THE HANDLING OF PATIENTS.
IF a student of medicine has learned a great deal in the orthodox medical schools or by study and self tuition, then he will have to handle patients. The efficiency and ability of the doctor are shown in the way he manages the sick and ailing who come to him. One can imagine a doctor of the greatest competence who nevertheless fails with his patients because he has not the right way with them. I knew two very eminent consultants. One was a specialist in disease of the digestive tract and the other was a mere specialist.
They were brimful of knowledge and they were highly respected by all medical men who knew them. They were well known for their scientific publications, but they had the misfortune of upsetting many of the patients whom they wished to treat. It happened to both these men that sick person shot up in bed, and asked with horrified gaze : “Who is that man ?” “That is Dr. So-and-so. the great specialist.” “Good gracious” exclaimed the patient, “take him away at once, I cannot bear the look of him.
Some were horrified at the first sight of these two men, others were greatly upset on closer acquaintance. The one man who was a specialist in diseases of the digestive tract had received so many rebuffs and humiliations that he was afraid to look people in the eyes. He gave the impression of a thief who had been caught in the act, or he between his legs.
The other man, the nerve specialist, had very powerful magnifying glasses on his nose through which he peered at his patients. Many of the nerve patients, seeing man peer at them with eyes twice their natural size, were upset, but they were still more upset when the specialist asked abrupt questions in the tones which were much disliked and resented. Both eminent men had to give up. Both had to start another occupation.
There are kindly insinuating doctors, there are abrupt, hectoring doctors who order, there are jocular doctors, there are doctors who look like undertakes. Many doctors have adopted a certain pose which they think suits them, but the patients look through the mask which they have adopted, and they have the feeling that they do not deal with a human being but with an actor who plays a part it indifferently.
The first thing which a doctor or lay healer should do is that he should be natural. His manners may not be perfect, he may lack many attractive qualification, but the genuineness of the man or woman will appeal to the patient, especially if the prescriber seems warm-hearted, sympathetic, kindly and understanding. The man of dry science does not appeal to anyone, not even to scientists. A sick scientist dose not want to have science he wants sympathy and understanding. He does not want a lecture on morbid anatomy, physiology, or pathology, he wants helpful advice.
An attractive waiting room and reception room are most important for everyone who wishes to succeed in the art of healing. If the rooms dedicated to the patient are gloomy, gaudy, in disorder, depressing, the patients gets disheartened. If, on the other hand, the rooms look cheerful and there is a happy atmosphere about the consulting room, it will encourage the patient immediately. Every patient should be received like a friend, whether he is a duke or a dust man, and should be made cordially welcome.
If a doctor or lay prescriber uses scientific instruments, they should, in my opinion, be kept out of sight. Most patients go to the doctor, not in order to have science forced down their throats, but to be given hope, confidence and relief. Hope is the finest tonic. Even if a case is absolutely incurable, one should not be cruel enough to allow the poor devil knows that he has cancer, that he has been given only a few weeks to live, one must cheerfully explain to him that miracles happen every day, and must point out to the patient all the facts which are in favour of his recovery.
He may have been operated upon, have been given radium, and at last may have been told that nothing further could be done, and to his inquiry the reply may have been given that he has so many or so few weeks to live. The prescriber can immediately retort : “It is very foolish to allows oneself to be depressed by a diagnosis which possibly is mistaken. Miracles happen every day. Many patients who were pronounced incurable by the highest authorities have become cured. I, personally, have seen numerous cases of that kind.
Besides, you Sir, have led a blameless life, have lived a sensible diet, come from good stock and have good vitality and many points in your favour, although you have lost a good deal of weight and look jaundiced. Very likely an improvement if the diet and better weather will do more for you than all the scientific treatments you have received so far.
Besides, Homoeopathy has never been tried on you, and Homoeopathy has to its credit a very large number of cancer cures in cases declared absolutely incurable by the highest orthodox authorities. Your previous advisers have neglected the factor of diet, the human factor, the question of inheritance of causation, etc. We shall start now on a totally different line, and I should not wonder if you would respond well to the new treatment”.
A few words of this kind will give unspeakable happiness to the patient, and in nine cases out of ten he will feel vastly better at the end of the interview than at the time when he entered the consulting room. Of course, it is not sufficient to be kindly, natural, and to encourage the patient. He should be carefully examined.
The prescriber should begin by inquiring into the health of the patients family. He should ask what the parents of grandparents died of, how many children they had, whether they are alive and healthy or what diseases they have suffered from, and then he should make up his mind if there is in the family a tuberculous strain, a nerve strain, a rheumatic strain, or whatever there may be.
Consequently, the individual asking for advice should be treated at once for the inherited tendency which may possibly be an important factor in the causation of the complaint.
Whatever the disease of disorder may be, a man or woman with a tuberculous tendency should be treated as if he or she had tuberculosis. It is quite unnecessary to examine the lungs, because only gross lesions can be discovered in the ordinary examination. Besides, enquiry will establish whether the patient is likely to suffer from tuberculosis. The tuberculous are apt to have a raised temperature towards evening. to have night sweats, etc. Whether there is cough, sputum and other indications of active tuberculosis seems to me a secondary matter.
If a patient suffering from cancer comes from a family in which there has been much tuberculosis, he should not only be treated for cancer but should be treated for tuberculosis as well, because somehow tuberculosis seems to be allied to cancer, and cancer is apt to develop on a tuberculous foundation. It can of no harm if a cancer patient is given a few doses of Tuberculinum or Bacillinum in a high potency once a week or so.
When the health history of the patient and his medical inheritance have been ascertained and every important factor should be put on paper by the prescriber, then the patient should be cross-examined very carefully. It the patient says : “I am racked with a cough”, the prescriber should immediately ask : “What kind of a cough is it ? A dry or moist cough ? Is the sputum raised easily or only with difficulty ? Is it loose, gluey, lumpy, stringy ? What is its colour ? What taste and smell is there ? and so forth. By looking up his repertory the prescriber will immediately be able to find suffers.
Every statement of the prescriber should be explored in every direction. If he complains about indigestion he must be asked ” “What form dose the indigestion take. Have you slight pain, violent pain, pain on a small surface such as a shilling or on a large surface ? Does it come on before, during or after meals ? What makes it better and what makes it worse ?” Pain in the stomach which is relieved by eating suggests Anacardium and a few other remedies.
The Anacardium patient has violent pain or great discomfort, and improvement sets in as soon as he eats or drinks something. In other cases pain in the stomach or abdomen is relieved by the voiding of gas.
If th patient complains about his heart, the prescriber should immediately remember that the so-called heart trouble may really be trouble in the lungs, or the heart may be embarrassed by the pressure of gas from an inflated stomach, by the pressure of an overloaded stomach, or both. In other words he must try to sift out every statement of the patient and get all the essential facts by careful enquiry.
Many people with heart disease have no idea that they have heart disease. They frequently say : “I am troubled with my breath,” or “I am troubled with my lungs.” In each individual case the prescriber must decide how much he can safely tell the patient. Many a patient has been terrified so greatly by the doctors and specialists that he has given up hop. Some of them have committed suicide. Some doctors think it good policy to frighten the patient in order to be sure that he will do what the doctor wishes him to do.
I have found it a good plan not to treatment, operations, etc., but to take them into my confidence and explain in popular language the case of the trouble. Even if a man obviously suffers from heart disease, it is ridiculous and inhuman to tell him in detail about the degeneration of the heart muscle or the mal-functioning of a heart valve or several heart valves. It is much better to assure the man that the heart is a self-repairing strains, that wise living will probably improve his heart.
It is perfectly useless to give him scientific tracings of the heart beat and scientific explanations of heart defects. After all, the heart cannot be mended by a doctor, surgeon or some other individual but only by nature. Many a man has been told by a specialist that his heart was in such a dreadful condition that insurance company would insure his life. Yet such men have been known to live to an extreme old age.
The patient should be made comfortable in the consulting room. He should be placed on a thoroughly comfortable chair in a good light shining on his face. That will ensure that the prescribers face is in darkness or semi-darkness and the patient will not be upset if some of his statements should bring to the prescribers face a look of horror, pity or compassion, which would dishearten the individual who seeks advice and help.
Some doctors and lay healers favour the use of instruments such as stethoscopes, the electro-cardiograph, an apparatus for measuring blood pressure, etc. The finest diagnostic instrument is the human brain. It is infinitely more efficient than the most cunningly devised scientific toys and tools.
In studying the patients case it is not so important to find the scientific name of the disease, but to discover the remedy. If a patient complains about his digestive troubles and tells the prescriber that he is relieved by eating, then the skilled homoeopath will immediately think of Anacardium, but he should not prescribe Anacardium merely because pain is relieved by eating.
He wishes to make quite certain that Anacardium is the right remedy. If he knows all the symptoms produce and cured by Anacardium, then he can cross-examine the patient in order to make certain whether Anacardium is the right remedy or not. If he has not adequate knowledge of the Materia Medica, then he should refer to his Materia Medica and ask the patient whether he possesses a number of the symptoms found under the heading of Anacardium.
The Anacardium patient usually has a bad memory, finds concentration difficult, is apt to curse and swear, is apt to suffer from eruptions, etc. If the prescriber puts a number of questions in order to make certain whether Anacardium is the patients remedy, and he feels certain the Anacardium is the right remedy, then he should give Anacardium.
If, on the other hand, he finds that the patient who apparently needs Anacardium has a good memory, good concentration is not shy, etc., he should search for another remedy which suits the patient better. It is disastrous to falsify evidence and to deceive oneself by making up ones mind that the patient ought to have such and such a remedy although only one or two of his symptoms call for it.
If a girl complains about delayed periods the prescriber will immediately think of Pulsatilla, especially if the girl should be fair-haired, blue-eyed, stout and tearful, but it is not sufficient that there are a few of the symptoms of Pulsatilla. He should make doubly sure by asking : ” Do you like or do you dislike fat and rich pastries > Do you feel better in the open air or indoors ? Do you lie in bed with your hands under your neck or over your head ? Have you a dry mouth and no thirst ? ” in order to make quite sure that Pulsatilla is really the right remedy.
An interrogation is far more pleasant to the average patient than a physical examination. Moreover, the interrogation brings out far more important facts than the physical examination. At the same time, patients should be carefully examined unless they strongly object to it ; otherwise important facts may be overlooked. One may discover that a patient unless they strongly object to it ; otherwise important facts may be overlooked.
One may discover that a patient has hundreds of moles on the body, and he has never mentioned their existence because he thinks they are unimportant. The existence of numerous moles suggests Thuja as a remedy and vaccinal poisoning as a cause. Again, undressing may show that the patient has a rupture or some skin disease may show that the patient has a rupture or some skin disease which he has not mentioned, or an enormous number of warts and pimples, or prolapse of the abdomen, or that there is a fibroid tumour in the womb, etc.
The outer examination is very important, and here again scientific instruments are far less needed than intelligence. A careful inspection of the right chest and the left chest will show whether a lung has shrunk. If there is a shrinkage of a lung, then the ribs follow.
The pumping out of the stomach, examination with X-ray and the gastroscope, may prove that the man has a prolapsed stomach, a stomach which hangs too low, but the facts of the position may be ascertained just as well by pressing ones hands round the lower abdomen of the patient and lifting it up. If the patient feels greatly relieve by the backward and upward pressure, he undoubtedly suffers from prolapse. If he finds the lifting upward and backward uncomfortable, then he has no prolapse.
When a patient suffers from anaemia, doctors frequently recommended a blood test. Blood tests may be theoretically interesting, but anyone with a pair of eyes can see at a glance if a patient is anaemic, full-blooded, sub-normal or normal. All the scientific tests cost money, and one should not waste the money of ones patients in unnecessary scientific enquiries.
If a patient arrives tired or nervous, then he should be given a little rest. A little chat about the weather, political events, etc., Will prove helpful, and the patient will appreciate it greatly if one makes him still more comfortable with a choice cigarette, a nice cup of tea, a good glass of wine or whatever may be called for. There are doctors who will never give a patient any refreshment. An exhausted and nervous patient will leave the consulting room of such a man in a much worse condition. Humanity demands that one should give hope, peace and comfort to the poor sufferers who come and ask for advice and help.
No one can become a good doctor unless he loves his work, loves his patients, loves mankind and wishes to relieve suffering. Medicine is not a profession. One can “profess” anything. Medicine is a calling, like religion. In every religion there are priests who ought never to have become priests, and there are some holy men who have taken up church work. Similarly, in medicine there are some good men and good healers, and there are others as well.
There are plenty of men who become doctors, not because they wish to help their suffering brothers and sisters, but because they believe they can obtain a pleasant social position and a comfortable income. Men who enter medicine for selfish reasons will never become good doctors and they will never find satisfactions in their work, even if they should financially prosper.
The interest of the patient must always be the foremost consideration of the prescriber. Some doctors have been dehumanized by what they call science. I have met many patients who have been gravely injured by so-called examinations. I remember the case of a poor fellow who had cancer of the bowel. He was taken to hospital and was examined by a surgeon by way of the back passage.
The surgeon treated him rather roughly and he suffered pain. There were a number of medical students who were looking on, and they were induced by the surgeon to make the same examination. About a dozen large and clumsy fingers were forced into the abdomen of the unfortunate individual, who collapsed. With mistaken heroism he endured the torture instead of protesting with the utmost energy against this abuse.
In examining one should never give pain. If examination is intolerably painful, then examination should be done under a local or a general anaesthetic, but the use of anaesthetics is often dangerous. I, personally, never advise examination of a bladder by means of the cystoscope under an anaesthetic. The cystoscope is an instrument almost as thick as a pencil which is bored into the bladder, causing a fearful strain on the urinary passage. Frequently laceration results.
If the examination is done, let us say, in the case of an enlarged prostate, the prostate may be injured or the bladder wall may suffer. A feeble old man, quite out of condition and enormously fat, came to me and told me that he had bladder trouble and that his doctor had sent him to an eminent bladder specialist. The specialist told him to an eminent bladder specialist. The specialist told him that it was obvious that he suffered from an enlarged prostate, but that he was in such a poor condition that an operation was quite out of the question.
Under these circumstances there was, of course, not the slightest reason to make an examination of the bladder unless from curiosity or with the object of earning a fee. the cystoscope is a biggish tube, with an electric light and a mirror at the end of it. Using it the surgeon can visually inspect every portion of the bladder wall and the openings where the urine from the kidneys flows into the bladder. I do not see much purpose in making this dangerous examination except if an operation has been injured for life by the rash or clumsy use of the cystoscope.
The poor old man went to the surgeon to be examined. He was put under an anesthetic. Consequently he did not feel pain. He did not realise that fearful internal damage was done. Brutally or clumsily the instrument was inserted, and after entirely purposeless examination it was withdrawn. Immediately on the withdrawal blood gushed out in torrents. The unfortunate individual collapsed, an ambulance had to be called, and he was taken home in a desperate condition.
Examination of the body openings with the finger can be done with the utmost gentleness or roughly. One should rather waste some time than give unnecessary pain to the patient. Gentleness on the part of the prescriber is always greatly appreciated by the sick.
If a doctor or lay prescriber calls upon patients, he must observe the best standards of department. It is a great mistake to go into the house of poor people and treat them as inferiors because they are poor, to talk to them roughly or talk down to them. Humble individuals do not like to be made to suffer. They are very sensitive to slights. Moreover, the doctor should enter the poorest cottage with a much consideration as he would show in entering the house of the wealthy. Even a poor working woman does not like to see her floor soiled by the doctors dirty boots.
When the doctor had ended his interrogation and has made a thorough physical examination, then he should tackle the all- important question of diet : “Many patients will airily say when asked about their diet : “I eat and drink what everyone eats and drinks.” Most people make a choice of their own. One can ascertain the true facts only if one takes down on paper all that is eaten and drunk at every meal and in between meals.