Medical examiner

“ When employing a native interpreter it is always well to keep in mind the fact that such assistants will rarely admit of ignorance of the language of the medical man and, furthermore, they try to twist the answers of the patients to make them agree with what they may think is in accordance with the desire of the examiner. Again in carrying out the physical examination it is difficult to be certain that the findings as to location or degree of pain, sensations, or time of appearance of lesions, as well as data as to pulmonary, renal and alimentary tract disorders, are correct. ”

“ A person wishing to enter upon the practice of medicine must present to the board of medical examiners a diploma from some medical college in good standing as provided by sec. 1, or shall present himself to the said board for examination upon anatomy, physiology, chemistry, pathology, surgery, obstetrics, and therapeutics. ”

“ Broughton Brandenburg, Imported Americans, 208.
[18] This imaginary sketch adheres in every detail to the facts. The medical examiners and inspectors become exceedingly expert in detecting disease, disability, or deception. If an overcoat is carried over the shoulder, they look for a false or stiff arm. The gait and general appearance indicate health or want of it to them, and all who do not appear normal are turned aside for further examination, which is thorough. The women have a special inspection by the matrons, who have to be both expert and alert to detect and reject the unworthy. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ To battle with the occult forces which play so important a part in determining the course or consequences of disease, it is absolutely essential that the physician should know all that is possible to be known of the patient’s history, and of the history of the patient’s family. ”

“ Invasive physical examination.—The term `invasive physical examination' means any medical examination that involves the exposure of private body parts, or any act during such examination that includes incision, insertion, or injection into the body, but does not include a hearing, vision, or scoliosis screening. ”

“ Average Standard of Skill of any Professed School must be Attained.—It is also a rule that one who professes to adhere to a particular school must come up to its average standard, and must be judged by its tests, and in the light of the present day. Thus a physician who would practise the reckless and indiscriminate bleeding which was in high repute not very many years ago, or should shut up a patient in fever and deny all cooling drinks, would doubtless find the old practice a poor excuse for his imbecility. ”

“ Dr. McCaw's chief work was in the Queen Street Hospital for Sick Children, where he had been physician for forty-two years; and only a few weeks ago he was appointed a vice-president. He was also examiner and clinical lecturer in children's diseases in the Queen's University of Belfast, and he contributed several articles to the British Medical Journal and other professional journals. ”

“ If the board be satisfied by examination that a person is duly qualified to practise either or all of said branches of medicine, as taught and practised by homœopathists, they shall certify the same under the hands and seals of two or all of such board. ”

“ A physician should refuse to testify as an expert unless he is conscious that he is really qualified as an expert.
Second: After accepting the responsibility, his first duty should be to make a diligent examination and preparation for his testimony, unless it is upon a subject with which he is familiar and which he is satisfied that he has already exhausted, by reading the best authorities that he can find, and by careful reflection upon particular questions as to which his opinion will be asked. ”

“ As to the act of examination itself, the physician should conduct it in such a way as not to harm the wounded person. Often simple inspection is the most that can be done, or the examination may have to be deferred altogether until the physician in charge informs the court that an examination may be safely made. It is often necessary for the expert to get information as to the original lesion from the physician in charge. If the wound has been a fatal one and if we are called in after death, we may examine the wound on the dead body with much more freedom. ”

“ For example, one not an oculist may speak as to the cause of injuries to an eye; one who has not made diseases of the mind a special study may give his opinion as to the existence of insanity; one not a practical chemist or analyst, but understanding the practical details of chemistry and the means of detecting poisons, may testify as to the tests in the chemical analysis of a stomach, and as to the tests usually applied to detect poison (278) . The law will even allow a physician to speak as to the length of time a mule has been suffering from a disease (279) . ”

“ It would seem, however, that where it is the duty of a physician to attend a person in a professional capacity or to acquire knowledge concerning him in such capacity, he cannot disclose information actually acquired in the performance of his duty. ”

“ Persons not graduates in medicine who had practised medicine in this State under a certificate issued by the State board of health prior to the passage of the act are authorized to practise medicine in all its departments. ”

“ 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. ”

“ 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. ”

“ Certainly, on some occasions, the examination to which the patient was subjected, in order to ascertain if he were truly a leper or not, seems to have been of the most searching and scrutinising nature. I have already alluded to the strict rules of examination that have been preserved for us in the works of different authors,98 and quoted the method recommended by Guy de Chauliac to be followed by physicians before they remitted suspected patients with medical certificates to the magistrates (cum literis medicorum ad rectores) . ”

“ However, the requirement under subsection (1) that an individual submit to a medical examination does not extend to a requirement that the individual submit to any procedure involving surgery or the injection into the body of any drug, but includes requiring the individual to undergo a breath‐analyser test or a toxicological examination or to provide blood or urine for a laboratory test. ”

“ If any applicant fail to pass a satisfactory examination before the board he shall not be permitted to stand a further examination within the next three months, nor shall he be required again to pay the fees prescribed, but no applicant shall be rejected on his examination on account of his adherence to any particular school of medicine or system of practice, nor on account of his views as to the method of treatment and the cure of disease. ”

“ Degree of Care and Skill Used a Question of Fact.—In [32] an action at law, whether brought by a physician to recover for his services, or by a patient to recover for malpractice or neglect, it is always a question of fact, to be determined by the jury under proper instructions as to the measure of care and skill required, whether or not the physician has in a given case used that degree of care and displayed that amount of skill which might reasonably be expected of a man of ordinary ability and professional skill. These same rules apply to the surgeon. ”

“ Nothing is required (in the absence of any statutory provision to the contrary) to entitle any one to give evidence as a medical witness, than that he has been educated in the science of medicine; and this he may be by study without practice, or by practice without study; it is not necessary that he should be a physician, or have studied for one, nor be a graduate, nor one licensed to practise, nor need he be or have been a practitioner (275) . ”

“ THE PATIENT IS LIVING, AND MEDICAL ASSISTANCE IS REQUIRED. This is the least complicated case that can occur; the medical inquirer has not only the advantage of the patient’s testimony, but that also of his own observations upon the symptoms and circumstances of the case. ”

“ 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. ”

“ DISEASE HAS CERTAIN UNMISTAKABLE SIGNS,
or symptoms, and, by reason of this fact, we have been enabled to originate and perfect a system of determining with the greatest accuracy the nature of chronic diseases without seeing and personally examining our patients. In recognizing diseases without a personal examination of the patient, we claim to possess no miraculous powers. We obtain our knowledge of the patient's disease by the practical application of well-established principles of modern science to the practice of medicine. ”

“ 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. ”

“ It is imperative to create an environment or a culture that reduces stress for the physician, to always use differential diagnoses even when the diagnosis seems obvious, and to train humble physicians who are willing to listen to patients and other team members so that they can revisit the evidence when they are questioned about their diagnosis or management of patients. ”

“ Medical observation is ever incomplete, unless it take cognizance of all the functions, the aggregate adequateness of which, respectively ascertained, constitutes and is essential to health. The state of each should be accurately examined, however unconnected it may appear to be with the prominent derangement. Diligent scrutiny will often detect a morbid condition where it was unsuspected; and a negative should never rest on surmise wherever direct evidence is attainable. ”

“ 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 the past seventy-five years medicine has progressed from an art to a science. The doctor today has diagnostic aids which would have seemed fabulous to the physician of a hundred years ago. Exact laboratory tests and the X ray enable the physician to base his treatment on definite knowledge. These are as available to the surgeon and doctor aboard ship as to the man working in the most modern and extensive medical center. ”