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not able to answer without compromising a client from whom he has obtained the information in his professional capacity. The law of the state of New York, in this particular, is explicit, and is as follows:
"A person duly authorised to practice physic or surgery shall not be allowed to disclose any information which he has acquired in attending a patient in his professional capacity, and which was necessary for him to act in that capacity."
A similar statutory law exists in several other states. To the question "what should be the conduct of the physician as regards his visitations to patients, in point of length and frequency?" The answer is that the first visit must necessarily be long in order to give sufficient time for diagnosis and for instructions, to the attendant or to the sufferer, as to the proper use of the remedies prescribed. But subsequent visits should not last longer than required to ascertain the condition of the patient and to give such directions as may be needed. After this, prolonged visits, as a general rule, are not conducive to the benefit of the patient. Short, frequent visits are absolutely necessary in cases of acute diseases.
The third section of the first article of the first chapter of the National System of Medical Morals tells of the necessity of frequent visits to the sick, but condemns unnecessary visits, as follows:
"Frequent visits to the sick are in general requisite, since they enable the physician to arrive at a more perfect knowledge of the disease to meet promptly every change
which may occur, and also tend to preserve the confidence of the patient. But unnecessary visits are to be avoided as they give useless anxiety to the patient, tend to diminish the authority of the physician, and render him liable to be suspected of interested motives."
It is asked "what constitutes frequent visits?" There are diseases which require the attention and observation of the physician two, three, or four times daily and perhaps once at night; whilst in other cases five or six visits each week would be regarded as too frequent. Beginners are apt to make too few visits to the sick, under the wrong impression that the patients or their relatives. might attribute frequency in the visitations to self-interest. The conscientious physician makes as many or as few visits as the case requires.
Of unnecessary visits Dr. Percival wrote, in the thirteenth section of his second chapter: "Visits to the sick should not be unseasonably repeated; because, when too frequent, they tend to diminish the authority of the physician, to produce instability in his practice, and to give rise to such occasional indulgences as are subversive of all medical regimen."
What should be the line of conduct in regard to prognostications?
The physician, after diagnosticating a disease, almost invariably, is at once asked, by the patient or by his friends, how long he will be ill or whether he will recover? Familiar as he is with the master's great book of prognostics, the wise medical adviser is ordinarily very cautious
in the expression of an opinion until he has completed his inquiries into the antecedent history of the patient, into the effect of previous treatment, if there has been any, and until he shall have carefully observed the general condition of the sufferer. This caution is proper even in a simple, promising case, some intercurrent affection or some unlooked-for serious complication may, at any moment, be detected. He knows that too much optimism is as bad as extreme pessimism in any case, and wisely avoids alarming the patient by expressing hopelessness and avoids encouraging him when there is absolutely no hope of recovery. In foretelling the termination of a disease the true physician is so tactful as neither to overencourage nor to discourage. He never promises a cure, nor does he brutally tell his patient that he is doomed to die at the date which he prophecies. It so often happens that apparently moribund patients rally and recover, that the old saw-"while there is life there is hope"should not be derided, for it is always consoling to relatives. Even in very malignant diseases, by good management and assiduous care, pain is mitigated and life is often prolonged and made tolerable for months and even for years. Hence it is that the experienced physician is always guarded in prognostics.
In the third section of his second chapter, Doctor Percival gives the following rules of conduct respecting prognostications:
"A physician should not be forward to make gloomy prognostications; because they savour of empiricism, by
magnifying the importance of his services in the treatment or cure of the disease. But he should not fail, on proper occasions, to give, to the friends of the patient, timely notice of danger, when it really occurs, and even to the patient himself, if absolutely necessary. This office, however, is so peculiarly alarming, when executed by him, that it ought to be declined, whenever it can be assigned to any other person of sufficient judgment and delicacy. For the physician should be the minister of hope and comfort to the sick; that by such cordials to the drooping spirit, he may smooth the bed of death; revive expiring life; and counteract the depressing influence of those maladies which rob the philosopher of fortitude and the christian of consolation."
The framers of the National System adopted this admirable section almost word for word, and added thereto the following:
"The life of a sick person can be shortened not only by the acts, but also by the words or the manner of the physician. It is, therefore, a sacred duty to guard himself carefully in this respect, and to avoid all things which. have a tendency to discourage the patient and to depress his spirits."
Gloomy pognostications made with intent to magnify medical skill are worse than dishonorable, and worthy only of those charlatans who pretend to be able to ward off any disease or to substitute a mild affection for a grave disorder. Those cunning, crafty, medical vultures incessantly prey upon the credulity of innocents whom
they encourage in the belief that all diseases are interchangeable through marvelous methods known only to them.
It is a lamentable fact that there are some physicians of the highest integrity who are ordinarily gloomy prognosticians and who, on entering the sick room, too often manifest groundless apprehension more, however, by look and manner than by words.
Doctor Flint contrasts the pessimistic and the optimistic physicians in his wonted happy style as follows: "Undue solemnity, anxiety, and apprehension in the looks, manner, or words of a medical attendant on the sick, are extremely unfortunate-they discourage patients, whereas, on the other hand, a cheerful mien, calmness of deportment, and verbal assurances, sometimes accomplish more than drugs."
One or two instances of hasty prognosis may not be without interest.
A well-known citizen consulted a physician who told him that the trouble of which he complained would prove fatal in the course of three or four months. The patient was alive and well fifteen years after that hasty declaration, whilst the Doctor had gone to sleep with his fathers a few years after this condemnation of the anxious sufferer. Another patient affected with some cardiac disturbance, when told by his physician that he had but one chance of life in a thousand and that the end would probably come very soon, said smilingly: Well, I shall take that one chance; and he lived more than thirty years