INTERFERENCE WITH PHYSICIANS.
Great latitude is allowed by the community in interfering with the
practice of physicians. It is the object of this chapter to point out
some of the ways in which this interference is exercised, and some of
the injurious consequences which result from it.
Sometimes the confidence which one feels in his own physician leads
him to put a low estimate upon the merits of other physicians and
to attempt to destroy the hold which they have upon the confidence
of their employers. Though this is very common, it is a most
unjustifiable interference. While it is right that every one should
be attached to the physician who has done well for him and his
family in their sickness, this furnishes no ground for disparaging
the physician to whom another is attached, perhaps for just as good
reasons. He may sincerely believe that his friend has misplaced
his confidence. But let him ask himself, am I sure—do I _know_,
that it is so? Have I the data on which I can properly base such an
opinion? Am I competent to judge of the comparative merits of the
two physicians from observing their practice? If every one, who is
tempted by a mere preference, or by pride of opinion to practice the
interference referred to, should put to himself such questions as
these, he would at least be less positive in his opinions, and less
zealous in his efforts to unsettle the confidence of others in the
physicians whom they employ.
Let me not be understood to mean that interference is proper in no
case whatever. There are cases, in which it is not only allowable,
but it is even an imperative duty. If you see a friend confiding in
a quack, or an unskilful and ignorant practitioner, it is your duty
to persuade him to relinquish such a misplaced confidence. But you
must remember that the evidence upon which you act should be clear
and satisfactory, and that no mere preference can justify such an
interference, however strong that preference may be. So also, if you
have a friend, who trusts his own life and that of his family in the
hands of an intemperate practitioner, it is a case which calls loudly
for the warnings of friendship. But in this case, you must have
better evidence of the fact, upon which your advice is based, than
mere suspicion, or vague reports.
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.
Let me not be understood, that I would have the friends of a patient
make no inquiries at all of the physician in relation to the case.
His intercourse with them should be candid and free, and the
intelligent and honorable physician wishes it to be so. All that
I claim is, that the practitioner should not be _harrassed_ with
inquiries, and especially with such scrutiny, and such expressions of
doubt as to the effect of remedies, as shall indicate their lack of
confidence in the treatment, and therefore tend to destroy his own
confidence in it. The physician knows, and for the most part should
be left to judge, how much ought to be communicated to the friends of
a patient in relation to his case.
Neither let me be understood to mean, that physicians are afraid
to have their practice watched and scanned. Every honorable and
intelligent practitioner is willing that his treatment of any case
be scanned most thoroughly, but he would prefer that it should be
done by _skilful_ eyes. The friends of the patient should always
remember, that they have not sufficient knowledge of the human
system, and of the effects of agents upon it, to appreciate properly
the workings of disease, and the operation of remedies; and they
should therefore be careful not to put themselves in the attitude of
_clinical_ critics—a station for which none but a physician is really
fitted. The physician himself is in constant danger of making wrong
inferences, on account of the complicated character of the system,
and the various circumstances which therefore modify the operation
of agents brought to bear upon it—even he, prepared as he is by
study and well-weighed experience to observe accurately, is obliged
to sift well the evidence in regard to the effects of remedies, in
order to avoid mistake in his conclusions. How much more then should
_they_ be cautious in the inferences which they draw, who have never
studied the human frame, and who have had but little experience of
the treatment of disease. And yet many make no scruple in forming the
most decided opinions of the practice of physicians, in every case of
which they have any knowledge, however limited, and in proclaiming
those opinions with all the authority of an oracle. The practitioner
is sometimes so much harrassed by these meddlers that he is in danger
of mixing up with the measures of his practice expedients to satisfy
or foil their officiousness—a compound which brings no benefit to
the patient. The attention and the skill of the physician should
be _concentrated_ upon one object—the proper treatment of the case
before him. And the expenditure of his ingenuity, in using feints
and practising concealments, to avoid a collision with the whims and
prejudices of by-standers, impairs this concentration to the injury
of the patient, and that sometimes a _fatal_ injury.
The influence of scrutiny in impairing the skilfulness of action is
seen on other subjects, as well as in the practice of medicine. The
eloquent clergyman, who would ordinarily carry his audience along
with him, while he is aiming with clear mind and zealous heart to
attain the _one_ great object of his preaching, the impression of the
truth upon the conscience would fail to produce the same effect upon
an audience of _critics_. For, to say nothing of the embarrassment
which the very idea of criticism occasions, his attention would be
distracted by supposed criticisms, which would suggest themselves
to his mind while he is speaking; and that concentration of mental
and moral energies upon one object, which is essential to true
eloquence, would be wanting. To be eloquent before such an audience,
he must either disarm their criticism, or he must forget that they
are critics, and look upon them only as men whose minds are to be
impressed and whose feelings are to be moved by the truth.
Take another illustration of quite a different character. A noted
juggler perceived, at the commencement of his performance, that
he was very narrowly watched by a gentleman whom he knew at once
to be a very acute observer. He was embarrassed, as I have seen a
practicer of the juggleries of animal magnetism embarrassed by a
similar cause, and he felt that he could not practice his deceptions
with so free and easy a hand, as he could if he were not watched by
so an intelligent an eye. The consciousness of being thus watched
distracted his mind, and prevented him from concentrating its
energies upon one object. The juggler immediately gave this gentleman
a piece of money, telling him that he must look out or he would get
it away from him in the course of the evening. At the conclusion of
the exhibition the gentleman said to the juggler, ‘well, sir, here
is your money—you see that I have kept it safely.’ ‘Yes,’ replied
he, ‘and I meant that you should, for I chose that you should have
something else to watch besides me.’
The case of the physician, whose practice is scrutinized by
by-standers, is worse even than that of the criticized clergyman, or
the watched juggler. For the criticism to which he is subjected is
not skilful, and is therefore not capable of appreciating the merit
of the measures which he employs. In the case of the clergyman, the
analogy would be more correct if his audience were illiterate, and
his subject were one of an abstruse and metaphysical character. Their
criticism would then bear a strong resemblance to that to which the
practice of the physician is often made to submit. If the physician
investigate the case before him, thoroughly and scientifically, the
reasonings upon which his treatment is based are often as much beyond
the knowledge of those who have not been instructed in the science
of medicine, as a strictly metaphysical argument is beyond the
knowledge, and therefore the criticism, of a plain unlearned audience.
A similar defect can be pointed out in the analogy of the case of
the juggler. However much he felt embarrassed by the keen eye which
he was conscious was watching him, he knew that if the way in which
his feats were performed was discovered, his skill would nevertheless
be appreciated and admired. The physician, as you have seen, has no
consolation of this kind. He knows that those who watch him have
generally so little knowledge of disease, and of its treatment, that
they cannot estimate with any correctness the skill with which he
meets the various phases presented by disease, with its numerous and
changing complications; and yet they are quite confident that they
are exactly right in their judgment on such points. He is watched by
ignorance, and ignorance, too, believing itself to be wise.
And farther, as the clergyman, if he be one, who, instead of
possessing true eloquence, is skilled in the mere tricks of oratory,
would prefer an ignorant and indiscriminating audience, and fears
one of an opposite character; and as a bungling juggler had rather
be watched by unskilful than skilful eyes; so the ignorant and
dishonorable physician is more at home, when the eyes of the
multitude are fixed upon him, than when he is under the scrutiny of
his medical brethren. And as many, who are incapable of being real
orators, study most faithfully the tricks of oratory, and so far
succeed as to deceive the superficial and the ignorant, so there is
many a physician, who, instead of bestowing all his energies upon
the management of disease, wastes them in learning the tricks of the
charlatan, which will enable him, like the mock orator, to make a
show of skill and acquire the reputation of possessing it with the
multitude. This he can do with more certainty than the pretender
in oratory, because he deals with subjects on which most men are
profoundly ignorant, and yet think themselves to be very wise. It is
for this reason, that the quackish physician, in common with the open
quack, addresses all his appeals to the multitude, and brings all
his arts to bear upon the one point of making such false displays as
will impress upon their minds the idea that he has uncommon knowledge
and skill. He therefore loves their credulous gaze, while he hates
the intelligent scrutiny of his brethren. There is no one thing, in
which the difference between the empirical and dishonorable physician
and the high-minded and truly skilful practitioner is more strongly
marked than in this.
The practice, then, of interfering with physicians in the
performance of their duties, which is so common in every community,
impairs their usefulness, not only directly, by embarrassing them
in their treatment of the sick, but also indirectly, by encouraging
the intrigues and manœuvres of the dishonorable in our profession.
We have no hope of persuading busy-bodies to abandon a practice of
which they are so fond; but we have a right to expect, that the wise
and good, who are so often betrayed into it by zeal for some favorite
physician, or remedy, or by a generous kindness, or an urgent anxiety
for the patient, will, upon seeing their error, renounce it, and
pursue in future such a course as will secure to the sick the best
efforts of the physician in their behalf.
FOOTNOTES:
[37] Though the plan of charging so much a visit, so universally
adopted by the profession, is on the whole the best general plan
of regulating the prices of the physician’s services, it is liable
to some abuses. Some variations from it must of course be allowed;
and in making these a door is opened for manœuvering on the part of
dishonorable practitioners. It is a very common ‘trick of the trade’
to make more visits than are necessary, perhaps quite short ones, and
then charge less per visit than is usually charged by medical men in
the same neighborhood. In this way the credit of being both a very
cheap and a very attentive physician is most unjustly obtained.