The Compleat Practitioner

Decrying the old family doctor is a fashionable medical pastime. Of the 170,000 U.S. physicians, more than half (55%) are now classed as specialists--and the specialist class is growing. Only last fortnight, Dean Willard C. Rappleye of Columbia University's School of Medicine predicted that group practice in community hospitals will eventually do away with the independent general practitioner. Said Dr. Rappleye: "Medical knowledge is now so complex . . . that . . . complete medical service can no longer be rendered by an individual physician alone."

But the general run of people still believe that the old family doctor has his points. And last week the No. 1 U.S. medical publishing house placed a sizable bet on the general practitioner's future: a five-volume, monumental compendium of modern medical knowledge (An Integrated Practice of Medicine, W. B. Saunders Co., $50). Its aim: to make the family doctor an up-to-date, "compleat practitioner."

The author of this work, which the publishers hope will be as history-making in its way as Uncle Tom's Cabin, is Dr. Harold Thomas Hyman, a top Manhattan physician and longtime Columbia pharmacology professor. A general practitioner himself, whose interests range from psychoanalysis to syphilis (TIME, April 22, 1940), Dr. Hyman was spurred by a deep conviction that medicine is an art as well as a science. He and a group of specialists spent six years compiling the five volumes.

Subdivided Patients. Dr. Hyman admits that, through specialization, medicine has become "disintegrated, dehumanized and depersonalized, to the distress of all concerned. . . . The individual patient has become divided and subdivided until each of his afflicted organs or systems may be under scrutiny by several technicians. . . .

"The physician has lost the 'feel' of the patient's home. The patient, in turn, has been separated from his 'Doc' by receptionists, internes, residents, admitting physicians, house-officers, ward assistants, dispensary workers, specialists, subspecialists, nurses, social service workers, dietitians, etc. . . . Overall knowledge and responsibility for the human life are the province of no one practitioner."

The Hyman manual leaves to specialists major surgery and the treatment of complicated ailments. But it provides the family doctor with a meticulously illustrated guide for diagnosing and coordinating treatments for almost every human ill. Conveniently indexed so that a doctor can start with symptoms and follow through to the latest approved treatment, it is a shrewd mixture of modern science and common sense.

Skillful Neglect. A good family doctor, observes Hyman, possesses two potent assets not to be found in a laboratory: sympathy and reassurance. Large doses of these healing agents, he says, should be carried in every doctor's kit. Other Hyman hints:

P: "The great majority of human ailments tend towards spontaneous recovery." A doctor must know when to apply "skillful neglect"; i.e., just tell the patient he is going to get well without treatment, or give him a harmless pill.

P: There is no cure for the common cold; U.S. doctors could save their patients millions of dollars on nostrums annually if they frankly admitted it.

P: Not all neurotics need treatment; in some cases (e.g., artists, writers, surgeons, politicians), a mild neurosis may be beneficial. Oliver Wendell Holmes, Hyman points out, observed that it is "the cranks that make the wheels go round."

P: If a specific drug fails to work, give it up; a good doctor learns to shift drugs as deftly as "a broken field runner."

P: A pill is better than a liquid medicine; it is easier to carry and doses are more precisely measured.

P:If an operation is optional, don't operate unless there is a 100-to-1 chance that the patient will survive. Poor risks for operations: fat people, alcoholics, psychotics.

P: A doctor should watch his language; to an anxious patient, the word "lump" may mean cancer; "murmur" may mean serious heart trouble. Don't tell a nervous, hypertensive patient what his blood pressure is.

P: Nothing helps like reassurance. "One of the great privileges of general practice is to witness the spectacle of the patient who simply will not be defeated by his infirmity."

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