Physician and patient

by Worthington Hooker

You discover in your conversations with a physician upon politics, religion, or the occurrences of the day, that he is very credulous. Have you a doubt that the same credulity follows him into a sick room, and mars the accuracy of his observations of disease and of the influence of remedies? And so, on the other hand, the physician who shows a sceptical cast of mind on other subjects, will assuredly be a doubter on a subject clothed with so much uncertainty as medicine is, and his treatment of disease will be marked by hesitation and lack of energy and firmness.

You see a physician apt to form his opinions on ordinary subjects hastily. Slight evidence satisfies him, and he makes up his mind at once. It may be that he does it with so much shrewdness that he is very apt to be right in his conclusions; but sometimes he is entirely wrong, because he has in his haste overlooked some apparently slight circumstances which are really of vital importance. There is quite a large class of such minds in the medical profession. They are better fitted to practice in acute forms of disease than in chronic cases. These latter require patient investigation to thread out all their intricate complications.

I once knew two physicians of considerable eminence, who had directly opposite casts of mind, in regard to the qualities to which I have just alluded. They lived and practised in the same neighborhood through a long life. The one would spend perhaps an hour in ferreting out all the hidden labyrinths of a chronic case, and I have often been delighted, as he would clearly and in choicest language unfold his views, after he had concluded his examination. The other never wanted more than a few minutes to learn all he wished to know of a case, and he was prepared to act. Possessed of much native shrewdness, it was astonishing to see how he would avoid error in forming his hasty opinions. He seemed to be aware in what his forte lay. He had an abhorrence of all long and intricate cases, and turned them over, so far as he could, to his brethren; and he took peculiar pleasure in managing acute cases, in which the changes were rapid, and the end either for good or ill came soon.

You discover in your conversations with one physician on common subjects, that he is very slow and cautious in adopting opinions, and when he has once adopted them he adheres to them with great tenacity; while another, on the contrary, is exceedingly changeable in his opinions. These opposite qualities, exhibited as they are abroad in society, go with them to the sick chamber, and they exert their full influence. The one will fix upon a course of practice in a given case with all due consideration, and when he has once fixed upon it, he will pursue it most faithfully, even though the progress of the case may furnish conclusive evidence that he is wrong. He will be blind to that evidence, because he believes most assuredly that he is right in his views of the case. The other will not pursue a course long enough to determine whether it be right, but will see continual reasons for change; and his course from the beginning to the end of a case will often present a medley of variations, from which no intelligent conclusions can be drawn. The one will have a few favorite remedies, which he reckons as old and tried friends, and he adds but few to the little group from year to year. The other will make frequent changes in the remedies which he employs, and will try in rapid succession the new medicines, which every fresh periodical bring to his notice.

Some men take strong views of everything which they see. They must always have an opinion, whether the evidence upon which it is based be sufficient or not; and that opinion fills the mind, and actuates all the conduct. They are apt to have very partial and exclusive views, overlooking in their ardor points, which, though they may have little apparent prominence, may, if properly examined, lead to discoveries of great importance. Such men in the medical profession always make a decided impression upon the public mind, and have many strong and ardent friends; and if they possess considerable talent, they generally acquire a dazzling reputation. It is true that they commit frequent and often great errors. But when their bold opinions turn out to be correct, it adds wonderfully to their reputation for acuteness and wisdom, while their errors are mostly concealed, and the whisper that tells of those errors that chance to be discovered, is effectually drowned in the noisy commendation of their enthusiastic adherents.

If I at all succeeded in my object in the chapter on the Uncertainty of Medicine, the reader was convinced that there is no pursuit in which a habit of accurate observation is more needed than in the practice of the medical art.

How then can a common observer test a physician in regard to this talent? If the observer were himself a physician, he could do this by watching him in his examinations of cases of disease. But as he is not, and is therefore ignorant of the subjects to be examined, he will fail in any attempt of this kind. He will be apt to commit, for example, this error. He sees that a physician makes a great many inquiries of his patients in regard to their complaints, and he may for this reason alone conclude that he is a nice observer. This minuteness of examination often gives a physician very unjustly this reputation; and in fact it is one of the most common tricks of the trade. There is often a great parade of questioning with very little true observation. A physician who is a skilful observer will learn more of a patient’s condition, by watching him as he lies in bed, and making a few inquiries, than another will by a multitude of questions; just as one man, who scarcely appears to look at anything as he passes through a street, may really observe and know more about the various objects in that street, than another man, who appears with eyes wide open to look at everything. A mere glance will sometimes reveal to the skilful observer the true nature of the case, when the unskilful have not been able to discover it with the most diligent examination of the symptoms. I will mention a single example. A man who was severely sick was attended by two physicians, who were somewhat at a loss in regard to the nature of his disease. Another physician, who was called in, before asking a single question, suspected from the posture of the patient that he had a hernia, in common language a rupture; and on examination this was found to be the case.

I might mention some other errors, to which the inquirer would be liable, if he attempted to judge directly of the physician’s mode of examining disease, but it is not necessary.

How then, the question recurs, shall he test the physician on the point under consideration?

Let him see how the physician observes in regard to some subject, with which he himself is acquainted. He will discover in this way what his habits of observation are; and he may be sure, that these same habits mark his investigations of disease in the chamber of the sick. No man has different habits of observation for different subjects.