A view of general practice from 1923

Extracts from “Index to General Practice”: A Campbell Stark 1923


As this book is likely to be most useful to men who are beginning General Practice, or whose experience of it is not large, some general remarks as to the nature of the work they are about to undertake will not be out of place. There is a fundamental difference between the work of a hospital physician, or surgeon, and that of the General Practitioner. Many of the disorders, the treatment of which makes up a large proportion of the General Practitioner’s work, are scarcely seen at hospitals. To the hospital physician, or surgeon, a patient is a more or less interesting example of a disease, and what he is concerned with is the treatment and pathology of that disease, as he sees it. He never sees the beginning of the disease, and not often the end of it, and the individuality of the patient, and his fate, are of minor importance.

In General Practice, on the contrary, the individuality of the patient is the first consideration. His temperament, his surroundings, and the routine of his ordinary life, must always be considered, and a Practitioner who fails to take these into account will not be very successful in his work.

The patient exacts from his medical attendant a close and continuous personal interest, he expects that his doctor will cure or relieve him of his disease, and if these conditions are not complied with he will try another man. It is obvious that such conditions involve, on the part of the General Practitioner, close and laborious work and a good deal of mental discipline.

The General Practitioner must expect to be at the call of his patient at any time of the night or day. He will have to listen gravely to nonsense and to bear patiently with prejudices, yet he must understand and sympathise with the patient’s point of view.

Nor must he imagine that all his expenditure of time and energy will be adequately remunerated. Of all professional men, the General Practitioner is the worst paid and the hardest worked. No other class of workers, manual or professional, would consent, in these days, to work for such hours and such pay. Nor must the Practitioner expect to be repaid for his services by the gratitude of his patients.
This is not an alluring prospect for a man beginning General Practice, but there are compensations. The life is a healthy one; a good deal of it is spent in the open air. It brings a man into contact with a large number of human beings, diverse and interesting, and to one who cares for his kind and for his profession, and who possesses a sense of humour, it soon becomes one of the most fascinating occupations in the world. It should always be remembered that the General Practitioner is the “Sealed Pattern” of the medical profession. By him the status and efficiency of the profession are judged, and on him depends its future in the social economy.

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Varied and interesting as General Practice may be, no one can deny that it is an exhausting occupation. The close attention, from eight to eighteen hours a day, to the complaints of sick people, the constant drain of sympathy, and the physical and mental fatigue involved, will sooner or later tell upon the strongest constitution. Many a General Practitioner after a busy season feels that he has shattered his own personality into pieces, and distributed the fragments among his patients. It is probable that in another two generations doctors will be the servants of the State. A high standard of efficiency will be demanded of them, but they will have adequate time allowed them for rest and recreation. The General Practitioner will then be spared the sordid competition with his fellows to make a livelihood out of sick humanity. No man can be too good for General Practice, but many a first-class man has been knocked out by overwork, or has been driven to despair by the harassing conditions of his life. The Practitioner should make up his mind to secure for himself a weekly half-holiday to spend in some form of recreation, and he should also make for himself a “Secret Orchard” dedicated to some form of art, literature, or science, into which he can retire at odd times and emerge refreshed for his daily work

It is essential to cultivate tranquillity of mind, and to avoid hurry and worry. Sympathy and personal interest are necessary for successful General Practice, but to allow them to impair judgment is bad both for the patient and for the Practitioner. The General Practitioner should take for his motto the maxim of Goethe, ” Ohne Hast ohne Fast.” Bodily health is the most valuable asset of the General Practitioner, and it should be carefully cherished. There are some simple rules which are obvious enough, but which are worth repeating. It should be remembered that the Practitioner is constantly exposed to infection of all kinds, and he should treat himself as though he were infected with some bacteria which might develop. He should keep as much as possible in the open air, sleep with the windows open at night, and drive in an open car rather than in a closed one. Avoid getting wet or chilled, and never go out at night or to an infectious case on an empty stomach. Some ingenious tailor might well devise a suit of clothes which includes both under and outer clothing, which could be easily slipped on, would be warm and comfortable, and not unsightly. It would be more convenient and sanitary than the combination of pyjamas and overcoat so often seen. Keep the nails short and carefully filed, and always wash the hands after touching an infectious case. I have not met with a case in which it has been proved that infection had been conveyed by the medical attendant, but a good many doctors have contracted fatal diseases from their patients. Some men are extraordinarily susceptible to infection with Pyogenic Bacteria, and such men should wear rubber gloves for the simplest septic operations. The General Practitioner should keep in his consulting room a supply of thin rubber finger-stalls for rectal examinations or other explorations.
Every General Practitioner who is dependent upon his professional earnings should belong to the Medical Sickness Society. A few months’ illness and a bad locum tenens may ruin any practice.

Extracts from “Index to General Practice” by A Campbell Stark 1923

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