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If a man intends to devote himself to general practice, then, in my opinion, it is hardly worth his while to add to the number of his registrable qualifications. The number and diversity of these will not help him to acquire patients. The general public only knows a man as a "doctor," and as it would be tantamount to advertising were the doctor to enumerate all his qualifications on his nameplate, and as this is never actually done, the public never gets to know how multiple his qualifications are. The time which is devoted to preparing for and passing extra examinations would be for him more profitably spent in gaining clinical experience, as such would be of far greater value to his patients. On the other hand, if a man desires hospital or public appointments or intends to specialise in one subject, then, of course, he must prepare himself for such by taking higher qualifications in medicine or surgery or in special branches, as public health, psychological medicine, etc.

It is to be presumed that the young man commencing practice has been thoroughly well trained in both theoretical and practical knowledge of his profession. To ensure success, however, he must cultivate certain virtues as they are of supreme importance to his patients, e.g., promptness, punctuality, reliability, easiness of manner, etc.

I. Promptness in Paying a Professional Visit.When you receive a message from a patient asking you to call, then go as soon as ever you can. One must remember that each individual esteems himself or herself above all others, and if we can foster this idea by promptness in responding to the



summons, we shall have raised ourself in that patient's estimation.

In the case of a new patient, make your visit to him the first on your list, even though it may not be quite convenient for you, and though it may even throw your other work somewhat out of order. To delay visiting a new patient until perhaps the afternoon, when the call has come in the morning, is not conducive to that patient's peace of mind. Indeed, it is no uncommon occurrence to find that owing to your delay the patient has sent for some other practitioner. Exceptionally, however, we may find that it is not in our power to pay him an early visit, and if so we ought, if possible, to acquaint the patient and state the hour when we shall call. If you have ever been ill yourself, you will know how one wearies for the doctor to pay his visit and how fretful we become as the hours pass and he does not appear. If instead of ourself we place an impatient and, perhaps, naturally irritable patient, it is plain how we may do our professional reputation harm by neglecting the call.

Apart altogether from the diplomacy of answering a call by a speedy visit, there may often be occurrences which demand urgent attention. In the case of sudden illness, the messenger is usually excited and flurried and leaves a message at your house, merely stating that you are to call at such and such an address. Or again, the message may have been delivered correctly, asking you to call at once, but your servant has not reported it correctly to you. In the majority of cases of illness there is no great reason why we should pay an early visit, but there

are acute diseases or accidents which necessitate immediate treatment. If we know that it is a case of hæmorrhage, of whatever kind, accident or poisoning, then we ought to go without a moment's delay. The loss of even a few minutes in any of these circumstances may make all the difference in saving or losing the life of an individual.

If you are fortunate in possessing that rara avis, an intelligent servant, it is well to instruct her how to take an intelligent interest in your work. In the case of an urgent message, she must be told to inquire into the nature of the illness or accident from the messenger, not from any inquisitive purpose, but in order that she may be able to inform you at once about it so that you can take the appropriate remedies or instruments. If you are not at home at the time, she ought to place the patient's name and address on the slate or book kept for the purpose of receiving names and addresses of patients, but she ought also to place a cross against those cases which require to be seen at once, and on your return she ought to inform you about the most serious cases.

Many patients are thoughtless and send messages asking us to call at once. Very often, when we have put ourselves to trouble to visit them early, we find that the patient has been ill for hours or days, and it was only because they were not getting well as quickly as they desired that they have invited our aid. In time, and as a consequence of the peremptory and erroneous requests for immediate service, we may begin to treat all such messages with indifference and pay our visits at our own convenience. In such cases as those I have mentioned it would be

a grave mistake to neglect the urgent summons, and a life-long regret may result from a carelessly delivered message.

2. Manner. Nature, unfortunately, does not give a good and easy manner to every person, and yet to none is it more important than to the practitioner of medicine. Happily, if not a natural gift, a gracious manner can to a great extent be cultivated by imitation and perseverance. One has known the shy, uncouth and clumsy student become in after years, if not polished and courteous, at least pleasant and affable. On the other hand, one has seen the rudeness of speech, manner and gait persevere throughout life.

In the case of the specialist, perhaps a degree of bad manner may not be so great a hindrance to success, but it is a very great handicap to the general practitioner. If there be a choice of medical attendants, then the ill-mannered man will soon become the ill-natured man because of his non-success. He sees his colleagues succeed and wonders why, with perhaps his known ability, he does not also attract patients. Even in the case of specialists or surgeons, however, the man with the good manner will have far more patients, even though he be not so proficient in a professional sense as his less favoured brethren.

Shyness is a natural and, in many cases, attractive attribute in young people, and if not excessive in degree is much to be preferred to the bumptious, forward manner found not infrequently in young men. With some regret one says it, that shyness is a passing phase, and as the practitioner becomes

more experienced in the handling of patients it passes off to a great extent. Its passing, however, should never be allowed to give place to arrogance, boastfulness and pride ("the never-failing vice of fools"), which also are the attributes of some professional men who have had worldly success beyond their merits. One always waits, with Horace, to hear what such a boaster will produce worthy of such inflated language. A stiff, abrupt and unsympathetic manner will repel a healthy individual, and a fortiori, a sick person will feel this aversion all the more. Even in the case of a consultant, manner is one of his greatest assets. I have been told by a patient after a consultation, “ Never bring that man to see me again. He may be clever, but he has no feeling."

Try to place yourself in the patient's place. He is suffering, as a rule, both in body and mind. He desires relief and he looks to you to afford it. He trusts you as the only one who can restore health to him. In common fairness you ought, therefore, to impress him with the fact that you mean to be his friend through his illness. Patiently listen to his story and complaints (for what patient is without them? How could he live without them? They are his daily meat and drink). Ask only those questions which are necessary or in order to keep him from straying away altogether from the main issue. Let him think that for the time being he is engrossing your whole attention (as, indeed, he ought). Instil into his mind the fact that you think him the most interesting and, indeed, the only case you have in your thoughts. Do not answer

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