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instructions clear and see that the nurse or attendant thoroughly understands what she has to do in the interests of the patient. It is always advisable to state when you intend to pay another professional visit. It is unsatisfactory to yourself, to the patient and to the relatives or nurse when you pay your visits in a haphazard manner. If so, you may arrive to find the patient asleep, the nurse out, etc., and such a visit is eminently unsatisfactory. Let them know when to expect you and they will then be prepared for you.
As patients are often either suspicious or jealous you ought not to indulge in long conversations with the nurse or other attendant outside of the patient's room. They often imagine that you must be talking about them and discussing their demerits. They feel aggrieved that if you have so long a time to spend it is not passed with them either to the profit of their health or to their amusement. Remember that your visit is being paid to the patient; therefore make your interview with the nurse as short as possible; otherwise you are showing discourtesy to the invalid.
What to Tell the Patient about his Illness.-It is often rather a difficult matter to judge just how much you ought to tell the patient. If you treat his illness lightly he may take a similar view and neglect to take sufficient care of himself. On the other hand, if you talk seriously to him about it he may become depressed and take a far too gloomy view of his trouble.
In cases of very serious illness the patient may ask your opinion of his case. Without unduly alarming
him you tell him what he is suffering from, but that probably in a day or two he will be much better. If, however, you notice that the patient is of a very nervous temperament, or where you have been previously warned not to tell the patient what disease he is actually suffering from or how dangerously ill he is, then one ought to refrain from telling the bare truth. Some prevarication may be required, but one can usually tactfully retire without giving much information to the patient while yet seeming to give a full answer. In cases of grave illness one must remember the great therapeutic value of hope. You ought to encourage your patients by every means in your power and so help to hasten their recovery or, at least, make their illness less trying to themselves and their relatives. Even in advanced cases of cancer or phthisis this element of hopefulness will tide the patient over many weeks, and what otherwise might have been a long-drawnout misery may be shortened to a very great extent.
On the other hand, it would be unkind, unwise as well as untruthful to hide from a dying patient the fact that this was so. He might wish to see certain relatives, make business arrangements, execute his disposition, and so forth. If we neglected the painful duty of informing him truly as to his condition, all these duties might be left until too late and grave harm might result as a consequence. It is seldom, however, that we are called upon to perform this unpleasant duty. It is usually done by some one closely related to the patient, and so the way is made easier for us, as we have only to confirm what has already been made known to him.
Unless in the case of nervous patients who are inclined to exaggerate their ailments, it is never wise to minimise an illness either to the patient or to his relatives. To the patient, the one supreme fact in life for the time being is his illness. It is the duty of the doctor to explain to him as clearly as he can what is really at fault and how long the probable duration of the trouble will be. One ought never to tell a patient of the possible complications which may arise in an illness such as his. After all, they are only possibilities and may not occur in his case. In the same way, we would only alarm him unnecessarily were we to tell him of the future course of his present illness. "Sufficient unto the day is the evil thereof." The disease goes on from day to day and its course is unfolded gradually to the sufferer without causing him undue alarm. In the case of nervous, hysterical or neurasthenic patients, it should be your endeavour to explain to them the nature of their trouble so as to stimulate them to help their own recovery. Employ your psycho-therapeutical powers and impress on the patient the benefit of self-determination in the cure of his affection. To such a patient his illness is a real and absorbing trouble, and the doctor who treats such cases in a light-hearted manner will assuredly make few cures and gain little reputation.
We may bear in mind the wise directions of Roger Ascham" Use not to lie, for that is unhonest; speak not every truth, for that is unneedful; yes, in time and place, a harmless lie is a great deal better than a hurtful truth."
Consultations.-Very often the practitioner finds
it necessary to call a consultant or specialist to see his patient. Sometimes you wish his help for your own satisfaction-to diagnose a difficult case, to confirm your diagnosis and treatment or to suggest some other line of treatment. On the other hand, the patient or his friends may have hinted that they would like a second opinion. It is wise never to neglect such a hint; indeed, one ought never to wait for such a suggestion; you ought always to forestall it, and it is very rare to find the patient or his friends unwilling to accede to the proposal. If you wait until patient or friends demand a consultation, you will have put yourself in an awkward position should the consultant order a different line of treatment or if the patient should die. If you are confident in your diagnosis and treatment of the case, then if you are right, you will only be supported in these by the consultant. If you are not sure in your own mind as to the nature of the case, there is all the more reason why you should have another medical man to help you.
On the other hand, the young practitioner is often too much inclined to invite a consultation. This may arise from lack of confidence in himself, but it certainly does not impress the patient or his relatives in your favour, if they see no definite reason for it and if the patient be not seriously ill.
A consultation is only required when the case is not going on favourably; either the patient is getting worse or he remains much in the same condition from day to day without appreciable change; it is also advisable in grave cases where the disease is likely to end in death.
If we think that the case is one suitable for surgical interference, then we call in a surgeon for his opinion. A specialist may be necessary in cases where the disease affects special organs or structures or where we think it may be the result of residence abroad. Therefore the specialist may be one conversant with nervous, mental, gynecological, tropical diseases, etc. It will seldom happen that the name of a practitioner suggested by the patient as a consultant is not acceptable to you. If you have any definite reason for not meeting him as such, tell the patient that you prefer not to meet him (but you need not tell the reason, as it might be to his prejudice) and suggest some one else.
Formerly, a medical practitioner would not meet in consultation one who practised homeopathy. Now, however, a much greater licence is allowed, and it is quite usual to meet in consultation those who hardly fulfil our ideas of conforming to the generally accepted principles of medicine. Thus, homeopaths, osteopaths, psycho-analysts, etc., may all be consulted as long as they hold qualifications enabling them to have their names on the Medical Register. It may be that you neither agree with the diagnosis nor treatment suggested by the consultant. It is your duty to state to him your own opinion and tell him that you disagree with his finding. No doubt a friendly discussion will end in compromise, so that you can tell the patient and his friends on what you agree regarding the case. On no account tell him or them the points on which you differ. To do so would only create doubt as to the diagnosis of each of you and might well lead to a