ON PROFESSIONAL ETIQUETTE
538 negotiating the sale of practices and procuring medical situations." -Pray, Mr. Editor, as you have visited other kinds of professional trading rather severely, express your opinion upon this editorial specimen. I cannot but think poor Dr. Clay had better have confined his attention to the manufacture of oxgall, than have thus exposed himself in the preparation of critical and encyclopaedic bile. I am, Sir, your obedient servant, London, Nov. 1848. AN OLD OBSTETRICIAN. ON PROFESSIONAL
... PROFESSIONAL ETIQUETTE. To the Editor of THE LANCET. SiR,—Your extra-England readers must have felt very considerable pleasure in perusing your remarks on the correspondence from Penang, East Indies, and published in your issue of April last. I am sure I did-first, because they were just in themselves, and applicable to the case in question; and next, because they very unequivocally declared that your supervision was not bounded by the confines of Britain, but extended to the remotest place wherever a body of professional men exists. As in friendship, " out of sight, out of mind," so in the profession: many think, that because they are far removed from the immediate surveillance of such a censor as THE LANCET, they are quite at liberty to conduct themselves towards their medical brethren as if there were no such thing in existence as professional etiquette or brotherly decorum. The system of the cateran seems to be ,their policy--"That they should take who have the power, And they should hold who can." Hence the many unprofessional artifices, the many clishonourable subterfuges, the many impudent and presuming trickeries, we daily see perpetrated by men who thus go on because of the impunity of the thing-because there is no recognised opinion as to the behaviour which ought to exist among us in these remote regions of the professional world. The consequence of all this is inevitable-that feeling of professional delicacy and honourable bearing, kept up to the mark among you at home, becomes dull and blunted with us, and, indifferent to the many occasions which occur to call it forth, each and all (with but few exceptions) consult their own immediate interests, and avail themselves of every means short of the most glaring injustice, or flagrant impropriety, to secure the patient's annual payment, or occasional fee. But there is another principle involved in the matter; one, too, quite as applicable to you at home as to us abroad: in all those cases wherein one medical man has sufficient reason to -feel offence at the undue interference of another practitioner, we are given to lay the blame on the intruder. Now I think there is a serious omission in this. Why not lay exactly as much (and sometimes more) on the side of the patient or his friends ? That another practitioner can interfere, without the patient or his friends (and it is in nine cases out of ten, the latter) being perfectly sensible of the impropriety of the act, is to suppose an absurdity. There are few in any classes of society who are not quite aware of what is due to their medical attendant in the great majority of such circumstances as give rise to the impropriety to be complained of; and to pass over their want of honourable feeling, and rest the whole onus of the irregularity on the offending practitioner, is to diminish by one half the guilt and meanness of the transaction. In a word, do not divide the guilt, but double it. In the case referred to, at Penang, Mr. Smith acted properly in calling to question the reverend interferer, on account of his impertinence ; and the only point of Mr. Smith's conduct I would make objection to, is one of omission; inasmuch as he did not act in like manner towards the immediate relatives of the patient. I would say, then, let professional men so act under similar circumstances, as to create a very unmistakable and lasting impression on the general mind-that not only are medical men responsible to each other in their professional intercourse, but that the public also are, in the manner here indicated, amenable to the same party. I do not believe I am arrogating any more power for our profession than is simply due from one man to another under any circumstances. All I claim is, that the public shall be actuated by the same kind of honourable feeling in the case of the professional man's attendance on the sick friend or relative, as it would be forced to guide itself by, in the common intercourse of society. I might give instances exemplifying the principle here insisted on, but the thing is so apparent that this is unnecessary. Trusting my professional brethren, both at home and abroad, will not deem me too presuming in calling their attention to the line of conduct above alluded to, I am, Sir, your obedient servant, SiR,—As there are no means of repressing improper conduct in medical men towards each other, except by giving it publicity, and so bringing upon the offender the reprehension of his medical brethren, I beg that you will insert the following statement in THE LANCET. I had been for some time attending a patient, labouring under pneumonia, when I expressed to the relatives my desire for a consultation, and my willingness to meet any medical man that they might choose. On Dr. Ritchie of Dollar being proposed, I immediately sent for that gentleman, and waited at the patient's house for his arrival. He accepted the invitation, but on entering the house, he did not even return my greeting, but proceeded at once to examine the patient, inquired of her about the medicines taken, tasted and smelt a mixture I had prescribed, and then proceeded to deliver his opinion and advice. I had waited very patiently during the above proceedings, and then said to Dr. Ritchie, that I wished to call his attention to certain points in the case, and to state the treatment that had been pursued ; and I suggested that we should retire to another room. He replied that it was quite unnecessary, and left the house. On reaching the outer door, he stated to the relatives, his views of the disease and of the treatment; and amongst other opinions of a similar character, he told them that he was not quite sure what the medicines were, but he rather thought something" might be added which would be beneficial.