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THE DOCTOR’S HARDSHIPS
A review of the counts in the indictment I have brought against private medical practice will shew that they arise out of the doctor’s position as a competitive private tradesman: that is, out of his poverty and dependence. And it should be borne in mind that doctors are expected to treat other people specially well whilst themselves submitting to specially inconsiderate treatment. The butcher and baker are not expected to feed the hungry unless the hungry can pay; but a doctor who allows a fellow-creature to suffer or perish without aid is regarded as a monster. Even if we must dismiss hospital service as really venal, the fact remains that most doctors do a good deal of gratuitous work in private practice all through their careers. And in his paid work the doctor is on a different footing to the tradesman. Although the articles he sells, advice and treatment, are the same for all classes, his fees have to be graduated like the income tax. The successful fashionable doctor may weed his poorer patients out from time to time, and finally use the College of Physicians[125] to place it out of his own power to accept low fees; but the ordinary general practitioner never makes out his bills without considering the taxable capacity of his patients.
Then there is the disregard of his own health and comfort which results from the fact that he is, by the nature of his work, an emergency man. We are polite and considerate to the doctor when there is nothing the matter, and we meet him as a friend or entertain him as a guest; but when the baby is suffering from croup, or its mother has a temperature of 104°, or its grandfather has broken his leg, nobody thinks of the doctor except as a healer and saviour. He may be hungry, weary, sleepy, run down by several successive nights disturbed by that instrument of torture, the night bell; but who ever thinks of this in the face of sudden sickness or accident? We think no more of the condition of a doctor attending a case than of the condition of a fireman at a fire. In other occupations night-work is specially recognized and provided for. The worker sleeps all day; has his breakfast in the evening; his lunch or di
In short, the doctor needs our help for the moment much more than we often need his. The ridicule of Moliere, the death of a well-informed and clever writer like the late Harold Frederic[128] in the hands of Christian Scientists (a sort of sealing with his blood of the contemptuous disbelief in and dislike of doctors he had bitterly expressed in his books), the scathing and quite justifiable exposure of medical practice in the novel by Mr. Maarten Maartens entitled The New Religion: all these trouble the doctor very little, and are in any case well set off by the popularity of Sir Luke Fildes’ famous picture,[129] and by the verdicts in which juries from time to time express their conviction that the doctor can do no wrong. The real woes of the doctor are the shabby coat, the wolf at the door, the tyra
THE PUBLIC DOCTOR
What then is to be done?
Fortunately we have not to begin absolutely from the begi
It is true, there are grave scandals in the public medical service. The public doctor may be also a private practitioner eking out his earnings by giving a little time to public work for a mean payment. There are cases in which the position is one which no successful practitioner will accept, and where, therefore, incapables or drunkards get automatically selected for the post, faute de mieux;[130] but even in these cases the doctor is less disastrous in his public capacity than in his private one: besides, the conditions which produce these bad cases are doomed, as the evil is now recognized and understood. A popular but unstable remedy is to enable local authorities, when they are too small to require the undivided time of such men as the Medical Officers of our great municipalities, to combine for public health purposes so that each may share the services of a highly paid official of the best class; but the right remedy is a larger area as the sanitary unit.
MEDICAL ORGANIZATION
Another advantage of public medical work is that it admits of organization, and consequently of the distribution of the work in such a ma
125
Professional organization for physicians in Britain.
126
Company doctors paid through workers’ contributions.
127
Sir James Paget (1814 — 1899), renowned English surgeon and pathologist.
128
American novelist (0856- I898).
129
Reference to The Doctor, a painting by Sir Luke Fildes ( 1844-1927), based on the death of his son, that depicts a doctor keeping watch at the bedside of a sick child.
130
For lack of a better (French).
131
Infections of the finger or toe.