Doctor and Patient

Part 1

Doctor and Patient

Papers on the Relationship of the Physician to Men and Institutions

BY FRANCIS WELD PEABODY, M.D.

Professor of Medicine, Harvard Medical School; Director of the Thorndike Memorial Laboratory; Visiting Physician and Chief of the Fourth Medical Service, Boston City Hospital 1921 to 1927

NEW YORK THE MACMILLAN COMPANY 1930

Copyright, 1930, By THE MACMILLAN COMPANY.

All rights reserved--no part of this book may be reproduced in any form without permission in writing from the publisher.

Set up and printed. Published June, 1930.

SET UP BY BROWN BROTHERS LINOTYPERS PRINTED IN THE UNITED STATES OF AMERICA BY THE FERRIS PRINTING COMPANY

Three of the papers in the collection have already appeared in print; “The Care of the Patient” is reprinted by permission from the Journal of the American Medical Association, Volume 88, pages 877 to 882, and The Harvard University Press. “The Physician and the Laboratory” is reprinted by permission from The Boston Medical and Surgical Journal (now The New England Journal of Medicine), Volume 187, Number 9. An expression of appreciation is also due the Journal of the American Medical Association for permission to reprint “The Soul of the Clinic,” which appeared in Volume 90.

CONTENTS

PAGE Introduction by Hans Zinsser, M.D. ix

The Public and the General Practitioner 1

The Care of the Patient 27

The Physician and the Laboratory 58

The Soul of the Clinic 72

INTRODUCTION TO COLLECTED PAPERS OF FRANCIS W. PEABODY

The writer of these papers, composed at different times for specific occasions, without thought at their writing, of eventual collective publication, was beloved by his friends for qualities of heart and mind that were not associated by them with his professional achievements. Yet as one thinks of him in retrospect, appraising him as a physician, one becomes more and more convinced that his great significance for American medicine sprang from those very qualities which endeared him in his personal relations, applied to and interwoven with his professional life. Intellectual and emotional sanity and integrity, from which wisdom, kindness and courtesy are derived, were the natural endowments which brought him distinction as a human being and which gave him an importance for American medicine possessed by very few of his contemporaries.

In the history of medicine there are many names associated with the discovery of facts, with learned treatises and with technical achievements of one kind or another; there are relatively few of whom we think especially as physicians in the sense in which this word is used in regard to Suydenham, for instance. It is a rare blending of learning and humanity, incisiveness of intellect and sensitiveness of the spirit, which occasionally come together in an individual who chooses the calling of Medicine; and then we have the great physician.

His professional life fell into a period of reorganization and unparalleled expansion in the medical world in which public attention quite naturally was focused on the material phases of these changes. Fundamental to these, however, and far more permanently significant, there was an intellectual reorganization and expansion which demanded the development of new leaders who might accomplish for our generation what men like Neusser, Nothnagel, McKenzie, Osler, Delafield, Shattuck and James had accomplished for the one just past. Of these young standard-bearers of the new Medicine he had become an affectionately acknowledged leader. As he grew in maturity and authority his interests were forced, almost in spite of himself, beyond his immediate work in laboratory and wards, into the more general problem of the relations of his profession to education, public health, sociology and, we may call it, its moral and philosophical bearing upon community life. In the educational phases of his work, the clinic which he headed at the Boston City Hospital represents a contribution to the constructive coördination of teaching, investigation and the care of the sick which solved many difficult problems and has already exerted a profound and lasting influence upon medical organization. This was his chief work at the end of his life and here he was continuing the studies which had already made him a noteworthy investigator and teacher.

But the imagination and critical faculties which had given value to his investigations were equally fertile in the more general aspects of his interests. Sought as a member of the most important scientific bodies of our country, he was capable of impersonal judgments and retained, as he would have indefinitely, that combination of the young heart and the old head in which the passage of time makes little difference and which, together, are the essentials of true understanding.

Of all his valuable contributions to the development of modern medicine, these short papers are the ones which deal most directly with the problems forced upon medicine by its own rapid development and by the increased opportunities and responsibilities which involved it with educational, social and economic changes. They deal with questions many of which are still unsolved, and their publication will serve to continue the influence of a voice that American medicine could ill afford to lose--one of clear-headedness, unsentimental idealism and the great wisdom of affectionate optimism.

Hans Zinsser.

Francis Weld Peabody

Born--November 24, 1881; died, October 13, 1927.

Degrees--A.B., Harvard, 1903. M.D., Harvard, 1907.

Positions--

Intern, Massachusetts General Hospital, 1907-08.

Part 2

Assistant Resident Physician, Johns Hopkins Hospital, 1908-09.

Fellow in Pathology, Johns Hopkins Hospital, 1909-10.

Student of Chemistry, University of Berlin, 1910.

Assistant Resident Physician, Hospital of the Rockefeller Institute, 1911-12.

Assistant of the Rockefeller Institute, 1911-12.

Resident Physician, Peter Bent Brigham Hospital, 1913-1915.

Member of Commission of Rockefeller Foundation to China, 1914.

Member of China Medical Board of the Rockefeller Foundation.

Member Red Cross Commission to Roumania, 1917.

Major, U. S. Army Medical Corps, 1918.

Assistant Professor of Medicine, Harvard Medical School, 1915-20.

Physician, Peter Bent Brigham Hospital, 1915-21.

Consulting Physician, The Collis P. Huntington Memorial Hospital, 1915-21.

Associate Professor of Medicine, Harvard Medical School, 1920-21.

Professor of Medicine, Harvard Medical School, 1921-27.

Visiting Professor of Medicine, Peking Union Medical College, 1921-1922.

Director of Thorndike Memorial Laboratory, Visiting Physician and Chief of The Fourth Medical Service, Boston City Hospital, 1922-27.

Consulting Physician, Peter Bent Brigham Hospital, 1922-27.

Member Board of Scientific Directors of the Rockefeller Institute, 1926-27.

THE PUBLIC AND THE GENERAL PRACTITIONER

Red Cross Meeting at the Tri-State Medical Association, Seattle, June, 1923.

“System and Efficiency,”--these watchwords of modern American business life, are beginning to be adopted by what used to be called the “learned professions”; and medicine, in particular, is entering a period in which “organization” and “service” seem destined to play a prominent and perhaps somewhat exaggerated rôle. The introduction of business methods and business phraseology into a profession which has hitherto been singularly free from a business atmosphere is to be explained in part by the general trend of the times, and in part by a praiseworthy attempt to give the public an opportunity to benefit more systematically from the extensive, though often complicated, advances of modern medicine. The function of the physician is no longer regarded as being limited to the care of the sick. “Health examinations” and “preventive medicine” for instance, are phrases as well known to the layman as to the doctor, and the medical profession is very properly preparing itself to offer to the public a new type of “service,” aimed, at least, at limiting the occurrence of disease. In making this broader program of usefulness available, there is every reason to believe that more and better work will be accomplished if the somewhat casual methods of many doctors are supplemented by those of the business world; but it is also of the utmost importance to remember that the experience of the centuries should neither be disregarded, nor subjected to modifications which, because they are new, may be too readily considered good. This conservative attitude applies chiefly, of course, to the age-old function of the physician in his relation to the sick. It may well be, though the question is debatable, that a new field, covering the care of the well, involves or permits something new in the relationship between doctor and patient. There may thus be some justification for the use of methods generally referred to as “putting the patient through the mill,” but there are already indications that the same methods applied to the care of the sick often lead to the patient’s confusion rather than to his peace of mind. And after all, the patient does deserve some consideration!

Any reorganization of the medical profession that threatens the personal bond between doctor and patient is to be viewed with suspicion, even if the object appears at first sight to be more thorough and careful practice. With the exception of the relationship that one may have with a member of one’s family, or with the priest, there is no human bond that is closer than that between physician and patient (or patient’s family), and attempts to substitute the methods of machine or organization, be they ever so efficient, are bound to fail.

Even the most forward-looking medical man must admit that for a long time to come, the main function of the medical profession will be to heal, relieve and comfort those who are sick or in distress, and plans which are devised to readjust the relationship between doctors and laymen must be based primarily on this consideration. New needs and opportunities are to be recognized and met as well as possible, but the chief thing is to be certain that in the name of the newer “Service” with its capital “S,” nothing of the old-fashioned, modest but effective service of doctor to patient is lost. I do not intend to suggest that relations between the layman and the medical profession should remain in the future exactly as they have been in the past. It is perfectly obvious that the manifold developments which have so increased the complexity of the practice of medicine make certain readjustments necessary, but it has become correspondingly clear that we must “watch our steps.” The protests of patients and their families or, to their credit, more often the muffled voice of their complaint, that they are no longer happy or contented in their relations with the medical profession are becoming more and more frequent. “I don’t think my case was handled right” is a phrase very commonly heard from patients who have had a long and varied medical experience, and curiously enough one is quite apt to find that it does not refer to the actual results of treatment. The modern layman of the educated, and often of the comparatively uneducated, classes, seems to have become surprisingly well aware of the fact that specific “cures” are not available for every disease or every symptom, and he is usually remarkably lenient in what he demands in the way of therapeutic results. His dissatisfaction has to do more with the general management of the case in which social and economic considerations are quite as important as its scientific aspects. He has attempted to get the best care, without regard to cost, and he finds that he has wasted his time and money going from one physician to another without finding anyone who can straighten out his troubles, or, what is more significant, is deeply interested in them.

Continue reading Doctor and Patient free in the Wunder reader →