The Specialist Disease
A novel written by Dr. A. J. Cronin which criticises the medical specialist has caused some comment in the papers lately. A writer in the Evening Standard gave the instance of a friend of his who, after having had a fall from a horse which brought on a form of rheumatism, went to his family doctor and was told that time and rest was the cure for his complaint. Not satisfied with this his friend came to London and spent a hundred pounds or so visiting specialists who did him no good. Finally he had to adopt the rest cure, and after some months was quite all right.
At the invitation of the News Chronicle, Dr. Harry Roberts gave his views in that paper (July 22nd, 1937).
In the course of his article Dr. Roberts makes the following remarks: —
I have known men who, with no special training and no special qualifications, having failed in general practice, have staked their last few hundred pounds on a room or a share of a room in the Harley Street area, offering themselves to the public as a throat and nose specialist, a skin specialist, or a psycho-therapeutist. . . .
Numerically, men of this kind constitute a fairly large proportion of the imputation of the fashionable medical area.
One or two ideas are suggested by the above statements. The first one is that people outside the medical profession are groping in the dark when they go to a specialist. They may be led to a competent man and they may be led to an incompetent. Even the competent is likely to be under the influence of his speciality. The man, for example, who is a cancer specialist is likely to twist, quite unintentionally, the symptoms of the patients who go to him into symptoms of cancer. There have been many instances of that kind of thing.
Why is it so difficult to find out the incompetent in the medical profession and why do unqualified people set up as specialists? The reason is quite clear to the Socialist.
The medical profession contains a proportion of competent and incompetent, just the same as any other trade. In the ordinary trades, however, there are men (foremen, managers, etc.) who are paid by the employers to find out and remove the incompetent. The medical profession, however, is one great trade union in which each doctor stands by the other and, so far, they have been able to resist any serious alteration of their methods. They are helped by the large body of wealthy people who are prepared to pay for the attention of doctors. Many of their complaints are due to high living, but quite a lot are purely imaginary.
The doctor, like the engine driver or the clerk, has to get a living. The getting a living (unless he has a private income) overrides all other considerations. If this can be accomplished by a brass plate with a fictitious specialised knowledge then the supporters of the present system cannot complain if the young doctor without patients gains them that way.
As long as a price is put upon knowledge and activity fraudulent methods will flourish. The only way to abolish them is by securing to everyone the satisfaction of his needs. The Socialist is working for this end.
When a man or a woman can devote their whole time and energy to becoming competent in whatever form of activity they may take up, without the haunting fear of being unable to obtain the elementary comforts of life, then there will be some security in going for advice to those who specialise in one way or another.