Physician and patient

by Worthington Hooker

Some of those, who are fond of practising the interference under consideration, hesitate not to make the most severe and reckless attacks upon the professional reputation of physicians. Indeed, such attacks are quite common in all circles. Though the non-professional observer, as you have seen, is not capable of estimating correctly the results of medical practice, many are in the habit of expressing their opinions upon this subject freely, and sometimes very harshly, especially when any case comes to a fatal issue. In such a case the busy partizans of other physicians are ready to cast blame upon the practitioner who has attended upon it, though all they may know in relation to it may be the idle rumors which come from gossiping tongues. The interests of the physician are often seriously injured by the reckless opinions thus expressed by men, who, though wholly incompetent to judge in such matters, from their wealth and standing have considerable influence.

The professional reputation of medical men seems to be considered by common consent as fair game for the shafts of all, whether high or low, learned or unlearned. Although the charge of mal-practice is a serious charge, especially when it has relation to the death of a patient, it is exceedingly common to hear this charge put forth without any hesitation, and in the most positive manner. So common is it, that it awakens but little feeling; and, though it be a shameful enormity, it seldom meets with any rebuke. A very severe rebuke was once administered by a judge in Massachusetts to a lawyer, for hinting at the charge of mal-practice against a physician, who was one of the parties in a case before the Court. The insinuation was intended as a sort of make-weight for the advantage of his client. The judge at once inquired of the lawyer, if he intended to make that a point, giving him to understand, that if he did, he would be expected to produce evidence bearing upon it. The lawyer said that he did not. ‘You will withdraw that point then,’ said the judge, ‘and indulge in no farther remarks upon it.’ Very soon, however, he made the same insinuation again. The judge interrupted him, and remarked, that, as a professional man’s reputation was of the highest value to him, and was even the means of his livelihood, he would not suffer it to be wantonly attacked in any case; and he told the lawyer, that, as he had twice brought the charge of mal-practice against this physician, he should not permit him to go on with his plea, till he had withdrawn it in writing. It would be well if the same regard for the value of professional reputation were felt by all our judges, and by all the wise and influential in the community.

Let me not be understood to claim, that the merits of physicians should not be canvassed at all by the community. There should be freedom of opinion upon this subject; and, when it will accomplish any good purpose, there should be freedom also in expressing that opinion. But the opinions of those who are ignorant of the subjects to which they relate, and who are not in possession of the facts in the case, ought at least to be uttered with some degree of modesty, and a mere blind preference is no justification of the bold opinionating, and the busy interference, which are so common with the train of zealous partizans, which some physicians draw after them.

Some in their zeal carry their interference even into the chamber of the sick, and disturb its quiet with debates in regard to the propriety of the practice which is pursued. To say nothing of the evil resulting from the excitement thus produced, the influence of the physician over the mind of the patient, which, as you will see in another chapter, is sometimes of great importance, is often destroyed in this way. Hope is as real a cordial to the sick as any restorative medicine that can be given. And the meddler, who attempts to destroy the confidence of a patient in his physician, and thus take from him the hope that he will be relieved by his skill, does as cruel an act as if he entered the sick room and snatched from the very lips of the enfeebled, languishing, and perhaps dying man, the cordial draught which was to revive him.

Some are zealous in their recommendation of medicines to the sick, and perhaps even urge the patient to take them without the knowledge of the attending physician. Such meddlers have no scruples in regard to this interference with the physician’s course, so long as the responsibility of the case remains upon his hands; but the moment that it is proposed to them to take the responsibility upon themselves, they shrink from it, notwithstanding the confidence and earnestness with which they urge the use of their favorite remedies.

It is amusing to see what various, and even opposite measures are recommended by different persons in the same case. The friends of a patient, who are anxious that everything should be done to save a life so valuable and dear to them, are often perplexed and troubled by the great variety of remedies urged upon them, and the plausible reasons, and the asserted cures, upon which these recommendations are based. And not a little firmness is required to resist the importunity of these meddlers, especially as it is often prompted by undoubted kindness. But the welfare of the patient demands it, and no fear of giving offence should hinder from pursuing the proper course. The adequate remedy in such circumstances is to thank such meddlers for their kindness, and tell them that the measures which they recommend shall be mentioned to the physician, and, if he thinks proper, they shall be used.

Some are disposed to restrict physicians in regard to the medicines which they shall give. While the practitioner should avoid a useless war with the notions and caprices of his employers, and should sometimes even yield to them in unessential matters, it is ordinarily not only compromising his own dignity and independence, but is doing an absolute injury to the patient, to make any concessions on this point. The omission of some remedy or measure, in obedience to prejudice, may prove very injurious, and even in some cases fatal. As a general rule, therefore, the physician should claim his right to pursue his own course, independent and untrammeled. He, and he alone, is responsible for the proper management of the case before him, and his rights are certainly commensurate with his responsibility, and should not be interfered with. But those who make medicine a trade, and who care more for popularity and patronage than they do for the interests of science, or the welfare of the sick, often submit, as a matter of policy, to this interference with their rights. They will do anything to satisfy their employers. They will, for example, pursue the homœopathic mode of practice, if it be desired, and stoop to the farce of infinitesimal globules. They must despise themselves for so doing, and deserve to be despised by others.

The frequency of a physician’s visits[37] should for the most part be left to his own judgment; for if he is not to be trusted in relation to this matter, he had better be dismissed, and another employed in his place. The conscientious physician is often much embarrassed by the complaints of his patients on this point. Some complain that his visits are too frequent, and others that they are not enough so. The attendance of the physician is sometimes discontinued too soon for the welfare of the patient, from motives of delicacy, where this fault-finding is practised. And, on the other hand, the extreme frequency of visits, which is sometimes required of the practitioner, especially by the wealthy, is in many cases injurious. For example, it may impair the mental influence, which it is important that the physician should maintain over his patient, or it may impose upon him almost a necessity to use too much medication, or to make too frequent changes in his course of practice in the case.

I trust that it is now clear to the reader, that all interferences with the practice of the physician are inconsistent with the best management of the sick. They repress that freedom of thought and action, which is an essential element of success in the treatment of disease, as well as in everything else. Even when no interference is intended, the anxiety of friends is sometimes the cause of so much embarrassment to the physician, as to be detrimental to the welfare of the patient. And there is no doubt, that, in spite of all the care that is lavished by numerous friends upon the sick in the higher walks of life, they are often, from the cause above alluded to, treated with less skill and judgment than the miserably attended sick in the cheerless habitations of the poor. This may appear at first though rather paradoxical to the reader; but let us examine this point, and you will easily see the reasonableness of the assertion.

I will suppose a case. A lady is sick under the care of her physician. Her husband and friends are exceedingly anxious in regard to the result of the case. They have many inquiries to make of the physician about her symptoms, his fears and hopes, the operation of medicines, &c. They ask him, perhaps, if he is not afraid that such a remedy will produce such an effect, and such an one such an effect; and they may even go so far as to attribute some unfavorable symptom to some medicine that has been administered. There are few physicians who are so independent, that they will not feel themselves embarrassed under such circumstances. The responsibility of an important case in itself occasions sufficient embarrassment, without adding to it by such a course. Napoleon, that shrewd observer of men, saw this in the case of his wife, and governed himself accordingly. He saw that there was danger, and that the physician was in a measure paralyzed by his sense of his responsibility. Instead of talking with him about the difficulties of the case, and expressing his apprehensions, he immediately said to him, “she is but a woman: forget that she is an empress, and treat her as you would the wife of a citizen of the Rue St. Denis.” This restored confidence to the physician; and his treatment of his royal patient was successful, when perhaps a timid course would have been fatal to her.