Physician and patient

by Worthington Hooker

It is a very common idea, that physicians are generally attached, to a foolish degree, to the rules of etiquette in their intercourse. Many talk as if the welfare of the sick, and sometimes even life, is sacrificed to it. The physician is often entreated to lay it aside, as being an obstacle in the way of his usefulness. When, for example, he is sent for to visit the patient of another physician without his knowledge, it is perhaps said to him, ‘we wish you to give up all etiquette—if you can do any good to this poor sufferer, do it.’

The impression which is so common in regard to this subject is an erroneous one. The rules of intercourse which govern the medical profession abridge no man’s liberty. A strict adherence to them favors freedom of intercourse, by maintaining mutual confidence; while a disregard of them destroys this freedom, by engendering mutual distrust. The truly honorable physician is therefore always scrupulous in obeying them, while the dishonorable physician prefers a lax observance, because it furnishes him with occasional opportunities of obtaining by his manœuvres advantages over his medical brethren.

I have thus noticed, as briefly as I could, some of the dishonorable practices which are common among physicians, impairing the harmony of their intercourse, and therefore limiting the usefulness of the profession. I have done so, principally because the community do not appreciate in any just degree the evil of these practices, and therefore those who are guilty of them generally escape with impunity, especially in the country, where there is no medical public opinion to control them, as there is in the cities and larger towns. It is well that the ‘tricks of the trade’ should be understood; and that the public should be able to discriminate, better than it now does, between those who are honorable practitioners, and those who are not.

The differences, the jealousies, and the quarrels of medical men have become proverbial. ‘Who shall decide when doctors disagree,’ is often uttered as a reproach upon the profession, not only in regard to its opinions but its practices also. It is manifest to every one, that a jealous and quarrelsome spirit is more prevalent among physicians, than it is in the other professions. The reasons for this I will briefly notice.

These reasons are to be found in the peculiar circumstances which attend the relations of physicians to each other, and the community.

As the reader has already seen, the public have, for the most part at least, no direct means of judging of the correctness of a physician’s practice, for the whole science of medicine is to them a mystery. He can commit the most gross and fatal errors, even while his patients and their friends may be reposing the most unlimited confidence in his skill and wisdom. His professional intercourse with them is indeed wholly a matter of confidence. The positions advanced by the lawyer can commonly be correctly appreciated by ordinary intelligence; the doctrines proclaimed by the clergyman it is the privilege and the duty of every man to examine by the light of the Bible; but the prescriptions of the physician must for the most part be taken upon trust. There is great room therefore for imposition; and the more, because with all this ignorance of medicine, most people are apt to think that they have no inconsiderable amount of knowledge on this subject.

It is in this facility with which deception can be practiced upon the community, that we find the principal circumstance that fosters the jealousies, the disagreements, and the bickerings which disgrace the medical profession. For it is this facility which tempts to the use of all those arts and manœuvres, that are so common among physicians. If the practice of these were confined to empirics, and to physicians who have an established character as dishonorable and intriguing men, the evil would by no means be as great as it now is. But it is not thus confined. The facility for deception is so great, and the temptations to turn it to profit are so many and constant, that many physicians, who are in the main honorable, occasionally yield to the temptation. This of course begets to some extent a general distrust, and then circumstances from time to time produce jealousy, perhaps disagreement and strife.

This state of things is promoted by the peculiar relations which the physician sustains to his employers. They are generally his warm friends, and are ready to act with zeal in his favor, and to recommend him earnestly to those upon whom they have any influence. The attachment of families to their physician is somewhat peculiar, differing essentially from the preferences which are felt in regard to other professional men. The result is, that each physician has a party in the community composed of all classes and ages, and a large portion of that party are active in urging his claims. This of itself so affects the competition in which he is engaged with his brethren, that it is apt to awaken distrust and jealousy. And besides, interferences are sometimes practised which aggravate the difficulty. Some attribute most of the strifes of physicians to these interferences; and assert that if their friends would let them alone, there would generally be no want of harmony among them. Though there is some truth in this remark, yet it is certain that physicians are often the prompters of these interferences. Some physicians always have a troop of busy-bodies trumpeting their fame. They have a tact in drawing such persons into their train, and they do it by precisely the same means by which the quack accomplishes the same object. The quack and the quackish physician are alike in this respect. The prompting influence, thus exerted, may not always be obvious, and sometimes is least so when it is the most effectual. The old adage, that the highest evidence of art is in the concealment of art, is applicable here.

The disposition to jealousy and strife in the medical profession is also promoted by the associations which are sometimes formed by physicians with each other, or with the community, for the sake of furthering their own selfish ends. Professional cliques on the one hand, and alliances with various societies, social, moral or religious, on the other, when relied upon as means of advancing one’s professional interests, are always inimical to the harmony of medical men. They render competition unfair and dishonorable and therefore contentious. The physician who calls to his aid the influence of a sect, or a party, or an association of any sort, in so doing not only places himself in an attitude to awaken distrust, but subjects himself in maintaining the alliance to a necessity for employing means of self-aggrandisement, which will conflict with the rights of others, and will therefore involve himself in either a secret, or an open warfare with his brethren.

It is peculiarly true of the physician, that he will always find it for his interest and especially for his comfort, to obey the injunction of the Apostle, ‘If it be possible, as much as lieth in you live peaceably with all men.’ Sometimes it is hardly ‘possible’ even for the strictly honest and honorable to do so. It is sometimes difficult to restrain the outburst of an honest indignation provoked by the base tricks of physicians, who, in spite of such tricks, hold an honorable position before the community. But it is best to do it, if ‘possible.’ For even if the act complained of be clearly and palpably a disgraceful one, the public, with their present ideas of the rules of medical intercourse, will not generally appreciate the true merits of the case. The friends of the physician who has committed the act will be disposed to think him right; and those who feel indifferent to the matter, will turn it off with the old remark, ‘two of a trade cannot agree,’ as if that settled it. If one who has been injured by a competitor manifest any sensitiveness, and is earnest in denouncing the act, he will generally make the matter worse for himself. And if his opponent keep still, and utter the little which he does say very slily, he will be sure to gain an advantage over his more honest, but less cunning, neighbor. It is especially true of the medical profession, that one gives dignity to a dishonorable opponent by stooping to quarrel with him. The artful often endeavor to provoke the honorable to strife, managing at the same time to produce the impression upon the public mind, that they themselves have no disposition to quarrel. The best course therefore, commonly is, to avoid as much as possible, and in a very quiet way, having any intercourse with the artful and intriguing in the profession.