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frequently happens, after a little mental tempest, that the repenting sufferer asks his dear Doctor to forgive him for having exhibited so much discontent, and warmly thanks him for so kindly overlooking the whims and caprices of a poor invalid. The conduct of a wise and kind physician in such circumstances, endears him to his patients and makes better men of them. As he treats his hospital patients so will he treat his private patients. A crown-head, whose physician had reason to be anxious about the consort then in child-bed, said to him: "Doctor, treat her as if she were the wife of a tradesman, a spicer." Treat your patients of the hospital as if they were emperors and empresses because they are human; and treat your private patients as well and as kindly as if they were inmates of charity hospitals.
3. What is the criterion of conduct of members of the housestaff in their relations to each other, to their visiting-physicians, to patients, and to attendants?
The deportment of members of the house-staff should be that of accomplished gentlemen who never forget the courtesy due to all; who have in their souls a filial love and respect for their visiting physicians; who are faithful and considerate in their attention to the sick; and kind in their treatment of the attendants.
4. On his arrival at the hospital should the visiting-physician await the coming of his house-physician before entering the wards?
On the contrary it is the house-physician who should await the arrival of the visiting-physician and be ready
with the rest of the staff to accompany him to the wards. This is a proper manifestation of the respect due to their foster-father on the part of the members of the staff who should never omit this ceremony which is a very wholesome disciplinary exercise.
5. In “making rounds," should the visiting-physician demand the attendance of every member of his staff?
Assuredly. For he needs them all and, besides, it is much to their interest to be on hand and listen to his instructions by which to profit.
6. In standing around a patient's bed for his examination, how should the staff and attendant be placed?
Ordinarily, the visiting-physician stands opposite the house-physician; next to the visiting-physician is the senior assistant with his book ready to note the remarks of the visiting-physician. At the foot of the bed stands. the junior assistant, and beside the house-physician is the post of the chief attendant.
7. Does the visiting-physician address his remarks solely to the house-physician?
The visiting-physician's general remarks on the patient's ailment and its treatment are for the benefit of all listeners, but in case of an unfavorable prognosis he reserves its statement for the ears of his staff exclusively. The patient should be spared the shock of such an announcement which may hasten his demise. It belongs to the clergyman to break gently to him his sad plight while giving him spiritual consolation. Besides, the date of the fatal event cannot always be predicted with absolute certainty
For this reason, the wise physician is generally cautious in his prognostications.
Certain special remarks of a disciplinary character are addressed only to the house-physician and in privacy.
8. Does the visiting-physician question the patient directly, or through the house-physician?
After the senior assistant shall have read the history of the patient and of his disease, the visiting-physician may choose to question the house-physician or the patient directly, or to obtain information from any one else likely to throw additional light upon the case toward assuring a correct diagnosis.
9. Does the visiting-physician ever rebuke publicly any member of his staff, or any attendant?
No visiting-physician having a parental regard for his staff ever thinks of rebuking publicly any of its members or any attendant. When a rebuke is merited, it is made in privacy and in the form of a fatherly admonition or of a short instructive lecture. A well-trained staff scarcely ever needs any sort of rebuke. A public rebuke would always be subversive of the discipline of patients in any case, and would surely lead to loss of confidence in, and of respect for, the staff.
10. Does the visiting-physician allow patients to approach him privately with questions or complaints?
No. Because this would be subversive of discipline. The questions or complaints should be addressed to the house-physician who, if necessary, may refer them to the visiting-physician who is likely to satisfy the anxious pa
tient by kind reassuring words, and the promise that his just grievances will meet with due attention.
II. What is the customary conduct of the visiting-physician at the bedside, and in the operating room?
The first clause of this question has already been answered in the replies to questions 6, 7, and 8. In the operating room, the rightly trained assistants know so well what each is deputed to do that the operator has but few orders to give and these are addressed to the house-physician. In the performance of an operation, howsoever intricate and difficult, there is no friction or confusion among well drilled assistants, or indeed in any case, so long as the operator is calm, composed, and skilful. Many are skilful, not so many are calm and composed in difficulties, and such are wont to lose self-control and thus create much disorder among assistants and attendants. A few remarkable instances of the freaks of neurotic operators may be worthy of mention.
The senior surgeon of a large hospital, a skilful, well meaning, but extremely excitable man during operations, was wont to clip off accidentally bits of flesh from the hands of his assistants and then scolding them for not "holding on and keeping still." In performing amputations he generally flung away the knife quickly after making the flaps, much to the danger and annoyance of bystanders, then, severing the bones he would dash the saw to the ground instead of handing it to an assistant. His aids never knew what to expect, during the work of the master "except cut fingers" and were in constant dread of
injury from the tools which he would throw about so carelessly during his periods of excitement. Still they all liked him for his good qualities, and for his great kindness to them.
Another operator noted for his amiability and gentleness in private life, was nevertheless the terror of his assistants at the operating table. Always finding fault with their doings and scolding all when there was no occasion.
Many years ago, in a foreign city, was witnessed the worst instance of impatience and brutality on the part of an operator whose appearance and manners were more like those of a matador than of a physician. During a long and bloody operation, that executioner never ceased to grossly abuse every member and attendant of his staff; calling each by name, in the presence of a large audience. The half conscious, screaming, almost exsanguine patient was a truly pitiable object, and the arena of the amphitheater bore no little resemblance to a slaughter-house!
Such sad examples are now fortunately of extreme rarity in this country or abroad.
The house-physician has many sore trials, anxieties, and responsibilities. Called at all hours of the day or night, he often has but little time for study or for rest. He is too often censured for what he should be praised; blamed when he deserves the most credit from friends and relatives, sometimes of those very patients to whom he had given the most constant and intelligent attention. But conscious of rectitude, he is wise enough to be silent and await further developments; certain to clear him of all