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.