Physician and patient

by Worthington Hooker

Suppose that you have a curious article in your possession, and you have become acquainted with all the facts in regard to it. If you show it to several physicians, and observe the inquiries which they make in relation to it, you can discover the different characters of their minds, and may thus know how they observe and investigate disease.

One of them asks perhaps but few questions, and some of those are irrelevant. He discovers but little in regard to the article, and you may be sure that he will never discover but little in regard to disease.

Another, after making a few inquiries, starts some supposition or theory, and this directs all his future inquiries. He of course obtains a very partial knowledge of the facts, and this is mingled with errors. And so it is with him in his investigation of medical subjects. He is a theorizing practitioner.

Another makes many inquiries, but they are of a rambling character. He finds out many of the facts in regard to the article, but by no means all of them. His observation is active, but it is without method and incomplete. Though he will be diligent in the investigation of disease, and will appear to most persons to be an acute and skilful observer, he never will obtain a thorough and complete knowledge of any case.

Another, by a natural succession of inquiries, discovers one fact after another, till he knows the whole. He does not ask a single irrelevant question. The answer to every question either developes a new fact, or confirms one already discovered. He separates accurately the probable from the true, wholly rejecting the merely plausible. He frames no theory. His search is only for facts. You may be sure that he will be a skilful observer in the sick room, and that in the investigation of disease he will be constantly adding to his store of valuable and well-arranged facts.

Do you wish to ascertain what characterizes a physician’s measures in the treatment of disease? Instead of watching his practice, of which, as you have seen, you cannot judge with any good degree of correctness, observe what measures he proposes when acting, not in the capacity of a physician, but in that of a citizen, a neighbor, a member of an association, and what reasons he gives for these measures. If you find that he advocates measures which show common sense, shrewdness, and good judgment, and which accomplish the purpose aimed at; you may safely conclude that the same common sense, shrewdness and good judgment mark his treatment of his patients, and that he is a skilful and successful practitioner of medicine.

A very little thing will sometimes develope some characteristic of a physician’s measures. A physician, as he starts his horse to leave you after a pleasant chat, finds the rein caught under some part of the harness. He pulls it up to disengage it; but, as he does not succeed, he gives it a twitch in which he succeeds no better. His face reddens, and he twitches again and again, each time more violently, and finally, by tearing out a loop in his harness, he disengages the rein. You may safely infer that that physician will be apt to have just such twitching measures in his treatment of the sick, and will in this way mar some things which are of some more importance than the loops in his harness.

It is quite a prevalent idea in the community, that a man may be an ignoramus in regard to other subjects, and yet may have great skill in medicine. It is supposed that there is in the healing art a sort of mysterious tact or skill, innate in the man, and not acquired like other knowledge. It is this idea which gives such a reputation, for infallibility almost, to the natural bone-setter. We find here, also, the reason that intemperance in a physician so little impairs the confidence of his employers. It must be obvious that in no employment is a steady and clear state of mind more needed; and the obscurity of mind and recklessness, which intoxication, even when existing only in a slight degree, invariably produces, must unfit the physician for the proper performance of his duties. And yet how many sensible people, who would fear to trust an intemperate stage-driver or engineer, will unhesitatingly commit their health and life to the care of an intemperate physician, because they suppose that he has a peculiar skill, of which even intoxication cannot deprive him. His drunkenness seems to act as a dark background, making his skill appear the brighter by contrast.[34]

In confirmation of this idea of the possession of innate skill, it is said that a man may be a fool on one subject, and yet may be a genius on another. A man may be, for instance, a great arithmetician, or a very ingenious mechanic, and may yet exhibit folly on most other subjects. This may be true in some few instances, but it is not at all common; and rare cases never can establish a general rule or principle. And besides, a genius in medicine, if he be a mere genius, in the popular sense of the term, makes but a poor practitioner. For true skill in the practice of medicine requires the possession of a wide range of talents, and among these sound judgment, or, (as it is familiarly called when used in reference to ordinary subjects,) common sense, is pre-eminent. This is a sine qua non in the physician. The most brilliant talents cannot make one a good practitioner without this qualification. They may make him an interesting lecturer, or writer, and may give him a high reputation in the community. But his lack of this practical talent must render him unsuccessful in the treatment of disease, and the lectures which he may give will be deficient in practical instruction, and the books which he may write will add nothing to that storehouse of facts, which come only from observation, guided by a discriminating judgment, and plain common sense. He may construct beautiful theories, and explain and defend them with ingenuity, but he never can be a reliable source of instruction and information to his medical brethren.

The reader has seen that there are then five ways of judging of the skill and the attainments of a physician. 1st. By examining his opinions on medical subjects, and the reasons upon which they are based. 2d. By observing his practice, and comparing its results with those of the practice of others. 3d. By inquiring into the evidences of his education. 4th. By observing the unbiassed opinions entertained of him by his medical brethren. 5th. By observing his mental qualities as they are exhibited in relation to those subjects which the observer himself understands.