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tice, the courts have uniformly held that the practiser is bound to bring to his case the ordinary degree of skill in his profession. In legal phrase, the implied contract of a physician or surgeon is not to cure, or to restore a part to its natural perfectness, but to treat his case with diligence and skill.
His contract, as implied in law, is that:
1. He possesses the reasonable degree of learning, skill, and experience, ordinary to other members of the profession; 2: That he will use reasonable and ordinary care and diligence in the treatment of the case committed to him; 3. That he will use his best judgment in all cases of doubt as to the best course of treatment. If the physician or surgeon make a special contract with his patient, he is held strictly by its terms.
Since the National System of laws for the government of physicians and of the people in their relations to physicians tells them what they shall and shall not do, it may be well, for the benefit of all concerned, to summarise these laws in brief sentences; beginning with what the physician shall and shall not do for the good of his patients. 1. Be ever ready to obey the calls of the sick.
2. Be imbued with the high character of your mission. 3. Bear in mind that the ease, health, and lives of your patients depend on your skill, attention, and fidelity. 4. Forget not that there is no tribunal other than your
own conscience to adjudge penalties for carelessness or neglect.
5. Unite tenderness with firmness in your deportment and so inspire your clients with respect, confidence, and gratitude.
6. Treat all your patients with attention, steadiness and humanity.
7. Be indulgent to the caprices or mental foibles of the sick.
8. Bear constantly in mind that delicacy and secrecy shall be strictly observed, and that secrecy extends beyond the period of professional services.
9. Make to the sick as many visits as are absolutely required, but no unnecessary visits.
10. Do not make gloomy prognostications within hearing of the sick.
11. Do not abandon a sufferer whose cure is beyond hope, but continue your ministrations to the last.
12. Be careful, when a consultation becomes necessary, to select a competent and loyal consultant.
13. Do not omit to exert your influence toward his reformation when a patient's habits are injurious to him in his sickness or afterward.
THE PATIENT AND HIS PHYSICIAN
Reciprocal obligations of patients and their physicians-The patient's selection of a physician-Prompt obedience to the directions of the physician either for the prevention or cure of disease-Importance of seeking advice at the earliest manifestation of any sickness-Irrelevant and wearisome details, in the statement of his case, to be avoided by the patient-Strict observance of the rules prescribed during convalescence-No friendly visits from physicians who are not in attendance-The patient to be always in readiness to receive his physician.
THE questions to be treated in this conference are of even greater import to the patient than to the physician who should spare no pains to make them known to all his clients in order that they may clearly understand the true nature of their relations and obligations to physicians whose ministrations they may invoke. It is the lack of knowledge of the characters of these relations and obligations that has too often led to grave misunderstandings, and to many evil consequences. For this want of knowledge of the laws governing the conduct of patients, medical men have been almost wholly answerable. It is therefore incumbent upon every individual physician to impart the needed information to all his patients, and upon the profession as a whole to enlighten the public on questions of medical morals the knowledge of which is essential to the well being of all communities.
The young inquirer into the principles of conduct of medical men very naturally propounds the following: "Since physicians are governed and bound by fixed rules to perform all the arduous duties required in the care of the sick, ought not their patients be equally governed and bound by rules that are essential to the preservation of health and to the cure of disease?”
The chief obligations of the patient to his physician, besides obedience to his directions, are loyalty, respect, gratitude, and due acknowledgment of the faithful services rendered. All patients are bound in obedience to their physicians, or take the consequences of disobedience, and are bound morally and legally to make due acknowledgment of services rendered. The strictest obedience of the sick was exacted from the very beginning of the healing art. The physician gave his instructions to the patient who was to be treated solely on condition of implicit pliance with these instructions; such was, and is still, the covenant.
The second sentence of the first Hippocratic aphorism: "The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals coöperate," shows that, even in early times, the rules governing the obligations of patients must emanate from their physicians who alone can make such rules. Without an understanding that the patient shall obey directions, the medical adviser is rarely willing to undertake the management of a sick person.
The principle of reciprocity between physician and
patient necessarily involves some proper return always, however, coupled with gratitude for a service rendered. The physician being bound to use his best abilities in ministering to the ails of his patients; these are equally bound to him in obedience, respect, gratitude, and other ways of manifesting their obligations. Therefore it is incumbent upon the physician to make known to all his patients the exact nature of his duties to them and of their obligations to him in order that they may clearly understand the purport of the contract.
The National System of Medical Morals was instituted for the protection and information, not only of physicians but of patients and of the public, and to impress upon all the fact that their obligations must necessarily be reciprocal. One of the objects of the National Medical Association, distinctly stated in its original plan of organization, is "the enlightenment and direction of public opinion in regard to the duties, responsibilities, and requirements of medical men." This object can be effected only by making the public acquainted with the laws of the associated members of the profession of medicine. That part of the national system which points out the reciprocal obligations of clients and physicians is so clear and just that no intelligent layman who reads it will question its propriety and absolute necessity, and all heedful readers will surely approve of the other parts which relate to the public and the state.
Even a cursory examination of the letter of the second article of the first chapter of the National System will not