A review of the counts in the indictment I have brought against private
medical practice will show that they arise out of the doctor's position
as a competitive private tradesman: that is, out of his poverty and
dependence. And it should be borne in mind that doctors are expected
to treat other people specially well whilst themselves submitting
to specially inconsiderate treatment. The butcher and baker are not
expected to feed the hungry unless the hungry can pay; but a doctor who
allows a fellow-creature to suffer or perish without aid is regarded as
a monster. Even if we must dismiss hospital service as really venal,
the fact remains that most doctors do a good deal of gratuitous work
in private practice all through their careers. And in his paid work the
doctor is on a different footing to the tradesman. Although the articles
he sells, advice and treatment, are the same for all classes, his fees
have to be graduated like the income tax. The successful fashionable
doctor may weed his poorer patients out from time to time, and finally
use the College of Physicians to place it out of his own power to accept
low fees; but the ordinary general practitioner never makes out his
bills without considering the taxable capacity of his patients.
Then there is the disregard of his own health and comfort which results
from the fact that he is, by the nature of his work, an emergency man.
We are polite and considerate to the doctor when there is nothing the
matter, and we meet him as a friend or entertain him as a guest; but
when the baby is suffering from croup, or its mother has a temperature
of 104 degrees, or its grandfather has broken his leg, nobody thinks
of the doctor except as a healer and saviour. He may be hungry,
weary, sleepy, run down by several successive nights disturbed by that
instrument of torture, the night bell; but who ever thinks of this
in the face of sudden sickness or accident? We think no more of the
condition of a doctor attending a case than of the condition of
a fireman at a fire. In other occupations night-work is specially
recognized and provided for. The worker sleeps all day; has his
breakfast in the evening; his lunch or dinner at midnight; his dinner or
supper before going to bed in the morning; and he changes to day-work
if he cannot stand night-work. But a doctor is expected to work day and
night. In practices which consist largely of workmen's clubs, and in
which the patients are therefore taken on wholesale terms and very
numerous, the unfortunate assistant, or the principal if he has no
assistant, often does not undress, knowing that he will be called up
before he has snatched an hour's sleep. To the strain of such inhuman
conditions must be added the constant risk of infection. One wonders
why the impatient doctors do not become savage and unmanageable, and the
patient ones imbecile. Perhaps they do, to some extent. And the pay is
wretched, and so uncertain that refusal to attend without payment in
advance becomes often a necessary measure of self-defence, whilst the
County Court has long ago put an end to the tradition that the doctor's
fee is an honorarium. Even the most eminent physicians, as such
biographies as those of Paget show, are sometimes miserably, inhumanly
poor until they are past their prime. In short, the doctor needs our
help for the moment much more than we often need his. The ridicule of
Moliere, the death of a well-informed and clever writer like the late
Harold Frederic in the hands of Christian Scientists (a sort of sealing
with his blood of the contemptuous disbelief in and dislike of doctors
he had bitterly expressed in his books), the scathing and quite
justifiable exposure of medical practice in the novel by Mr. Maarten
Maartens entitled The New Religion: all these trouble the doctor very
little, and are in any case well set off by the popularity of Sir Luke
Fildes' famous picture, and by the verdicts in which juries from time to
time express their conviction that the doctor can do no wrong. The
real woes of the doctor are the shabby coat, the wolf at the door,
the tyranny of ignorant patients, the work-day of 24 hours, and the
uselessness of honestly prescribing what most of the patients really
need: that is, not medicine, but money.