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One ought never to relate the illnesses of other patients to the one whom you are attending, nor try to acquire a reputation by recounting the number of cases of such and such a disease which you have cured. To do so is a form of self-adulation and is very bad taste. I have heard patients speak with contempt of certain doctors who were always loud in their own self-praise. The way in which you treat each patient should be its own recommendation, and if this proves satisfactory and pleasing, then you will not need to laud yourself, for your patients will do it for you, and your practice will extend without any direct effort on your part.
Courtesy to Patients." Ut homines sunt, ita morem geras." The medical man's work brings him in contact with people of every class of society. Especially is this so in the case of the country practitioner; one visit may be paid to the lord of the manor, the next to the ploughman. Every patient should be treated with equal respect. It is disease the doctor has to treat, and this finds its tenant in the peer as in the pauper; herein lies the nobility of our profession. The medical man wages a constant battle against disease which has no respect of persons.
In treating patients of the aristocracy, you must bear yourself with the dignity which lies behind you in your profession. There must be no mock humility, no feeling that you are having a favour conferred upon you by being asked to treat Lord or Lady So-and-so. Really you are not treating them, but fighting a certain disease which for the time being has its locus in Lord or Lady So-and-so. Do your duty as a physician and remember never to boast that you
have been called upon to treat such patients. However much they may condescend to you, never let your manner become familiar with them. If so, they will soon lose respect for you. They may esteem you as a good practitioner, but not as a man. 'He who sows courtesy reaps friendship, and he who plants kindness gathers love."
In treating patients belonging to the artisan or labouring classes, remember to keep your own selfrespect. Be polite, dignified and courteous to them, but on no account become too familiar, for it will only lower you in their estimation. Always remember your position as doctor, and do not allow them to forget their attitude towards you. There is no need, however, to treat them as social inferiors. No man need be either superior or inferior to the other— only let us thank Providence that we have not been born under conditions which do not favour the growth of nobility of character.
INCREASING ONE'S PRACTICE; DURATION
Duration of Visit.-In visiting private patients one must conform to a certain standard for each class. An extremely hasty visit and brief examination of the patient does little to enhance the reputation of the doctor, and the excuse of extreme business on his part will hardly palliate it. Besides, it is in many cases neither satisfactory to oneself nor fair to the patient who is buying our goods, i.e., our professional skill. By a hurried and careless examination, we may easily overlook some important physical sign of disease. How often is a latent pneumonia missed and diagnosed as a bronchial catarrh, merely because the doctor has not made a careful physical examination. Even though the practitioner is paying gratuitous visits to a patient, it is his duty to give him the best of his skill, for if you do not, you are preventing him from employing another doctor, who might treat him more satisfactorily. It has to be remembered that we are to be paid by the number and length of our professional visits, and if we do not give our patient the best of our knowledge and skill, then we are defrauding him to that extent. We should be doing, what in the workman is called "scamped work," i.e., false or dishonourable work.
In many cases the amount of time we have to expend on the examination and treatment of a patient will never be compensated to us in the way of adequate remuneration, but we have sworn the Hippocratic oath that into whatever houses we enter, we will go into them for the benefit of the sick; and besides this, surely few practitioners look at their work from a purely financial aspect. If we have thought merely of making money, then we have chosen the wrong profession. A certain amount of money we do require in order to live, and it is pleasing to know that the great majority of medical practitioners are not only able to live, but to live comfortably upon what they earn. Our profession, however, exists as such for the alleviation of suffering and illness, for the shortening of the period of sickness, for promoting more healthy lives, and so most directly for the well-being of the population and the good and prosperity of the State.
The length of time, therefore, which each visit occupies must depend on the nature of the case to a very large extent. In cases of chronic illness, the visit need not extend beyond a few minutes, while in the case of acute illness, we must leave nothing uninvestigated which might help us to benefit the patient.
There are, however, many chronic cases of illness where the patients rely on the doctor not so much for advice and treatment as for the pleasure of a chat. Such cases consume one's time and waste one's energy; yet if one hurries away without perhaps drinking a cup of tea, great offence is given. One must visit these cases when one can afford the
time to indulge in such rich feasts of conversation. These patients usually belong to the upper classes, many are highly educated, and it is just here where the learning and accomplishments of the doctor show to advantage. One reason why some doctors acquire large practices amongst the upper classes is because of their brilliance as conversationalists, quickness of wit and readiness in repartee. If these qualities are associated with a good all-round knowledge of their profession, it will go far to make him not only a successful but a distinguished doctor. "He is a charming man and so well educated; "he can talk on any subject;" "he is so well read in classical or in current literature," etc.; such remarks are by no means infrequently heard, and indicate that the young doctor should not confine his mind merely to professional subjects.
There is the garrulous patient, who belongs to "the herd of such, who think too little, and who talk too much," who is usually (but not invariably) a woman. She either comes to one's consulting-room or sends for one to call. It is impossible to get her to come to a full stop. Her sentences run on continuously with semicolons merely to indicate the sense. Her conversation is seldom about her illness (if, indeed, she has any) and we fail to find a moment's pause in which to ask her about her malady. As the moments are, at least, precious to us, we have to bring her oratory to an end. This is by no means easy to do, as such patients are very susceptible and take offence readily. In my own consulting-room I had a concealed bell-push under my table desk, and it was easy to summon the servant who was instructed