21 MAY 1948, Page 15

DOCTORS AND PATIENTS

Snt,—Your correspondent, Mr. J. C. Levine, writing about the expected increase in the numbers of patients to be attended by doctors after July 5th, ends with the statement, "The doctors are surely capable of weeding out those who demand unnecessary attention." Here is one who would make no claim to do this with anything like complete accuracy. There is a large range of conditions in which the doctor has to rely on the patiefit's description of his subjective symptoms. There is no doubt that with my medical knoidedge I could tell a tale which even after expensive investiga- tions would make it impossible for a physician to say positively that I hadn't got a duodenal ulcer. At the end of the search he might be doubtful, but he would be morally obliged to give me the benefit of the doubt—and a certificate for extra eggs and milk. The girl who stays away from work for two days each month because of pain is, in all pro- bability, a genuine sufferer, but if she isn't there is no doctor in the world who can prove it. To convert disease into an asset is a very dangerous policy: The effects on the standard of the practice of medicine of providing a situation where it is to the patient's advantage to simulate ill health are grievous. Medicine is a very difficult art, and unless it grows from a foundation of good faith between patient and doctor it is impossible. From an organisation which encourages bad faith one of two results may follow. The doctor may become suspicious ; and sympathy with anything except gross and palpable disease flies out of the window. Alternatively he may be so keen not to turn away any genuine sufferer that he actually creates disease by diag-