Physician and patient

by Worthington Hooker

I presume it is sufficiently clear to the reader, from the views which I have before presented, that the community cannot judge with any degree of correctness directly, of the practice of physicians,—either of the truth of the principles on which it is based, or of its actual results.

How then shall the community judge of physicians? This question I will endeavor to answer.

The view which I gave, in the first chapter, of the uncertainty of medicine, I trust, made it obvious to the reader, that a thorough education is pre-eminently necessary to the proper practice of the medical art. In endeavoring therefore to form an estimate of the qualifications of any physician, let the evidence of his having obtained such an education be well considered.

But what is this evidence? Is it to be found in the bare fact that he has a diploma, obtained from some respectable medical institution? While a diploma is worth something as evidence, as there must be some improvement of the means of education, in order to pass the examination requisite to obtain it; yet it must necessarily be defective evidence. That the truth may be more fully ascertained, let the inquiry be made, how far the physician has improved the advantages he has had; for it must be remembered, that it is especially true of medicine, that a diligent and wise use of limited opportunities will impart more knowledge and skill, than can be acquired by a careless and unwise use of the most extensive advantages afforded by the profession.

I will allow that there are difficulties in the way of arriving at the truth in this inquiry, and the public are often most grossly deceived by the parade which is made by some physicians, in regard to the opportunities which they have enjoyed. Still, I apprehend, that the erroneous judgment of the public in regard to such cases, arises from a too ready confidence in mere pretensions, and that it can be avoided for the most part by a little more pains-taking in making the inquiry, and by applying tests of another character, to which I shall soon allude.

But education in the science of medicine is practically despised by quite a large portion of the community. Though this sentiment is not often distinctly avowed, yet it exists to a greater extent than is generally supposed. It shows itself in an indifference to the true evidences of a physician’s qualifications, and in a readiness to put the quack on a level with the thoroughly-educated physician, or even above him. These indications of the prevalence of this sentiment, are not confined to the ignorant; but they often appear among the well informed, and even the learned.

Sometimes this sentiment is boldly avowed in language like the following: ‘I care little about the evidence of a physician’s having had an education. The fact that he is successful in treating disease is worth vastly more than a piece of parchment. Many a man has risen to eminence in other professions by his own exertions, without any great amount of education; and why should not this be the case in the practice of medicine? There was Franklin, who rose by his own efforts to a post of honor and usefulness far above multitudes of his cotemporaries, who had a most finished education; and why should there not be Franklins in medicine, as well as in other departments of knowledge?’

The assertion, that success in curing disease is worth more than a piece of parchment, is strictly true. But the evidences, on which a correct estimate of success can be formed, are not ordinarily, as the reader has seen in the chapter on Good and Bad Practice, within the reach of the community; and the attempts which it makes to form an estimate from the defective evidence at its command, often result in the bestowment of the praise due to success upon those who are really unsuccessful.

As to the use which is made of so great a name as that of Franklin to justify a disregard of education in medicine, I remark, that those who hold such language forget three very plain truths. 1st. That self-education is, after all that can be said, education. It is education acquired in spite of difficulties, and without the aids which men usually have. 2d. That education thus obtained indicates the possession of uncommon power of mind. There are but few Franklins in any profession. It is not common for men to rise to eminence with the small means which he enjoyed, and in face of the difficulties which he encountered. 3d. That Franklin, and all those men who have thus risen to eminence, so far from despising education, made most diligent use of all the means of education which they could command, aspiring all the time to higher and higher advantages; and while they lamented the deficiencies of their own early training, they labored most assiduously to give to others the most extensive means of acquiring knowledge. Very different from this, I cannot avoid remarking in this connexion, is the spirit of those pretenders in medicine, who affect to despise education, and who claim that they have an innate skill, which education can neither impart nor improve.

I shall in another chapter maintain, that it is both the duty and the interest of the community, to demand that there shall be a respectable standard of education in the medical profession, and will therefore dismiss this topic for the present.