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branch of his professional work. No one can be a good general practitioner unless he has an all-round knowledge of his profession, and the fuller and deeper this knowledge is, so much the more satisfaction will his work afford him. There must surely, however, be one branch to which he is chiefly attracted, or if not, then he ought to set himself to cultivate with particular assiduity one special subject. To this one he should devote much of his spare time, working in laboratories, in hospitals, post mortem theatres, etc., so as to make his knowledge as complete as may be. Apart altogether from the personal satisfaction of knowing one subject thoroughly well, he will have made himself a specialist in this particular line. I am not now considering those practitioners who specialise from the first and who, in large centres, devote their whole time to the practice of one special subject alone, but I speak of the general practitioner, who, in the country it may be, has devoted special study to one branch. There are ample opportunities for the practice of many of these in the smaller towns, and even villages. Cottage hospitals exist all over our land, and those who wish to perform special surgical work have thus the means at their disposal. Not only will his own patients enjoy the benefits of this special knowledge, but his professional colleagues will frequently call for advice and help from their specialised brother, and this at far less cost than the bringing of a specialist from some large city.
I would, therefore, strongly advise every young man to pursue some particular branch, not only for his own improvement, but more especially because many practitioners who have commenced in general practice have laid the foundation of specialised and lucrative practice while engaged in the routine duties of the general practitioner.
Study Abroad.-Before finally settling down as assistant or partner or engaging in one's own practice, it is well for the young man to enlarge his professional views as well as his mind generally by studying and travelling abroad for some months. If one has a little money to expend (as a good investment also) then teaching centres and hospitals in other countries should be visited, and opportunity taken to observe how one's profession is carried on by other peoples than ourselves. In this way a broadening of one's experience will result, and this will remove, to a large extent, the narrowness and prejudices of the particular school in which we have been trained. There were brave men before Agamemnon, and while preserving all loyalty to our teachers, we are led to see that there are other teachers and operators as good as, or even better than those who instructed us.
In former years, Germany and Austria were the happy hunting grounds of most of the young graduates, and thus an undue influence was exerted on British and American medicine through the teachers in these countries. There are, and always have been, as good teachers and operators in France, Italy and the United States of America as any in Germany or Austria, and British students always find a warm reception at any of the teaching centres in these countries. One will never regret six months spent abroad in the pursuit of one's profession. It is always wise to take letters of introduction, as in that way a greater interest is taken in you than when you go quite independently.
If one cannot afford either the expense or time for this foreign travel, then much of the world can be seen by going as a ship's surgeon. During the voyage there is ample time for study, and opportunity should be taken at each port to visit the local hospitals and make oneself conversant with diseases of other countries. In this way one may gain a large experience in many of the diseases of the tropics, and this at no expense to oneself.
These prolonged absences from home must be made before one begins one's permanent work, because the opportunity of taking a lengthened holiday does not often present itself to the busy practitioner.
Assistantships.-A medical man usually engages an assistant by the year, though, as a rule, he can make his own arrangement as to the period of engagement.
Either principal or assistant can terminate the engagement by giving a month's notice. Here, again, each may make his own arrangement as to the length of time of giving notice; the period may be shortened to one week if desired.
An assistant may be dismissed immediately if he has been guilty of any grave error, e.g., neglecting to visit patients under his charge, disobedience to orders, insolence, etc. He receives payment, however, up to the time of departure.
An assistant is bound to give loyal service to his principal, and to conduct his part of the practice as
if he were the principal himself. On no account must he ever make any remarks to the patients derogatory to his master, or mention any failing or weakness which he may have. Any fees which he receives he must pay back to the principal, e.g., fees received as witness in court, performing post mortem examinations, etc., as these were the result of work done and time occupied, both on behalf of the principal. It is, however, by no means an infrequent arrangement that the assistant receives half or whole of the midwifery fees and any special remunerations.
In drawing up a contract with an assistant it is usual to state that, after leaving his service, the assistant must not begin practice within a radius of so many miles-in country districts this might be twenty miles; in towns two or three miles. Sometimes the restriction is in point of time the assistant not to start in practice near his former master for five to ten years subsequent to his departure. This is only right and just, and is done because the assistant gets to know all his principal's patients, and might, if he were unscrupulous, easily influence them against the doctor and in favour of himself were he to engage in practice in the neighbourhood.
Under the Workmen's Compensation Acts, etc., every assistant must be insured against injury or accident. The rates for these insurances are based on the amount of salary paid.
THERE is no more responsible nor anxious undertaking than that of a young man starting in practice on his own account. It is not to be lightly undertaken, but requires much thought and care, for having once launched himself on his life-work, it is very difficult to commence afresh, if the voyage has not commenced satisfactorily, or more especially if it does not promise well.
Before beginning your own practice it is necessary for you to have gained experience of what general practice consists in: this is best accomplished by going to a medical man as his assistant. If you intend to practise in a special locality, then it is advisable to gain your experience in another locality more or less remote from that in which you mean to settle permanently. It is inevitable that the beginner will make mistakes of some sort or anothererrors in diagnosis, in treatment or in manner. It is well, therefore, that such should not be known where one is to take up one's permanent residence; hence the benefit of gaining experience elsewhere.
In many cases, however, the doctor who has taken an assistant, finds the help so invaluable that he offer him a share in his practice, and so he settles down at once to a permanency.
Without the purchase of a practice, it is a slow process to build up one now by one's own efforts.