require them,
?which
and
We shall not, as down
general
to which
The incidents
of conduct.
laws
observations apply,
our
but
are
a
and
occasions
few of the endless
of circumstances and relations which mark the inter-
variety course
we
to prevent the sense of embarrassbring. have already intimated, attempt to lay
so
ment which the occasions
of
professional colleagues;
but
which uniform method of action is in which rules
can
misunderstanding. the management of
render the
occasions
are
they
urgently
greatest service
And first let
vis
offer
a
011
for, and preventing
called in
few remarks
on
consultations.
It must be remembered that in India ail Medical
practiConsiilting Physician and Consulting Surgeon do not exist in those capacities; all enter general practice alike, although at the Presidency Towns the presence of educational institutions determines the pursuits of individuals in special lines, and so creates a class of men who in those lines are peculiarly qualified to give assistance in case of difficulty. In these circumstances of equality, the position of the person called in to the aid of his colleague is one of extreme delicacy; and we regret to say that, in our judgment, this is It is not sufficiently recognized by the profession in India. intelligible, perhaps, and even natural that Medical Officers whose earlier lives have been spent in detached stations, or at least whose previous duties and charges have been such as to render them perforce independent of contemporaries, should fail to cultivate the finer perceptions necessary to guide them without friction through the mazes of active professional life in a city. However that may be, the deficiency exists, and there follows on
tioners
PROFESSIONAL COURTESY. Let not iuto
our
readers be misled
supposing that, in the pride
by the heading
of this article
of the Editorial chair,
we
ourselves the powers of a dictator in matters of that we seek to reduce to a system that which is of
to or
dependent
arrogate
opinion, necessity
the feelings of individuals. The unwritten laws spring from cultivated taste and refinement
on
of conduct which
of character must yet remain unwritten. They cannot be gathered into a code, and if they could, it wouid be idle to at-
"We harbour
tempt it, for they could not be enforced.
design
the
on
In
of our readers.
patience
our
no
such
last issue we
few observations on the
question of fees, and endeavoured based as it is on partially which, roughly established usage, we think may be accepted as an equitable guide in the peculiar position cf Medical Officers serving in In very close relation with this subject stands the India. due observance of professional courtesy between the members of our body; and the relation is made peculiarly close by the system of annual engagements between doctor and patient, which prevails throughout this country, whereby no sick man offered
a
to sketch
the advice of any one but his chosen attendant, at least, until he has obtained the consent of
have
can
with
scheme
a
propriety
the latter. Under this occurrence
and
the tact want of
a
incidents and
system
in Calcutta and the
of Medical
temper
and
men,
rule of action is felt even
recognized
Tact and
uniform scale of fees.
a
situations
temper
embarrassment.
alike in moments of
are
of
daily
larger stations, which sorely try in which the
more
not
than that of
given
to all
A proueuess to
easy
are
provocation and hasty expression very commonly belongs to natures that, in their calmer moments, are the most liberal and kind, and the man who in deliberation would be the staunchest advocate of is not
conducive
everything
'.infrequently
the one
who,
to
the credit of his
cloth,
when called on to act under
sudden wound to his amour propre, cannot restrain the angry look, the hasty word and ill-considered act that lay the foundation of so much professional
a
ill-feeling.
"We
are
in
danger
ot
being
told that
we
are
writing,
not of
weakness, but of that of human nature in general. It is true: and it is because there is so much in the position
professional
in India to call forth these weaknesses of the urgent need of pointing attention to the subject; and we feel assured that nothing can be more powerful in removing the evil results from among us, than a few rules
of our
colleagues
nature, that
we
see
of conduct framed as
nearly
as
possible
to suit the occasions
it
are
on
the same
footing.
The
want of mutual confidence among the members of the profession, and a strong disinclination to consult in difficulties, a
to the manifest
disadvantage of patient and physician alike. corrected, and we do not intend to shrink from the expression of our views as to the duty of each one concerned, in the conviction that, after the adoption of some such views, the correction could not be long delayed. A difficult case occurs, and another opinion is wanted. It may be suggested by either the patient or his adviser. In tin: former case the individual to be consulted is commonly named with the suggestion, and one stumbling block is removed. In the other, it is left to the choice of the family adviser. Now, common honesty requires that he should summon the person whom he thinks best able to help him under the special circumstances of the case; and yet we do not hesitate to say that this obvious duty is daily lost sight of in the desire to advance the interests of an intimate friend, or in the pursuit of some object foreign to the work in hand. The public are not blind to this. We have ourselves heard in this city very severe remarks on this particular topic from non-professional men, which show how keenly our brethren are watched, when life and death are in the balance. The most brilliant professional attainments often lie hidden from the outside world; but, on a point like this, they are more acute judges than ourselves ; and it needs no long observation to show how soon the fairest reputation may be blemished, when singleness of purpose ceases to This should be
move
the will.
A few words sician
or
that press
absent,
now
of the
position
and conduct of the Phy-
consulted.
Prominent among the points for consideration here, but in practice conspicuously
Surgeon
is a full
recognition
of the fact that
the COiWultin'"'
May 1,
THE QUESTION OF "PHYSIC."
1866.] is called i.i to
Physician adviser.
We
speak
as
not to
counsel,
much from
our
replace the family
own
observation
remarks that have often been made to us, when
we
as
from
say that the
demeanour of the former in India is
commonly such as to show aa entire want of appreciation of this most simple and intelligible position. We have heard of gentlemen in consultation treating the family Physicians as persons who have voluntarily resigned in their favour, examining and questioning the patient without reference to them, giving their individual opinions, t.c cathedra, in presence of the patient or his friends, and even declaring the hour at which they, unsolicited, intended to pay their next visit! With such experience as this before us, we do not feel thai any apology is needed for the suggestions we propose to offer. of
College
for the observance of certain formalities in
views
his
express
on
the
in which consultations
manner
Much that he said
should be conducted.
was
based
on
actual
usage, a little perhaps was suggested by his own instinct, but it was not 011 this account the less valuable, for it came from of the ablest of
one
plished called tioner
Physicians and most polished and accomspoke in substance thus:?"Whenever I am a patient in consultation, the family practi-
of men. lie in
to see
precedes
invited to do
me
so
into the sick-room.
by
him ; and
having
I do not
enter until
done all that is necessarv
bedside, I leave the room, while my colleague is yet in satisfy myself on all points connected with the present condition of the patient, by examination and questions addressed him ; but for the history of the case, and indeed for to all commuuicated information, I look to his medical adviser. I carefully defer the expression of my own opinions him ; and, as a general until after my conterence with rule, when we have jointly arrived at a conclusion, I request him to make it known to the patient. The only occasion of departure from this latter rule is, when there seems, from one cause or other, to be 9. desire on the part of the patient or friends to hear my views from my own lips, and at such times the desire is invariably shared by the general practitioner. It must be remembered that a Fhysician in consultation is courteously placed by a colleague in a position of authority, and it behoves him to use his advantage with the utmost delicacy towards his contemporary." These are not empty formalities; every one of them has a meaning; and if in England they be thought necessary, where the distinction of physician and general practitioner obtains, and where those who meet are socially strangers to each other, how at the it.
I
much
more are
socially equal,
they
needed here, where all
and
probably intimate,
are
professionally
and
and temptations to
laxity untimely self-assertion may, to iuture good feeling. We
are therefore strong, and where and too often does, become fatal cannot offer to our readers a lino of conduct better calculated to secure the confidence of their fellows than that laid down by our
friend.
a special danger exposed in India. There is little risk in England of the consulting physician being called upon to take tin: place of the family practitioner; the difference of profession a I status is a safeguard against this. But it is otherwise here ; there, is no one to consult but those who also engage in family practice, and who may therefore find themselves, from circumstance* arising out of their consultation, invited to supplant the friend who has introduced them. Such a thing has occurred within, our own experience. We wish we could rest secure in the be-
lief that it will not
occur
hereafter.
There are other points connected with
which we
Physicians makes provision in its bye-laws consultation; thus the prescription, which is the result of the conference, is to be jointly signed by those in attendance, and in the event of a difference of opinion between them, it devolves on the one last called to propose a third counseller; but beyond these points there is nothing, as far as we know, laid down by autiiority on the subject. Many years ago it was our good fortune to hear a London Physician of the highest standing The
It will not be out of place here to allude to
to which we are
are
of no less
propose to advert
importance on an early
than
Professional courtesy
consultations,
occasion.
to which
?which
and
We shall not, as down
general
to which
The incidents
of conduct.
laws
observations apply,
our
but
are
a
and
occasions
few of the endless
of circumstances and relations which mark the inter-
variety course
we
to prevent the sense of embarrassbring. have already intimated, attempt to lay
so
ment which the occasions
of
professional colleagues;
but
which uniform method of action is in which rules
can
misunderstanding. the management of
render the
occasions
are
they
urgently
greatest service
And first let
vis
offer
a
011
for, and preventing
called in
few remarks
on
consultations.
It must be remembered that in India ail Medical
practiConsiilting Physician and Consulting Surgeon do not exist in those capacities; all enter general practice alike, although at the Presidency Towns the presence of educational institutions determines the pursuits of individuals in special lines, and so creates a class of men who in those lines are peculiarly qualified to give assistance in case of difficulty. In these circumstances of equality, the position of the person called in to the aid of his colleague is one of extreme delicacy; and we regret to say that, in our judgment, this is It is not sufficiently recognized by the profession in India. intelligible, perhaps, and even natural that Medical Officers whose earlier lives have been spent in detached stations, or at least whose previous duties and charges have been such as to render them perforce independent of contemporaries, should fail to cultivate the finer perceptions necessary to guide them without friction through the mazes of active professional life in a city. However that may be, the deficiency exists, and there follows on
tioners
PROFESSIONAL COURTESY. Let not iuto
our
readers be misled
supposing that, in the pride
by the heading
of this article
of the Editorial chair,
we
ourselves the powers of a dictator in matters of that we seek to reduce to a system that which is of
to or
dependent
arrogate
opinion, necessity
the feelings of individuals. The unwritten laws spring from cultivated taste and refinement
on
of conduct which
of character must yet remain unwritten. They cannot be gathered into a code, and if they could, it wouid be idle to at-
"We harbour
tempt it, for they could not be enforced.
design
the
on
In
of our readers.
patience
our
no
such
last issue we
few observations on the
question of fees, and endeavoured based as it is on partially which, roughly established usage, we think may be accepted as an equitable guide in the peculiar position cf Medical Officers serving in In very close relation with this subject stands the India. due observance of professional courtesy between the members of our body; and the relation is made peculiarly close by the system of annual engagements between doctor and patient, which prevails throughout this country, whereby no sick man offered
a
to sketch
the advice of any one but his chosen attendant, at least, until he has obtained the consent of
have
can
with
scheme
a
propriety
the latter. Under this occurrence
and
the tact want of
a
incidents and
system
in Calcutta and the
of Medical
temper
and
men,
rule of action is felt even
recognized
Tact and
uniform scale of fees.
a
situations
temper
embarrassment.
alike in moments of
are
of
daily
larger stations, which sorely try in which the
more
not
than that of
given
to all
A proueuess to
easy
are
provocation and hasty expression very commonly belongs to natures that, in their calmer moments, are the most liberal and kind, and the man who in deliberation would be the staunchest advocate of is not
conducive
everything
'.infrequently
the one
who,
to
the credit of his
cloth,
when called on to act under
sudden wound to his amour propre, cannot restrain the angry look, the hasty word and ill-considered act that lay the foundation of so much professional
a
ill-feeling.
"We
are
in
danger
ot
being
told that
we
are
writing,
not of
weakness, but of that of human nature in general. It is true: and it is because there is so much in the position
professional
in India to call forth these weaknesses of the urgent need of pointing attention to the subject; and we feel assured that nothing can be more powerful in removing the evil results from among us, than a few rules
of our
colleagues
nature, that
we
see
of conduct framed as
nearly
as
possible
to suit the occasions
it
are
on
the same
footing.
The
want of mutual confidence among the members of the profession, and a strong disinclination to consult in difficulties, a
to the manifest
disadvantage of patient and physician alike. corrected, and we do not intend to shrink from the expression of our views as to the duty of each one concerned, in the conviction that, after the adoption of some such views, the correction could not be long delayed. A difficult case occurs, and another opinion is wanted. It may be suggested by either the patient or his adviser. In tin: former case the individual to be consulted is commonly named with the suggestion, and one stumbling block is removed. In the other, it is left to the choice of the family adviser. Now, common honesty requires that he should summon the person whom he thinks best able to help him under the special circumstances of the case; and yet we do not hesitate to say that this obvious duty is daily lost sight of in the desire to advance the interests of an intimate friend, or in the pursuit of some object foreign to the work in hand. The public are not blind to this. We have ourselves heard in this city very severe remarks on this particular topic from non-professional men, which show how keenly our brethren are watched, when life and death are in the balance. The most brilliant professional attainments often lie hidden from the outside world; but, on a point like this, they are more acute judges than ourselves ; and it needs no long observation to show how soon the fairest reputation may be blemished, when singleness of purpose ceases to This should be
move
the will.
A few words sician
or
that press
absent,
now
of the
position
and conduct of the Phy-
consulted.
Prominent among the points for consideration here, but in practice conspicuously
Surgeon
is a full
recognition
of the fact that
the COiWultin'"'
May 1,
THE QUESTION OF "PHYSIC."
1866.] is called i.i to
Physician adviser.
We
speak
as
not to
counsel,
much from
our
replace the family
own
observation
remarks that have often been made to us, when
we
as
from
say that the
demeanour of the former in India is
commonly such as to show aa entire want of appreciation of this most simple and intelligible position. We have heard of gentlemen in consultation treating the family Physicians as persons who have voluntarily resigned in their favour, examining and questioning the patient without reference to them, giving their individual opinions, t.c cathedra, in presence of the patient or his friends, and even declaring the hour at which they, unsolicited, intended to pay their next visit! With such experience as this before us, we do not feel thai any apology is needed for the suggestions we propose to offer. of
College
for the observance of certain formalities in
views
his
express
on
the
in which consultations
manner
Much that he said
should be conducted.
was
based
on
actual
usage, a little perhaps was suggested by his own instinct, but it was not 011 this account the less valuable, for it came from of the ablest of
one
plished called tioner
Physicians and most polished and accomspoke in substance thus:?"Whenever I am a patient in consultation, the family practi-
of men. lie in
to see
precedes
invited to do
me
so
into the sick-room.
by
him ; and
having
I do not
enter until
done all that is necessarv
bedside, I leave the room, while my colleague is yet in satisfy myself on all points connected with the present condition of the patient, by examination and questions addressed him ; but for the history of the case, and indeed for to all commuuicated information, I look to his medical adviser. I carefully defer the expression of my own opinions him ; and, as a general until after my conterence with rule, when we have jointly arrived at a conclusion, I request him to make it known to the patient. The only occasion of departure from this latter rule is, when there seems, from one cause or other, to be 9. desire on the part of the patient or friends to hear my views from my own lips, and at such times the desire is invariably shared by the general practitioner. It must be remembered that a Fhysician in consultation is courteously placed by a colleague in a position of authority, and it behoves him to use his advantage with the utmost delicacy towards his contemporary." These are not empty formalities; every one of them has a meaning; and if in England they be thought necessary, where the distinction of physician and general practitioner obtains, and where those who meet are socially strangers to each other, how at the it.
I
much
more are
socially equal,
they
needed here, where all
and
probably intimate,
are
professionally
and
and temptations to
laxity untimely self-assertion may, to iuture good feeling. We
are therefore strong, and where and too often does, become fatal cannot offer to our readers a lino of conduct better calculated to secure the confidence of their fellows than that laid down by our
friend.
a special danger exposed in India. There is little risk in England of the consulting physician being called upon to take tin: place of the family practitioner; the difference of profession a I status is a safeguard against this. But it is otherwise here ; there, is no one to consult but those who also engage in family practice, and who may therefore find themselves, from circumstance* arising out of their consultation, invited to supplant the friend who has introduced them. Such a thing has occurred within, our own experience. We wish we could rest secure in the be-
lief that it will not
occur
hereafter.
There are other points connected with
which we
Physicians makes provision in its bye-laws consultation; thus the prescription, which is the result of the conference, is to be jointly signed by those in attendance, and in the event of a difference of opinion between them, it devolves on the one last called to propose a third counseller; but beyond these points there is nothing, as far as we know, laid down by autiiority on the subject. Many years ago it was our good fortune to hear a London Physician of the highest standing The
It will not be out of place here to allude to
to which we are
are
of no less
propose to advert
importance on an early
than
Professional courtesy
consultations,
occasion.
to which
