Medical consultation

“ While not permitting any member of our professional staff to travel and solicit practice, yet we are always willing to accommodate and send a specialist to visit important or critical cases in consultation, or otherwise, or to perform important surgical operations as explained on page 971 of this book. ”

“ For more than a quarter of a century, the Specialists of the Invalids Hotel and Surgical Institute having charge of this department of practice, have been actively engaged battling with diseases of the nervous system. As a result of this long time and vast experience, they have naturally developed and thoroughly tested many valuable remedial agencies for the relief and cure of this class of sufferers. Many of these can be successfully prescribed and used at the patients' homes without a personal consultation; while others can only be brought into use at our Institution. ”

“ General practitioners shall mainly provide such services as diagnosis, treatment, referral, prevention, healthcare and rehabilitation of common diseases and frequently-occurring diseases, chronic diseases management, and health management. ”

“ Each intern is assigned multiple cases to be seen across rotations. Interns will be assigned a faculty supervisor who is responsible for supervising the evaluation, treatment, and documentation for trans-rotational cases. Supervision for trans-rotational cases will be scheduled, although unscheduled supervision for urgent or emergent issues is always available. As stated above, high-risk patients are to be discussed with supervisors and documented PRIOR TO departure of the patient from the clinic or service. ”

“ We shall not advise treatment for these more grave disorders which should always, for the safety of the patient, be attended by the family physician, except to recommend some simple means which may be employed in the initial stage of the disease, or when a physician's services cannot be promptly secured. ”

“ In the more dangerous, obscure, or complicated forms of chronic diseases, the correct diagnosis and successful treatment of which tax all the skill possessed by the experienced specialist, the invalid will not be misled into the dangerous policy of relying upon his own judgment and treatment, but will be counseled not to postpone until too late, the employment of a skillful physician. ”

“ The practice of medicine is every year becoming [pg 293] more successful. New and improved methods of treating disease are being discovered and developed, and the conscientious physician will avail himself of all the means, by a knowledge of which he may benefit his fellow-men. ”

“ Doctors came to see her singly and in consultation, talked much in French, German, and Latin, blamed one another, and prescribed a great variety of medicines for all the diseases known to them, but the simple idea never occurred to any of them that they could not know the disease Natásha was suffering from, as no disease suffered by a live man can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine—not a disease of the lungs, liver, skin, heart, nerves, and so on mentioned in medical books, but a disease consisting of one of the innumerable combinations of the maladies of those organs. This simple thought could not occur to the doctors ”

“ In no class of diseases is greater care, scientific knowledge and skill more necessary than in the treatment of nervous affections. Almost every case is a law unto itself, and must receive careful consideration, pains-taking advice and specially prescribed treatment suited to the peculiarities of the individual. Hereditary influences, causes of the disease and constitutional peculiarities of the patient must all be taken into account. ”

“ The specialist, the treatment of chronic diseases being his vocation, is equally annoyed if consulted by those suffering from acute diseases, but does not pursue the inconsistent course of assuming to treat them. ”

“ In short, a physician or surgeon cannot contract with a patient that the patient shall waive any claim for damages growing out of his want of ordinary care and skill. Nevertheless, the physician or surgeon may frankly inform his patient of his want of knowledge and experience as to the particular kind of treatment required by any special and unusual disease or injury. ”

“ The specialist, however, dealing with chronic diseases exclusively, will occasionally meet with a case which has been the rounds of the home physicians without benefit, that will tax his skill and require the exercise of all his perceptive faculties to determine the exact condition of the patient's system, upon which the obstinacy of the disease depends. When this is ascertained, the remedies will naturally suggest themselves, and the malady will generally yield to them. ”

“ In ordinary practice, the physician's time is divided in his consideration of acute, chronic, surgical, and obstetrical cases; in fact, much of it is occupied in riding to reach his patients. His attention is continually diverted from one class of cases to another, effectually preventing investigation in any particular direction. ”

“ Definition, Exceptions.—Any person is deemed practising medicine, surgery, or obstetrics, or to be a physician, who publicly professes to be a physician, surgeon, or obstetrician, and assumes the duties, or who makes a practice of prescribing, or prescribing and furnishing medicine for the sick, or who publicly professes to cure or heal by any means whatsoever ”

“ Thus it so often happens that the general practitioner pursues old methods of treatment which science has long since replaced with others, acknowledged to be superior. The specialist, on the contrary, by confining his studies and researches to one class of diseases only, is enabled to inform himself thoroughly and accurately on all the improvements made in the methods and means of practice in his special department. ”

“ I take pleasure in recommending your institution to the afflicted, believing that you have the very best treatment for chronic diseases known, and I have had an opportunity to satisfy myself, from conversation with other invalids in your Institution, of the care and skillful treatment that you administer, and its excellent effects. ”

“ Our improved and perfected system of diagnosing, or determining, the exact nature and extent of chronic affections, which, in most cases, we are able to do at a distance, and without a personal examination of the patient, as will be more particularly explained in the appendix, or latter part of this little book, has enabled us to avoid the blunders so often committed by the general practitioner, who not infrequently treats those afflicted with chronic ailments peculiar to women, for long weeks, and perhaps months, without ever discovering their real and true disease, or condition. ”

“ Often a patient is sent a long distance to consult a medical man, and to return to his own physician for treatment based on the diagnosis made. In these instances the doctor consulted is expected to write his views privately to the patient's doctor, and to recommend treatment. ”

“ ADVANTAGES OF SPECIALTIES.
By thorough organization and a perfect system of subdividing the practice of medicine and surgery in this institution, every invalid consulting us is treated by a specialist—one who devotes his undivided attention to the particular class of diseases to which his or her case belongs. The advantage of this arrangement must be obvious. Medical science offers a vast field for investigation, and no physician can, within the limit of a single life-time, achieve the highest degree of success in the treatment of every malady incident to humanity. ”

“ Three physicians give their sole attention to diseases peculiar to women and three to those of the nasal organs, throat and chest, embracing all chronic diseases of the respiratory organs. Thus we have a full council of three and four physicians in these several specialties. In several other divisions we have two specialists. No case is slighted either in the examination or in the treatment. All doubtful, obscure or difficult cases are submitted to a council composed of several physicians and surgeons. Skilled pharmaceutists are employed to compound the medicines prescribed. ”

“ SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE TREATED—OPERATION—AFTER-TREATMENT, ETC. Every medical practitioner must have met with a certain class of cases which has set at defiance every effort at diagnosis, baffled every treatment, and belied every prognosis. ”

“ Few professions require more careful preparation by one who seeks to enter it than that of medicine. It has to deal with all those subtle and mysterious influences upon which health and life depend, and requires not only a knowledge of the properties of vegetable and mineral substances, but of the human body in all its complicated parts, and their relation to each other, as well as their influence upon the mind. The physician must be able to detect readily the presence of disease, and prescribe appropriate remedies for its removal. ”

“ At a period when pathological research is lending its aid in investigating the appearances of disease in every part of the body, and many nice distinctions in diagnosis are aimed at, which are better calculated for nosological than practical purposes, it seems to me not a little extraordinary, that so few have cultivated that most important branch of medicine, the study of the diseases of children. ”

“ It is a subject not unbecoming the highest attainments, to increase the stock of medical knowledge in that branch of our art. So important, indeed, to society, is the successful treatment of infantile diseases, that happy shall I be, if any effort of mine shall awaken attention to this hitherto neglected department of medicine. ”

“ It is immaterial that another person employs the physician to examine the patient, and to report to the employer, and that the person examined does not appear to desire any knowledge as to his condition; if the examination is made as a professional act, the relation of physician and patient is established between the physician and the person examined, even though it be the only interview. ”

“ Having specialists who devote their entire time and attention to the study of these diseases, we are able to relieve and cure a large number painlessly and speedily, in which the awkward manipulations of physicians or surgeons, whose hands, untrained by constant and skillful use, not only fail to effect any benefit, but set up new, or aggravate existing, disease. ”

“ Only through extensive experience can the medical practitioner become expert at detecting and successfully meeting, by rational scientific and carefully adapted treatment, the many phases and complications incident to the different forms and stages of this very prevalent malady. ”

“ In hospitals, too, the law of the physician is more absolute; his orders are punctually obeyed; neither weakness nor perverseness counteracts his matured purpose, and thus, in hospital practice alone, perhaps, has he fair opportunity afforded him for proving of what his art is capable. It needs little reflection to see that observations of disease so made, must lead to more accurate discrimination, sounder judgment, and more efficient treatment than mere private practice, subject, as it is, to continual influences, tending to give it a wrong direction, can ever teach. ”

“ The great majority of physicians allow acute maladies, diseases of children, and the practice of midwifery, to engross most of their time and attention. They manifest an absorbing interest in everything that [pg 958] relates to these subjects, and devote little or no time to acquiring an intimate knowledge of the great variety of chronic maladies which afflict mankind. ”

“ The advances in general medical science and practice have also necessitated great elaboration of the resources for the study and treatment of the physical condition of the patients. Instruments of precision, laboratories, x-ray departments, dental and surgical operating rooms, massage and hydrotherapy departments, facilities for eye, throat, nose, and ear examinations and treatment, and all the other means of determining disease processes and applying proper treatment have been supplied and the methods and standards of modern clinical medicine and surgery are utilized. ”

“ It is perhaps not too much to say that everybody nowadays knows as much about the treatment of disease as a large proportion of the members of the medical profession did in your time. As you may readily suppose, this is a situation which, even apart from the general improvement in health, would enable the people to get on with one physician where a score formerly found business. We doctors are merely specialists and experts on subjects that everybody is supposed to be well grounded in. ”

“ The training goals of this rotation include; familiarizing the Navy interns with the most frequently used psychological assessment measures in Navy and other military settings, developing an understanding of the administration and interpretation of these measures, as well as gaining experience working in a consultation role within a medical system. Interns attend weekly individual and group supervision, as well as a didactic seminar. ”

“ The treatment most generally successful may have been deduced from an extensive examination of cases faithfully and accurately recorded, and yet it may be wholly inadmissible in the particular instance in which its application is contemplated. As was before remarked, the only security against error lies in adapting the remedies not according to the name given to the disease, nor to the alleged success of former cases, but to the special derangements which prevail in the several functions of the individual frame under consideration. ”