On the other hand, when the doctor is in the dock, or is the defendant
in an action for malpractice, he has to struggle against the inevitable
result of his former pretences to infinite knowledge and unerring skill.
He has taught the jury and the judge, and even his own counsel, to
believe that every doctor can, with a glance at the tongue, a touch
on the pulse, and a reading of the clinical thermometer, diagnose with
absolute certainty a patient's complaint, also that on dissecting a dead
body he can infallibly put his finger on the cause of death, and, in
cases where poisoning is suspected, the nature of the poison used. Now
all this supposed exactness and infallibility is imaginary; and to
treat a doctor as if his mistakes were necessarily malicious or corrupt
malpractices (an inevitable deduction from the postulate that the
doctor, being omniscient, cannot make mistakes) is as unjust as to
blame the nearest apothecary for not being prepared to supply you with
sixpenny-worth of the elixir of life, or the nearest motor garage for
not having perpetual motion on sale in gallon tins. But if apothecaries
and motor car makers habitually advertized elixir of life and perpetual
motion, and succeeded in creating a strong general belief that they
could supply it, they would find themselves in an awkward position if
they were indicted for allowing a customer to die, or for burning a
chauffeur by putting petrol into his car. That is the predicament the
doctor finds himself in when he has to defend himself against a charge
of malpractice by a plea of ignorance and fallibility. His plea is
received with flat credulity; and he gets little sympathy, even from
laymen who know, because he has brought the incredulity on himself. If
he escapes, he can only do so by opening the eyes of the jury to the
facts that medical science is as yet very imperfectly differentiated
from common curemongering witchcraft; that diagnosis, though it means in
many instances (including even the identification of pathogenic bacilli
under the microscope) only a choice among terms so loose that they would
not be accepted as definitions in any really exact science, is, even at
that, an uncertain and difficult matter on which doctors often differ;
and that the very best medical opinion and treatment varies widely from
doctor to doctor, one practitioner prescribing six or seven scheduled
poisons for so familiar a disease as enteric fever where another will
not tolerate drugs at all; one starving a patient whom another would
stuff; one urging an operation which another would regard as unnecessary
and dangerous; one giving alcohol and meat which another would sternly
forbid, etc., etc., etc.: all these discrepancies arising not between
the opinion of good doctors and bad ones (the medical contention is,
of course, that a bad doctor is an impossibility), but between
practitioners of equal eminence and authority. Usually it is impossible
to persuade the jury that these facts are facts. Juries seldom notice
facts; and they have been taught to regard any doubts of the omniscience
and omnipotence of doctors as blasphemy. Even the fact that doctors
themselves die of the very diseases they profess to cure passes
unnoticed. We do not shoot out our lips and shake our heads, saying,
"They save others: themselves they cannot save": their reputation
stands, like an African king's palace, on a foundation of dead bodies;
and the result is that the verdict goes against the defendant when the
defendant is a doctor accused of malpractice.
Fortunately for the doctors, they very seldom find themselves in this
position, because it is so difficult to prove anything against them. The
only evidence that can decide a case of malpractice is expert evidence:
that is, the evidence of other doctors; and every doctor will allow a
colleague to decimate a whole countryside sooner than violate the bond
of professional etiquet by giving him away. It is the nurse who gives
the doctor away in private, because every nurse has some particular
doctor whom she likes; and she usually assures her patients that all the
others are disastrous noodles, and soothes the tedium of the sick-bed
by gossip about their blunders. She will even give a doctor away for the
sake of making the patient believe that she knows more than the doctor.
But she dare not, for her livelihood, give the doctor away in public.
And the doctors stand by one another at all costs. Now and then some
doctor in an unassailable position, like the late Sir William Gull, will
go into the witness box and say what he really thinks about the way a
patient has been treated; but such behavior is considered little short
of infamous by his colleagues.