Physician and patient

by Worthington Hooker

Sometimes, when there is perfect agreement between physicians in a consultation, the friends of the patient in some way get the impression that their views of the case are really different. They therefore sound the consulting physician on the subject. If he be an honorable man, he will at once say that they have agreed upon the course to be pursued, that he approves of it entirely, and that the attending physician will carry it into effect. But if he be unprincipled and intriguing, he will increase the impression, or even create it if it do not already exist, that there is disagreement; and he will do it so adroitly, that, while he will say nothing that is tangible, he will yet excite curiosity to know his views more fully, and feed the desire, which perhaps some partizan of his has awakened by his representations, that he shall take charge of the patient. If he thus gets possession of the case, as is often done, he will perhaps adopt the very course agreed upon in consultation with his brother physician, from whom he has filched it, and will alter only the form of the medicines, so as to give the appearance of an actual change in the treatment.

If after a consultation the patient improves, and the change is attributed by his friends to some particular remedy, credit is sometimes acquired by the dishonorable physician, by producing the impression that the remedy was suggested by himself. He makes perhaps no distinct assertion to that effect, especially if there be no ground for it, but in his conversations with the patient and his friends, he throws out such hints, and manifests so much interest and delight in speaking of the effects of the remedy, that the desired impression is made.

When, on the other hand, a case terminates fatally, and, as often happens, the friends of the patient are disposed to find fault, and fix upon some remedy, or measure, as the chief cause of death, the intriguing practitioner seeks to make capital for himself by fastening the blame upon the physician who had the management of the case. He does this, not by any direct and open attack upon him, for then he would be exposed, but by slyly ministering to prejudices which he finds awakened against him, or by exciting such prejudices by insinuations, and remarks of so indefinite a character, that he is effectually screened from detection.

Physicians who are called in consultation often have opportunities of defending the reputation of the attending physician from unjust attacks. And if they fail to make the defence when truth demands it, they may be quite as guilty as they would be if they volunteered the attack themselves, for they give to it their sanction; and yet, by doing no positive act, they shield themselves from blame. Lending a listening ear to aspersions upon the reputation of a medical brother, negative as the act is, is under some circumstances more base, and does more harm, than any open and bold attack.

An artifice, which is not unfrequently employed by the dishonorable physician after being called in consultation, is this. On meeting some friend of the patient he inquires very particularly about the case, asks whether this or that medicine or measure has been tried, expresses by word, or perhaps only by his manner, some surprise at being answered in the negative, though he really has no reason for doing so, and says that he will see the attending physician in relation to the matter. He does not see him—he has no intention to do so. His only object is to create dissatisfaction, or, if the patient dies, to produce the impression, that the measures which he alluded to were agreed upon, and ought to have been followed, and if they had been, they perhaps would have saved the patient.

The selfish and cunning physician is apt to make comparisons between the cases to which he is called in consultation, and some of his own cases of the same complaint, which he speaks of as having been very severe, though they terminated successfully. His object is to set forth his own skill, and in doing this he commonly very much over-estimates the severity of the disease in his own cases.

Some physicians manifest a deep interest in the patients of their brethren, and make many inquiries of their friends, in regard to the nature of the disease, and the mode of treatment. And if their services are requested in consultation, they are exceedingly attentive at the time, and make some very friendly calls afterwards. This undue attention, assuming the guise of great kindness and a lively interest in the welfare of the patient, though a burdensome and pains-taking trick, is nevertheless a very common one.

Sometimes a physician is called in consultation in a case which is not of a grave character, because the friends of the patient think that the attending physician places too low an estimate upon the severity of the disease. If he be an honorable man, he will under such circumstances have no hesitation as to his duty, but will at once say, that the attending physician is right in his views of the case, and that they are unnecessarily alarmed. The cunning and dishonorable practitioner pursues a different course. He makes a great show of examining the case thoroughly, asking many utterly needless questions; and, though he may sooth the anxieties of the family of the patient, and express the belief that he will recover, he does it in such a way as to favor the impression, that the attending physician was not really aware of the magnitude of the case, but that he on the other hand, has estimated it aright, and has looked into it as it should be done.

The dishonorable physician often makes difficulty, by attempting to hold on to the patient of another, when he has been called in a case of emergency. His plain duty under such circumstances is to give up the patient to the family physician when he arrives, or to request that, for this purpose, he should be sent for, if it has not already been done. And in all cases, in which the physician is doubtful, whether he has been called accidentally or from choice, he should take measures to remove the doubt. Some, in their eagerness to get practice, make no effort to settle this question, but disregard all the evidence which may appear against their claim to the patient; and, taking it for granted that the case is theirs, proceed at once to its treatment, and hang on to it till they are actually driven from the ground. And if they have a good share of assurance, they manage by this dishonorable course to keep possession of many cases which rightfully belong to their more modest neighbors. For many persons, from the fear of giving offence, are reluctant to tell them frankly that their services are needed only for the present emergency, and the physician of the family feels that it would be at least awkward for him to assert his rights under such circumstances.

Sometimes a second physician is sent for to see a patient without the knowledge of the one in attendance. This may be done from the whim of the moment, or from the earnest recommendation of some meddler, or from a desire to obtain the opinions of another practitioner, which, it is perhaps thought, will be more candid and unbiassed, without a formal consultation. A strictly honorable man, when thus called in, declines giving any opinion at all, for he considers that he has no right to have anything to do with the case, unless he meets the attending physician in consultation, or the case is fully and openly transferred to his care. Not so with the dishonorable and intriguing physician. Such calls furnish him with opportunities for exercising his cunning, which are too good to be lost.