The Doctor's Dilemma: Preface on DoctorsShaw, Bernard
Philosophy
The Doctor's Dilemma: Preface on Doctors
Shaw, Bernard
Physicians
the practice of law not only led to a judge having to hang, but the
hangman to judge, or if in the army matters were so arranged that it
would be possible for the drummer boy to be in command at Waterloo
whilst the Duke of Wellington was playing the drum in Brussels, we
should not be consoled by the reflection that our hangmen were thereby
made a little more judicial-minded, and our drummers more responsible,
than in foreign countries where the legal and military professions
recognized the advantages of division of labor.
Under such conditions no statistics as to the graduation of professional
ability among doctors are available. Assuming that doctors are normal
men and not magicians (and it is unfortunately very hard to persuade
people to admit so much and thereby destroy the romance of doctoring)
we may guess that the medical profession, like the other professions,
consists of a small percentage of highly gifted persons at one end,
and a small percentage of altogether disastrous duffers at the other.
Between these extremes comes the main body of doctors (also, of
course, with a weak and a strong end) who can be trusted to work under
regulations with more or less aid from above according to the gravity
of the case. Or, to put it in terms of the cases, there are cases that
present no difficulties, and can be dealt with by a nurse or student at
one end of the scale, and cases that require watching and handling by
the very highest existing skill at the other; whilst between come
the great mass of cases which need visits from the doctor of ordinary
ability and from the chiefs of the profession in the proportion of, say,
seven to none, seven to one, three to one, one to one, or, for a day
or two, none to one. Such a service is organized at present only
in hospitals; though in large towns the practice of calling in the
consultant acts, to some extent, as a substitute for it. But in the
latter case it is quite unregulated except by professional etiquet,
which, as we have seen, has for its object, not the health of the
patient or of the community at large, but the protection of the doctor's
livelihood and the concealment of his errors. And as the consultant is
an expensive luxury, he is a last resource rather, as he should be, than
a matter of course, in all cases where the general practitioner is not
equal to the occasion: a predicament in which a very capable man may
find himself at any time through the cropping up of a case of which he
has had no clinical experience.
THE SOCIAL SOLUTION OF THE MEDICAL PROBLEM
Public-domain text, read in full here on John Shaqi.
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