Doctors

In that extravagant world of which I dream, in which people will live in
delightful cottages and ground rents will serve instead of rates, and
everyone will have a chance of being happy--in that impossible world all
doctors will be members of one great organisation for the public health,
with all or most of their income guaranteed to them: I doubt if there
will be any private doctors at all.

Heaven forbid I should seem to write a word against doctors as they are.
Daily I marvel at the wonders the general practitioner achieves, having
regard to the difficulties of his position.

But I cannot hide from myself, and I do not intend to hide from anyone
else, my firm persuasion that the services the general practitioner is
able to render us are not one-tenth so effectual as they might be if,
instead of his being a private adventurer, he were a member of a sanely
organised public machine. Consider what his training and equipment are,
consider the peculiar difficulties of his work, and then consider for a
moment what better conditions might be invented, and perhaps you will
not think my estimate of one-tenth an excessive understatement in this
matter.

Nearly the whole of our medical profession and most of our apparatus for
teaching and training doctors subsist on strictly commercial lines by
earning fees. This chief source of revenue is eked out by the wanton
charity of old women, and conspicuous subscriptions by popularity
hunters, and a small but growing contribution (in the salaries of
medical officers of health and so forth) from the public funds. But the
fact remains that for the great mass of the medical profession there is
no living to be got except at a salary for hospital practice or by
earning fees in receiving or attending upon private cases.

So long as a doctor is learning or adding to knowledge, he earns
nothing, and the common, unintelligent man does not see why he should
earn anything. So that a doctor who has no religious passion for poverty
and self-devotion gets through the minimum of training and learning as
quickly and as cheaply as possible, and does all he can to fill up the
rest of his time in passing rapidly from case to case. The busier he
keeps, the less his leisure for thought and learning, the richer he
grows, and the more he is esteemed. His four or five years of hasty,
crowded study are supposed to give him a complete and final knowledge of
the treatment of every sort of disease, and he goes on year after year,
often without co-operation, working mechanically in the common incidents
of practice, births, cases of measles and whooping cough, and so forth,
and blundering more or less in whatever else turns up.

There are no public specialists to whom he can conveniently refer the
difficulties he constantly encounters; only in the case of rich patients
is the specialist available; there are no properly organised information
bureaus for him, and no means whatever of keeping him informed upon
progress and discovery in medical science. He is not even required to
set apart a month or so in every two or three years in order to return
to lectures and hospitals and refresh his knowledge. Indeed, the income
of the average general practitioner would not permit of such a thing,
and almost the only means of contact between him and current thought
lies in the one or other of our two great medical weeklies to which he
happens to subscribe.

Now just as I have nothing but praise for the average general
practitioner, so I have nothing but praise and admiration for those
stalwart-looking publications. Without them I can imagine nothing but
the most terrible intellectual atrophy among our medical men. But since
they are private properties run for profit they have to pay, and half
their bulk consists of the brilliantly written advertisements of new
drugs and apparatus. They give much knowledge, they do much to ventilate
perplexing questions, but a broadly conceived and properly endowed
weekly circular could, I believe, do much more. At any rate, in my
Utopia this duty of feeding up the general practitioners will not be
left to private enterprise.

Behind the first line of my medical army will be a second line of able
men constantly digesting new research for its practical
needs--correcting, explaining, announcing; and, in addition, a force of
public specialists to whom every difficulty in diagnosis will be at once
referred. And there will be a properly organised system of reliefs that
will allow the general practitioner and his right hand, the nurse, to
come back to the refreshment of study before his knowledge and mind have
got rusty. But then my Utopia is a Socialistic system. Under our present
system of competitive scramble, under any system that reduces medical
practice to mere fee-hunting nothing of this sort is possible.

Then in my Utopia, for every medical man who was mainly occupied in
practice, I would have another who was mainly occupied in or about
research. People hear so much about modern research that they do not
realise how entirely inadequate it is in amount and equipment. Our
general public is still too stupid to understand the need and value of
sustained investigations in any branch of knowledge at all. In spite of
all the lessons of the last century, it still fails to realise how
discovery and invention enrich the community and how paying an
investment is the public employment of clever people to think and
experiment for the benefit of all. It still expects to get a Newton or a
Joule for �800 a year, and requires him to conduct his researches in the
margin of time left over when he has got through his annual eighty or
ninety lectures. It imagines discoveries are a sort of inspiration that
comes when professors are running to catch trains. It seems incapable of
imagining how enormous are the untried possibilities of research. Of
course, if you will only pay a handful of men salaries at which the cook
of any large London hotel would turn up his nose, you cannot expect to
have the master minds of the world at your service; and save for a few
independent or devoted men, therefore, it is not reasonable to suppose
that such a poor little dribble of medical research as is now going on
is in the hands of persons of much more than average mental equipment.
How can it be?

One hears a lot of the rigorous research into the problem of cancer that
is now going on. Does the reader realise that all the men in the whole
world who are giving any considerable proportion of their time to this
cancer research would pack into a very small room, that they are
working in little groups without any properly organised system of
intercommunication, and that half of them are earning less than a
quarter of the salary of a Bond Street shopwalker by those vastly
important inquiries? Not one cancer case in twenty thousand is being
properly described and reported. And yet, in comparison with other
diseases, cancer is being particularly well attended to.

The general complacency with the progress in knowledge we have made and
are making is ridiculously unjustifiable. Enormous things were no doubt
done in the nineteenth century in many fields of knowledge, but all that
was done was out of all proportion petty in comparison with what might
have been done. I suppose the whole of the unprecedented progress in
material knowledge of the nineteenth century was the work of two or
three thousand men, who toiled against opposition, spite and endless
disadvantages, without proper means of intercommunication and with
wretched facilities for experiment. Such discoveries as were
distinctively medical were the work of only a few hundred men. Now,
suppose instead of that scattered band of un-co-ordinated workers a
great army of hundreds of thousands of well-paid men; suppose, for
instance, the community had kept as many scientific and medical
investigators as it has bookmakers and racing touts and men about
town--should we not know a thousand times as much as we do about disease
and health and strength and power?

But these are Utopian questionings. The sane, practical man shakes his
head, smiles pityingly at my dreamy impracticability, and passes them
by.