Know Your Consultant
CONSUMER'S GUIDE TO THE PROFESSIONS — 3
By JOHN ROWAN WILSON
TN ordinary circumstances a patient doesn't 'choose a consultant—his general practitioner chooses for him. If he is a private patient the
doctor suggests someone he thinks is competent and who will charge a fee suited to the patient's means. If he is a National Health patient, the doctor will usually send him up to the hospital out-patient department. Here he will be seen by a consultant or one of the registrars.
Either way, the patient has little to say in the matter. However, there are certain clues as to the nature of consultants and the way they be- have which may be of value in assessing them. The first thing to realise is that medicine on a consultant level is not, like general practice, a single occupation—it is a great variety of different occupations requiring men of differing mental and physical make-up. Most consultants are men of a fairly high grade of intelligence, since the ex- amination system is extremely rigorous and selective. When they fail in practice it is usually not from stupidity, but from a lack of emotional or physical suitability for the specialist branch they have chosen.
The primary division is, of course, into physi- cians and surgeons. A surgical operation is (or should be) a decisive act and requires a man of decisive personality. It is no occupation for a ditherer, or a man who is troubled by constant doubts of his own abilities. In general, a good surgeon tends to be a rough extroverted man. He doesn't (except in novels) have remote, olympian manners or long sensitive fingers. He is cheerful and rather bossy. He also has a tendency to show off. After all, in his particular form of theatre he is always the star performer. A certain degree of flamboyance is not only tolerated, but positively expected.
Much of the surgeon's behaviour is designed to establish himself as a person on whom the patient can lean during what is bound to be a frightening experience. If the surgeon is har- assed and worried he is not supposed to show it, either in the theatre or outside. A surgeon does not usually like to get too involved with a patient on a personal level—this can be a distracting influence for a man who has to take quick deci- sions and deal in calculated risks. He likes the patient to be optimistic and co-operative, but essentially passive. If he thinks in terms of part- nership, it is that between a horse and its rider. It is perhaps significant that Lord Malvern, the originator of this famous phrase, was himself a surgeon.
These remarks apply particularly to the general, all-purpose surgeon, working in the abdomen or thorax. There are certain branches of surgery which have special characteristics. Plastic surgery, for instance, is rather like a cross between sculpture and dressmaking. It calls for a sense of symmetry and design, for patient working and meticulous technique. For bone and joint surgery, on the other hand, the art of the cabinet-maker comes in very useful. There is another curious feature about orthopaedic surgeons. They are re- nowned for their irritability. The most likely explanation for this is, quite simply, that in ortho- paedic surgery you don't bury your failures. They come limping up to your out-patients to plague you for years afterwards. It is enough to get on anyone's nerves.
The consultant physician is a different cup of tea altogether. He should be a man of contem- plative disposition, with an analytical attitude towards life's problems. The good physician is in no hurry. He examines you at great length. He leans heavily on modern biochemical and pathological tests, and is skilled at their interpre- tation. He knows that for really effective treat- ment he requires your understanding and co- operation. He is prepared to pay for this by treating you as an intelligent, sensitive individual rather than a piece of machinery to be mended.
Medicine, too, has its special branches, and the nature of these sub-specialities calls for special types of men. Neurology, the study of nervous diseases, is a case in point. Neurology is to a very large extent an intellectual exercise, since few neurological diseases can be effectively treated and the speciality consists very largely of intricate problems and diagnosis. There is a kind of crossword puzzle element to it. Once the puzzle has been solved, the diagnosis made, that is the end of the matter. The result of this is that most neurologists, like surgeons, feel no necessity to get involved with patients as individuals, and have a similar tendency towards: coldness and egotism. The heart specialist, by contrast, is very heavily involved, not only with treatment, but with detailed advice to patients about how to adjust their future activities to their disability. A cardiologist has to be, above all things, a man of the world. He has to understand the significance of a patient's occupation, his financial circum- stances, his domestic background. He has to think not only in terms of life but of useful life. And he has to work in harmony with heart surgeons.
These are only a few of the sub-specialities. There are the paediatricians, for instance, whose particular problem is that they can only com- municate with their patients to a limited extent. Paediatrics, from this point of view, may be re- garded as half-way between human and veterin- ary medicine. There are the cynical world-weary gynaecologists, even more mechanistic in approach than the general surgeons. One could speak also of the atmosphere of cheerful good fellowship which for some reason always sur- rounds the treatment of venereal diseases, or of the macabre gaiety of Home Office pathologists. And finally the psychiatrists. But they surely de- serve an article to themselves.
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