PATIENT-MADE THERAPEUTICS

To all these blunders and ignorances doctors are no less subject than the rest of us.  They are not trained in the use of evidence, nor in biometrics, nor in the psychology of human credulity, nor in the incidence of economic pressure.  Further, they must believe, on the whole, what their patients believe, just as they must wear the sort of hat their patients wear.  The doctor may lay down the law despotically enough to the patient at points where the patient’s mind is simply blank; but when the patient has a prejudice the doctor must either keep it in countenance or lose his patient.  If people are persuaded that night air is dangerous to health and that fresh air makes them catch cold it will not be possible for a doctor to make his living in private practice if he prescribes ventilation.  We have to go back no further than the days of The Pickwick Papers to find ourselves in a world where people slept in four-post beds with curtains drawn closely round to exclude as much air as possible.  Had Mr. Pickwick’s doctor told him that he would be much healthier if he slept on a camp bed by an open window, Mr. Pickwick would have regarded him as a crank and called in another doctor.  Had he gone on to forbid Mr. Pickwick to drink brandy and water whenever he felt chilly, and assured him that if he were deprived of meat or salt for a whole year, he would not only not die, but would be none the worse, Mr. Pickwick would have fled from his presence as from that of a dangerous madman.  And in these matters the doctor cannot cheat his patient.  If he has no faith in drugs or vaccination, and the patient has, he can cheat him with colored water and pass his lancet through the flame of a spirit lamp before scratching his arm.  But he cannot make him change his daily habits without knowing it.

THE REFORMS ALSO COME FROM THE LAITY

In the main, then, the doctor learns that if he gets ahead of the superstitions of his patients he is a ruined man; and the result is that he instinctively takes care not to get ahead of them.  That is why all the changes come from the laity.  It was not until an agitation had been conducted for many years by laymen, including quacks and faddists of all kinds, that the public was sufficiently impressed to make it possible for the doctors to open their minds and their mouths on the subject of fresh air, cold water, temperance, and the rest of the new fashions in hygiene.  At present the tables have been turned on many old prejudices.  Plenty of our most popular elderly doctors believe that cold tubs in the morning are unnatural, exhausting, and rheumatic; that fresh air is a fad and that everybody is the better for a glass or two of port wine every day; but they no longer dare say as much until they know exactly where they are; for many very desirable patients in country houses have lately been persuaded that their first duty is to get up at six in the morning and begin the day by taking a walk barefoot through the dewy grass.  He who shows the least scepticism as to this practice is at once suspected of being “an old-fashioned doctor,” and dismissed to make room for a younger man.