You may be saying to yourselves at this point, or long before it, “but all this boils down to a plea for the maintenance of the family physician, the general practitioner, that is.” Very good; that is what I am saying, that and some other things. This because I see a gradual, that and some other things. This because I see a gradual, but definite tendency to eliminate the physician that I advance many of these points.
The spread of specialism and the increased interest of the public in medical matters have both of them combined to narrow the function of the general practitioner, who is, or who should be, the clinician pax excellence, almost to the vanishing point. I regard this as being no less dangerous to the public than it would be for the passengers of the ship if the captain left the bridge and the chief engineer, or the chief steward, or the radio operator, took his place. But I see the equivalent of this being done day after day.
Whereas formerly, the physician kept control of the case and exercise his judgment in deciding the program of treatment,he now, all too often, stands aside and allows his specialist colleagues to take charge, over the shoulders of whom, as it were, he gets an occasional and momentary glance of his patient. Or-and this experience becomes more and more frequent-he isnt there at all. The specialist is there from the first, one, or a number, for it is not uncommon to see a patient being treated by a committee, just as though he were a banking concern, run by a board of directors; only the patient is in a worse plight, because even a back has its manager.
But the trouble is not alone on account of the growth of specialism and the gregariousness of the public. “The fault is in ourselves that we are underlings”.
To tell the truth, we are afraid of simplicity, and yet it is simplicity, with a dash of courage and independence. We are scared stiff, if the fact be known, lest, whilst we slept last night, or whilst we took out brief holiday, some great advance may have taken place in medicine of which we are unaware. But we neednt worry, for science, like nature, never proceeds by leaps.
Besides, we shall hear all about it soon enough, either from the chemists traveller or from our patients, or from the headlines in the daily press. In other words, that lag, which is often called conservation, and for which we are so often censured, is an extremely useful asset in the doctors mental equipment. For nature is herself conservative, and yields little or nothing to our hustling.
Meantime, we must try, quite tactfully, to brake up the situation resulting from the patients own knowledge ability-if I may use such a word, since this actually obstructs us in getting to the root of his trouble. He knows a lot of technical terms, and quite often he can no longer tell us his symptoms in plain language. “What is the matter with you?” we ask him. “Blood- pressure, doctor,” he replies. “No, but what are you suffering from?” “I told you, doctor, blood-pressure.”
And since we must make a beginning somehow we say, “Yes, but tell me how it is affecting you.” “Oh, you mean my giddiness”, or “my headache”, and at last we are back at scratch. He carries his electrocardiographic tracing about with him and points out to us the deviations of the T-wave from the accepted normal. The X-ray pictures of his opaque meal have preceded his visit-with excess postage to pay-so-also have the results of a biochemical research, duly recorded, with a seal more excessive than commendable, upon a form of enormous excessive than commendable, upon a form of enormous size.
And if now we gently push these things aside and ask him a few simple questions and then examine him with our unaided senses, he thinks out methods are mediaeval. He little knows how ultra-modern they really are.
Some of this pseudomedical knowledge on the part of the patient is paraded with a genuine hope that it may save time and also expense. Indeed, a wholesome corrective to the excesses of the clinic system is being made apparent nowadays by the necessity for economy on the patients part. For it is a fact that modern doctoring has become too expensive for many people. When I asked a patient recently to let me examine him, he demurred, saying, “No, please give me something for my headache; I dont want a diagnosis, it costs too much”.
But the path by which we regain our clinical acumen, as we must regain it in the patients and our own interest, matters little: whether it be by the new road of clinical research or by frustration, or by economy or by sheer mother-wit. We never should have left the bed-rock of clinical medicine. And the sooner we return to it the better.
The kind physician, on his round, fulfils
His busy day in wrestling with our ills;
Allays a fever, stills some racking pain;
And spares not hand, nor heart, nor eager brain;
Braces the fearful, soothes the anxious breast,
And at the urgent call renounces rest.
Contagion daunts him not, immune he walks
Where germs are rife, their virulence he balks;
Spending himself, his work is never done
When epidemics, like quicksilver, run..
O can we praise or value overmuch
His skill, his cheering presence, healing touch?
Nay! Since from birth until the hour of death
He fails us not. O, let us with the breath
Of prayer and blessing follow where he goes,
The KIND PHYSICIAN each, in illness, knows!.
Brenda Murray Draper. HUTCHINSON and WAUCHOPE, For and Against Doctors.
