DOCTORS CANNOT “GRAB PATIENTS.”

Star (Christchurch), Issue 18959, 4 January 1930, Page 9

DOCTORS CANNOT “GRAB PATIENTS.”

MEDICAL ETIQUETTE AND THE LAW COURT.

(By H. A. YELDHAM.) A coroner, commenting upon professional secrecy recently, attempted to make a distinction between a doctor on the staff of a hospital and a doctor in private practice, in the matter of accepting statements from his patients as given in strict confidence. Every doctor is absolutely forbidden to make any use, apart from personal professional reasons, of any statement made by a patient during a consultation or whilst under treatment by him. The circumstances in which the statement is made are immaterial to the issues. Should a Doctor Tell? Again and again it has been argued that in the event of the doctor becoming possessed of the knowledge which makes it dangerous, in his opinion, for the fiancee of his patient to remain unwarned of the disease from which his patient is suffering, it is right for him to make use of this knowledge for the protection of the fiancee, but the duty of the doctor begins and ends in his medical or surgical treatment. It is distrust of the local doctor in this matter which often sends a patient outside his own district for treatment. It has happened that the revelation of a certain line of treatment, in itself suggesting the diseases for which it has been recommended, has brought about a quarrel between husband and wife, which would not have taken place without the treatment having been described. The most successful medical practitioners are those who confine their remarks to a limited field, asking questions, giving advice, ordering remedies, passing perhaps a few compliments and commenting upon the weather. To use the words of an English medical tutor, “ The position of the doctor in this respect is that of the Roman Catholic priest.” However, should a doctor refuse to reply to a question under the direction of a judge in court, the doctor can be committed for contempt. A Point of Etiquette. There is nothing to prevent a doctor from issuing accounts for fees owing as often as he pleases, but it is a breach of etiquette for him to put legal pressure upon a patient to recover a debt, although this is sometimes done. He does it at the risk of damaging his reputation and practice. A consulting physician who is a fellow of his college is, in fact, forbidden to demand fees. His fee is supposed to be a voluntary honorarium. A general medical practitioner who has recently filed his petition stated in evidence that he had earned sufficient to pay all his expenses, but as he did not dun his patients they did not pay,*and so forced him into bankruptcy. Another doctor in similar circumstances, abandoned his practice, and as his debts to tradespeople equalled his patients’ debts to him, transferred his debts to the tradesmen and left them to collect what they could ! Another prohibition relates to advertising. In this matter, a doctor’s name, qualifications, and address (or change of address during holiday or otherwise) comprise the limits of his legitimate advertisement. Should he write a testimonial for an advertised article, or contribute to the lay press, or giv* public demonstrations, or otherwise attempt to steal a march upon his medical competitors, he is in danger of haying his name removed from the medical register. He may not give assistance (such as administering an anaesthetic) to any unqualified (unregistered) person, and only recently has he been permitted to give a public lecture upon his own special subject. By means of games, music, athletics, attendance upon reported accidents, social entertainments, and other affairs which “ get into the newspapers,” this advertising prohibition is often evaded but all these methods are regarded with suspicion by the British Medical Association and the Medical Council Death Certificates. A doctor is free to refuse to attend anyone at any tin. 3, but he can be ordered to appear as a witness, to perform a post-mortem examination, and give a certificate of death l under penalty of a fine if refused) in all cases attended by him up to within a reasonable time of the death, or order an inquiry. It is this and the popular dislike of post-mortems which accounts for so many unsatisfactory death certificates being given. A great pathologist of London has said that eighty per cent of death certificates given are incorrect. “ Professional etiquette ” is much more talked about by the public than by members of the profession. It amounts to no more than gentlemanly conduct one to another. When called in as a consultant, or to assist, it is not right to openly criticise, nor to attempt to “ grab ” the patient, nor to make any violent alteration or sudden change in the treatment. It is wrong to discredit in any way the conduct of a colleague, or to come into his district without warning and the paying of a formal call upon the resident. The “ splitting ” of fees is forbidden, and it is unwise to permit a new patient to speak of the disadvantages of a previous attendant. Perhaps the treatment of his nurses and his general bearing towards them is the best guide to the gentle breeding or otherwise of a doctor. Although it is usual for the attending doctor to suggest the name of a con sultant when one is needed, it is better to permit the family or relatives to select the “ second opinion ” because there is always a suspicion that the consultant may be a personal friend of the regular attendant and chosen in order to “ do him a good turn ” rather than because his diagnosis and advice are of special value. It is always advisable for a doctor to insist upon the presence of a female friend when a woman comes for a necessary examina tion, and the neglect of this precaution has ruined many reputations

A Note of Warning. Unless a very old friend the doctor must avoid being dragged into domestic differences, and be extremely careful when called to be present at the making or witnessing of a will. There are a thousand little niceties of conduct to be considered by, and hundreds of small actions “ verboten,” to a doctor, inconsequent in any other profession. His path is “ set about with little wilful thorns.” The present tendency in the direction of specialism is likely to add some further prohibitions shortly, because the general practitioner will surely protest against the fee of one guinea which the specialist demands, as compared with the half guinea accepted by the former, although to be a capable general practitioner requires much more skill and much harder work, and ten times the knowledge and experience. It is strange that the prohibition which would most

benefit the public, viz, a limitation of fees, has never been considered, the same operation costing from five to fifty guineas, according to the fancy of the surgeon, whose skill is sometimes estimated by the amount charged, which should not be in a profession at its worst better than any other.