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in such a contingency to tell me that I was wanted at once. This did well on most occasions; while, on visiting them, the excuse of an appointment or the giving of a lecture, etc., allowed one to escape without giving much offence, though one could not avoid noticing the disappointment which this occasioned.
Dress. From a business point of view it is of the greatest importance that the doctor should be well dressed. The insignificant man is made almost handsome by a well-cut and well-fitting suit, while the well-built man is made impressive. Good clothing makes a man self-respecting and increases his stock of self-importance. The patient also derives satisfaction from the fact that his medical attendant is a well-dressed and well-groomed man; so in every way it is advantageous to attend to one's personal appearance.
It is of equal importance to see that one keeps oneself clean and tidy. The medical profession has not always been remarkable for this virtue, and the many doctors whom Dickens describes did not inspire respect owing to their generally slovenly dress, dirty linen and unshaved faces. Good clothes, well kept and clean linen, neat necktie and shoes are all indications of a careful habit. One ought to pay particular attention to the cleanliness of their hands and nails, as one cannot imagine anything more repugnant than a person with unclean hands examining one's body, not to speak of one's ears, mouth or nose. One knows many doctors who are very careless in this respect, and as a consequence their practices are confined to the poorer classes.
Hours of Work.-Habits of early rising are easily formed and much valuable time can be rescued from Morpheus if this habit is acquired. The hour of rising should be 7 a.m., or certainly not later than 7.30 a.m., so that breakfast may be over by 8.30. This allows time for reading or letter-writing before patients arrive.
The hours will necessarily vary according to the class of one's practice, but speaking generally, the following will be found convenient :—
From nine to ten o'clock patients come to consult the doctor either at his own house or at his surgery. From 10 a.m. to 1 or 1.30 p.m. he should pay visits to his patients.
On arriving home lunch should be taken and patients again seen in consultation from two to three o'clock.
Afternoon calls are again paid from 3 to 6 p.m. Probably a cup of afternoon tea will have been taken in the house of some patient, or, if not, a cup of tea may be taken on arrival home.
Up till seven o'clock patients are again seen at home or in the surgery. By having one's consultation hour early, the whole evening after dinner is left for relaxation or education. This evening leisure should not be broken into by further medical work except under necessity. Patients ought to be made to realise that a medical man requires relaxation as much as or, indeed, even more than other people.
Unfortunately, in working-class practices, this early evening consulting hour is not convenient to one's patients. It must, therefore, be changed to
7 to 8 p.m. One must dine, therefore, at six o'clock or after eight, and this latter is an hour too late for ordinary people and is, indeed, not even suited to the wealthy.
The habit of paying evening visits (though highly appreciated by some patients) is one which ought sedulously to be avoided; only very acute or urgent cases require an evening visit.
Midwifery cases are a fertile source of loss of much time to the practitioner. In one way, fortunately, the majority of them occur during the night, and in this way less of one's daylight work is interfered with. If, however, the practitioner has an extensive obstetric practice, the loss of sleep may soon tell on his health.
This loss of time is experienced much more in working-class practices than in the better-class ones. In the former the woman is attended usually by a more or less untrained nurse or by some wholly untrained female relative. These people, therefore, send for the doctor, not indeed because there is any need, but because perhaps the parturient patient is crying out a great deal, or because they think she is getting exhausted (more probably they themselves are getting tired), and "perhaps you could hasten matters." Many an unnecessary visit is paid under such annoying circumstances.
With better-class patients, midwifery is much less trying. There is a well-trained maternity nurse in charge, and she will see to it for her own reputation, that you are not called until delivery is imminent and only when your services are really necessary. No circumstance can be more annoying to yourself,
to the husband and other relatives than your presence in the house long before your assistance is required. If you arrive thus early, the patient may plead with you not to leave her as she feels that with you at hand her condition is less grievous. You do not like to contradict her at such a time, so hours may linger on while you grow sleepy in forced converse with her husband or mother, until the time of delivery is fully accomplished. It is because of this waste of time that many doctors now advise their obstetric patients to enter maternity homes, where they will be looked after by trained nurses, and where the accoucheur will receive that expert help which is so often necessary in cases of abnormal labour. Then again, it is only where there is an expert nurse that labour can be carried through during partial narcosis (e.g., by scopolomine-morphine, "twilight sleep"), and this is only safely supervised in a maternity nursing home.
In private practice the accoucheur soon gets to know the nurses who are reliable and capable, and if he insists only on such nurses being engaged by his expectant patients, he will find that his midwifery work will become much easier.
Increasing One's Practice.-The young practitioner is, of course, most anxious to obtain new and better-class patients, as his income will increase only by such acquisitions. This is not always an easy matter. In residential districts, the population does not change to any great extent and most families have already their medical attendant. It is mainly by the influx of new families into the district that one's practice increases. The doctor is prevented
from canvassing for patients, not alone by his own good feeling of what is right, but by the restraints of the General Medical Council, which makes any such solicitation a penal or disciplinary offence. He has, therefore, to rely on the recommendation of those patients whom he already has to secure fresh names to add to his visiting list.
A medical man must never ask the local chemist or druggist to recommend him as a practitioner to his customers. It hardly needs to be stated that it would be a grave penal offence for a doctor to contract with any one (e.g., hotel or boarding-house keeper, maternity nurse, etc.) to pay him a percentage on new patients obtained or on fees received through such agency. Very often, however, a hotel or boarding-house keeper will recommend his private medical attendant to any of his guests who may have been taken ill in his house, and, of course, such cases ought to be readily accepted.