a train of symptoms arises, threatening immediate destruction. And to add to the painfulness of the case, perhaps the friends of the patient have not perceived the change, so secret has it been. As he goes to make his usual daily visit, cheered with the expectation of finding his patient better, he is overwhelmed with surprise when he sees, as he enters the sick chamber, that death is rapidly and surely doing its work. Besides seeing his own hope extinguished in a moment, he feels an unutterable pang in the necessity, thus suddenly pressing upon him, of destroying the hopes of the fond friends by whom the patient is surrounded.

In the Chapter on the Moral Influence of Physicians, I have spoken of the intimate relation, in which the physician stands to so many families, and of the strength and tenderness which his attachment to them acquires, by the exercise of an active sympathy during a long series of years. The accumulation of sympathy which thus occurs deepens the sorrow which he feels, as he sees in the case of some member of a family, upon which he has long attended, that his efforts are unavailing, and that the resources of his art are all exhausted. And as the friends gather round the bed of death, though by a habit of self-control he has an air of composure which is generally attributed to want of feeling he makes one of that circle, entering into their griefs as the sympathizing friend, as well as the faithful physician. And the very confidence which is reposed in him, gratifying as it is, sometimes adds poignancy to his grief. ‘You saved my life, and why cant you save my husband?’—said a woman to me in the extremity of her agony, when I told her that it was not possible for her husband to recover.

Another circumstance which adds to the sorrow of the physician in such seasons, especially when long acquaintance has created a strong personal attachment, is the total want of preparation with which many come to the hour of death. Even if the physician be not a religious man, this consideration must press upon him at times with a painful interest, if he has the common feelings of humanity. Especially will this be the case, when he is obliged to witness some of those horrible scenes, which sometimes occur in the last hours of a career of vice.

The sorrowful scenes, which the physician witnesses occasionally in the ordinary routine of his business, come with a painful frequency, when some fatal epidemic is prevalent in the community. Then night and day his mind is filled with anxiety. The sorrows of bereavement continually call for his sympathy. And in the midst of all this, he avoids solicitude for his own safety, only by forgetting himself in the arduous duties which he performs for others’ welfare. While he sees others fleeing from the pestilence, he must be ever at his post. Though he may see some of his brethren falling around him, humanity demands of him that he should go on in his services to the sick, and to the honor of our profession I believe it may be said, that this demand is very seldom disregarded. During the prevalence of the yellow fever in Philadelphia in 1793, of the thirty-five physicians who remained in the city, eight (nearly one fourth of the whole number, died, and but three escaped an attack of the disease).

One of the greatest trials which the physician has to bear is the ingratitude of those upon whom he has conferred favors. There are services rendered by the medical man who is faithful to his high trust, for which no money is an adequate compensation. His reward for such services comes from two sources—the satisfaction always attending the performance of duty, and the gratitude of those to whom they are rendered. The wealthy by no means discharge in full their obligations to the physician, who attends upon them in all their sickness with unwearied fidelity, when they pay him in full for his attendance. They owe to him the affection of a true friendship, and the gratitude due to something more than a professional performance of duty in their behalf. The relation of a physician to his employers is not shut up within the narrow limits of mere pecuniary considerations. There is a sacredness in it, which should forbid its being subjected to the changes incident to the common relations of trade and commerce among men. But many do not so regard it. They dismiss a physician for as slight a reason as governs them in ceasing to buy of one man, and giving their patronage to another, or, as Dr. Rush says, “with as little feeling as they dismiss a servant, or dispose of a family horse.” A mere whim, or caprice, is often suffered to dissolve this relation, though it may have existed for years. And generally the more frivolous and unfounded the reason for the change, the greater will be the zeal with which they laud their new favorite, and the harsher will be the aspersions, which they will cast upon the professional character of the old and tried friend, whom they have deserted.