Approximately 100 years ago a medical practitioner, probably based in London, wrote a series of articles on how to manage and maintain a medical practice. These were collated in a hard back book with the title 'Tactics' but no record of the author's name or whether it was ever published. It was discovered in an antique book shop and given to me when I was a young doctor. I have often referred back to it as a fascinating insight to the practice of medicine a century ago and since my retirement from hospital medicine I have added commentary on the issues of commonality between 2 doctors separated by 100 years. It is hoped that non-medics will also find the complexities of the doctor-patient relationship less mysterious, sometimes amusing and sometimes scary, after reading my anecdotal experiences and those of 'Our Practitioner'. This snapshot in to the past provides us with an overall flavour of the day to day strivings of a medical practitioner, to be successful in his practice. The emphasis is very biased to making a good impression in order to make a good living. When comparing modern day medical practice with his views we see a number of fascinating differences. He emphasises the importance of influencing women as it is their word of mouth that will enhance his reputation. At the same time, however, he sees them as being "much more impressionable through the emotional and aesthetic faculties." The paternalistic approach with patients is very much in evidence. There seems to be a tendency to avoid, where possible, the breaking of any bad news and a reluctance to discuss the mechanisms by which the limited available therapies work. We get an insight in to the class system pertaining at that time. "With working people a greater heartiness in the tone of voice is desirable, while avoiding any undignified familiarity. Such patients are often embarrassed at meeting their 'betters', afraid that they are giving trouble or intruding." More is written about neurasthenia and I suspect a lot of our practitioner's experience revolved around the differential between neurosis and disease. There would have been much greater pressure in light of childhood mortality rates and a lot of his expertise would have involved dealing with bereaved parents. I think his need to impress patients with his attention to detail, 'cleverness' and professionalism teaches us a lot about the general practice of medicine at that time and there are many useful observations that ring true in today's doctor-patient relationships, even allowing for a gap of 100 years.
About the Author: Steve Connellan is a retired Consultant Respiratory Physician. He trained at St Mary's Hospital in London. His experience of the doctor-patient relationship is based on a broad variety of posts both abroad and in the UK. In the later years as a Consultant and Clinical Director he was exposed to all the components of doctor and patient management which included treatment, governance, teaching, finance, research and development. He has worked for both the NHS and the private sector and his main specialist interests have included COPD, asthma and allergy. Apart from publishing papers on medical research this is his first attempt, as part of the luxury of retirement, at publishing a book. His co-author is unknown and referred to as 'Our Practitioner'. We can only infer that he was a medical practitioner working probably in London around 1910 at a time when there was considerable competition for medical attention. His commentary suggests that he was an astute business man who had developed a variety of approaches with patients to ensure that they remained confident in his care. Hence the original title of his compilation of articles was 'Tactics'. This is all we know about him unless a reader is able to identify him from his writings!