(From The Medical World)
THE vast proportions that unqualified practice is assuming, not only in this but in other countries, must cause serious concern to those interested in the future of medical practice. One hears the terms “quack” and “quackery” used as if they were synonymous with unqualified practitioner and unqualified practice, while at the same time one hears of quackery within medical practice.
Now, a quack is generally held to be an ignorant pretender to skill in medicine or surgery, and in this sense the term my be made applicable to some of those within as well as those without the profession of medicine. Indeed, the cynic may even be heard to remark that “all doctors are quacks”.
Medical writers are constantly reminding us that medicine is not an exact science. But medicine is not a science at all: it is an art, the art of restoring and preserving health by means of remedial aids, diet, regimen and the like. It is true that certain sciences, for example, chemistry and biology, are embraced within its scope, but to speak of medicine as a science is incorrect.
The consideration of medicine as an art makes at once apparent the ease with which the members of the medical profession fall into two main groups, namely, those who lean towards the pursuit of science, and those who are attract to practice. And so far as knowledge is concerned, a judicious combination of scientific and clinician makes the ideal practitioner. But more than this is required; he must have in addition at indescribable something which is called personality, before he can make headway in dealing with ailing humanity.
For without this, many brilliant men have been completely overshadowed by their intellectual inferiors. And this leads one to speculate as to whether it would not be a good plan to weed out the “unsuitables” in their student days. Although some students do improve with the passing of the years, yet there are others who are so obviously unsuitable in the beginning that they would be well advised to adopt another calling.
In regard to suitability the parents are not likely to be the best judges, and it is for this reason that the decision in best left in the hands of the headmaster or headmistress if a school or college, rather than in the hands of the dean of a medical school who is naturally anxious to increase e number of the students. If, however, a medical teacher considers a pupil unsuited for a medical career, it is surely the duty of the teacher to inform the pupil, and to urge him to adopt some other career.
This weeding out would at least do something towards diminishing that overcrowding of the medical profession of which so much is heard to-day. But one is all the time up against the competition of the medical profession of which so much is heard to-day. But one is all the time up against the competition of the medical schools, striving by every known stratagem to increase the number of their students.
And at the same time encouraging parents and pupils in the belief that a qualification to practice, when obtained, is a passport to immediate monetary reward, the amount, alas! too often exaggerated. Parents and guardians would be well advised to make full enquiries before encouraging their sons or daughters to enter into a profession where the qualities necessary for success are so many and so varied, that the successful medico would probably have achieved a high position in any other calling.
Unqualified practitioners are often referred to as unskilled persons, but many are highly skilled in what they attempt to do. The well-known ability of hospital orderlies and assistants in the departments for electrical, radiological and physical treatment bears witness to this. The unqualified practitioner may be a healer of various ills, by attempts to influence the mind of the patient. Now the mental element in illness is at all times difficult to measure, but all those who are brought in contact with sickness and suffering should ever be alive to its signal importance.
The amount of the mental disturbance varies with the nature and situation of the particular ailment and with the character of the patient. The misuse of the word “imaginary” is productive of much harm. There is no such thing as an imaginary ailment. The so-called imaginary ailment is often a very real affliction, requiring both skill and experience to cure. The brusque qualified practitioner may tell his patient that his (the patients ) trouble is largely or wholly imaginary, and may prescribe a sedative that merely makes the patient worse.
And this may not have been a single experience as far as the patient is concerned, for somewhat similar advice may have been obtained from other medical practitioners. Is it to be wondered at that, in these circumstances, the patient hearing of a “healer” who has perhaps cured some friends, rushes off to obtain the expected cure. The healer probably possesses both personality and a knowledge of human nature, enabling him to handle cases of this character with a full measure of success.
Every successful medical practitioner is wittingly, or more often unwittingly, a psychologist, and it is to this that he owes his ability to cope with the mental element in disease. Imagination is the most necessary and the most dangerous attribute of the human mind. And the frequency and importance of a distorted imagination as a complication of illness is liable to be overlooked or under-estimated by those who have not yet acquired the capacity to minister to a mind diseased.
But the unqualified practitioner may ply his calling in other directions. He may lay claim to cure by pills and portions or by the external use of drugs, salves, or applications of various kinds. And it is here that he comes into direct conflict with orthodox medicine.
It is freely stated that it is the less intelligent classes who resort to unqualified practitioners, but this is not correct. All classes of the community from the highest to the lowest are attracted, not merely because the desire to be cured is uppermost in their minds, but still more because orthodox medicine has failed to give them relief.
And the fact that a steady stream of sufferers continues to flow unchecked into the consulting-room of a particular unqualified practitioner, while the consulting- room of his qualified neighbour is gradually deserted, is an indication that the sufferers not only obtain relief but recommended others. Sometimes it is an old-fashioned remedy that is being used, or a Nature cure, or again, some kind of balneotherapy or hydro-therapy by means of packs, douches, sprays, or again, some other method of treatment is being utilized.
It must be admitted, however, that there is room for improvement in the modern teaching of therapy. There is, moreover, a tendency to overtook or rather to disregard the old and well tried remedies and to replace them by others of doubtful value. Students are not taught household remedies, many of which are of proved value and are often effectual where other methods fail.
And it is a little disconcerting to the medical practitioner to find the housewife succeed in effecting a cure where the efforts of “scientific medicine” had failed. And the various herbal teas and other folk remedies are well worthy of study by those who seek discover something new by resuscitating that which is very old.
There is much that may be learned from some of the Nature cures and the correct attitude to adopt to these and other methods is not to cast them aside with scornful disdain, an attitude that has persisted throughout the ages, but to make enquiry regarding the details of each method and the results obtained.
The greater part of what is now inclined under the title of “Physical Medicine” is the direct outcome of the work of the unqualified practitioner. Any physio-therapy is being taken up with enthusiasm by medical practitioners, thereby setting an example that should be followed.
In other words, whatever is found to be good in the practice of the unqualified practitioner should be absorbed and incorporated in orthodox medicine. For hitherto, it has been the attitude of the orthodox practitioner to the methods of those beyond the pale, that has been the real stumbling-block to the adoption of methods of treatment of proved value.
Much, too, has been learned from those who practice manipulation as a curative measure. And the principle of extension and movement as applied to painful joints is one that the bonesetter has taught the surgeon while the various grips (ingenious and effectual) that are used for different kinds of manipulation are being gradually employed in surgical practice. The bonesetter, free from the tyranny of pathology, discovered the value of movement through daring where the orthodox surgeon feared to try.
The lessons to be learned from that excellent book by Hilton, entitled “Rest and Pain”, have continued to produce a profound effect on the professional mind.
Yet unqualified practitioners who practised what has now been awarded the grandiose title of “Manipulative Surgery” , were obtaining results by movement in cases where rest was regarded as essential and movement harmful or even dangerous. The results obtained were received with incredulity until the undoubted benefit in so many cases began to filter through the public into the medical profession.
And like so many innovations that have ultimately come to be regarded as valuable additions to modern therapy, this particular innovation passed through what one may almost term the customary three stages, namely, ridicule, discussion, adoption.
Attempts have been made from time to time to urge the promotion of legislation “to abolish quackery”, but such attempts are not likely to succeed. The best way to deal with the menace of unqualified practice is to incorporate into orthodox medicine all that is good in it and to improve the teaching of therapeutical methods to students and graduates so that there will be a diminishing necessity for members of the public to have recourse to unqualified practice because of the failure to obtain relief from orthodox medicine.