And when he leaves the hospital,
often with the largest and noblest conception of the physician's place
in life, what do we do with him? He becomes a "private practitioner,"
which means, as Duclaux, the late distinguished Director of the Pasteur
Institute, put it, that we place him on the level of a retail grocer
who must patiently stand behind his counter (without the privilege of
advertising himself) until the public are pleased to come and buy
advice or drugs which are usually applied for too late to be of much
use, and may be thrown away at the buyer's good pleasure, without the
possibility of any protest by the seller. It is little wonder that in
many cases the doctor's work and aims suffer under such conditions; his
nature is subdued to what it works in; he clings convulsively to his
counter and its retail methods.
The fact is--and it is a fact that is slowly becoming apparent to
all--that the private practice of medicine is out of date. It fails to
answer the needs of our time. There are various reasons why this should
be the case, but two are fundamental. In the first place, medicine has
outgrown the capacity of any individual doctor; the only adequate
private practitioner must have a sound general knowledge of medicine
with an expert knowledge of a dozen specialties; that is to say, he must
give place to a staff of doctors acting co-ordinately, for the present
system, or lack of system, by which a patient wanders at random from
private practitioner to specialist, from specialist to specialist
_ad infinitum_, is altogether mischievous.
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