The Pacific commercial advertiser. [volume] (Honolulu, Hawaiian Islands) 1856-1888, 1878-07-13

'-- A@-AAA So ~ ~ ~AAN-
IS matter OF notOriety. that the unpOpulaTity of tn
Hospital among the natives is in great measur
due to their dislike 10 the person who holds tn
position of Hospital Physician. In the course o
0 two years experience in practice in Honolulu.
o have repeatedly met instances in which patient
who could not be properly treated in their owl
homes, and who ought 10 have been In the HOspi
= TAI, nave refused positively 10 60 there tor the rea
e son above mentioned. In view of the facts which
have come under my own observation. as well as
OF those which have been related TO mt by respon-
: slble parties. l believe myself to be fully justified in
the statement made in my article in the HGicGiidH
Gazette OF Nov. 18th, 1877. that the popularity
OF the Hospital can be greatly increased and its
mlnIstratlons rendered more acceptable 10 the class
I0r Whom 1t Is chiefly Intended, by an enlargement
Of its medical staff"
Of course, it may be said that this a~ntipathy TO
the present Hospital Physician and his style of ad-
mlnIstratlon is unreasonable and unfounded. But
even were this true, it would not alter the fact of
such antipathy existing, nor Of its being a serious
bar to the usefulness Of the Hospital and in view
Of that fact it would still be the duty Of the Board Of
Trustees TO recognize the existence of such a feeling
and to do everything in their power TO remove it,
so far as the same could be done without interfering
with the due, proper and efficient administration Of
the Institution. That the addition of two or more
physicians to the medical staff would in a great
measure obviate the difficulty complained Of is GER
tain and that such an addition would impair the
efficiency and usefulness of the Hospital is, in view
of the experience of other similar institutions else
where, an assertion destitute not only of truth but
even Of plausibility.
1t may be, moreover, confidently asserted that an
enlargement Of the medical staff, so far from in any
way impairing the efficiency ofour Hospital admins
tration, would not only tend to inspire confidence
and goodwill among the natives. but would actually
improve the quality of the service and greatly benefit
the patients. On this point it ought not to be ne
cessary to dwell at any length. The advantages of
frequent consultations and comparisons of views
among medical men are sufficiently obvious. That
the united judgment, experience and skill Of three
or four intelligent practitioners are to be preferred
TO the comparatively limited resources of any one of
them, is n proposition whose simple statement ought
to carry conviction. Were the Hospital service d.
vided among several physicians, the comparatively
small number of patients under the care of each one,
would enable him to give them a much larger
amount OF time and attention than they can possibly
receive under the present arrangement each pbysi-
clan would be as free and in his own
department and among his own patients as DR..
Mchibbin now is, while for any doubtful or difficult
case occurring IN the service of any one of them, the
opinion and judgment, and if necessary the assist
ance, OF all his associates would be Immediately
available.
AT this point of the discussion a few figures may
not be out of place, as showing the exceedingly
limited amount OF attention which each patient can
possibly receive from the physician under the pre-
sent system. l suppose l shall hardly be accused Of
any extravaganza of statement when l estimate the
time required for a faithful and conscientious per- |
formance of professional duty at an average of three
minutes for each patient. Now, eighty patients at
three minutes each will occupy two hundred and
NNtJ -HN0NSI1 ~ St INGf 70 IL 10 Al e |
cessary to say that this is an amount of time which
no physician with practice of his own to attend to
outside can be expected to give, or will give, to hos
pital service. DR.. McKibbin does not do anything of |
the kind, and it is not reasonable to expect that he
should, especially in view of the fact that in addition
to his private practice he keeps a drug store, and
besides his Hospital appointment, holds several other
salaried Government offices, none of which, | pre-
sumo, he would care to have classed as sinecures.
There can be no reasonable doubt that three or four
physicians attending the Hospital, and having from
twenty to twenty-five patients under the care Of
each, would be In every way an Improvement on the
present system and give decidedly better results.
Among the advantages of such a plan as is here
recommended would be that in dividing the patients
among the several attending physicians, they would
at the same time be classified in such n manner that
each member of the medical staff could have under
his care the class of cases in which be felt a special
interest, and in the treatment of which he had spe-
cial experience and skill. The advantages Of q
division of labor, which are fully recognised In other
departments of business and professional life. are no
less obvious here. This fact is perfectly well under
stood and recognised at the present day in all places
where the number of physicians and the amount Of
practice 10 be divided among them is sufficient IN
allow of such a classification. In Great Britain, for
instance, the distinction between medicine and sur
gerry has been so sharply drawn that the rractition-
ers of each receive a separate diploma, and the sur
geon Is not spoken of or called doctor at all. In the
United States, though every practitioner is supposed
to be both physician aud surgeon, and his diploma
covers both grades, it is nevertheless true that in
the large cities, and, in fact, wherever the field is
sufficiently large to allow of choice, all serious cases
of surgery 60 TO men who make a speciality Of it, and
the same is true to a great extent of other branches.
In all the leading cities are TO be found those who
make a speciality of the eye and ear for instance
others who devote themselves to disorders of the
brain and nervous system others again who attend
almost exclusively to diseases and affections peculiar
to women, &C., &c.
In this way much better results are realised than
IS possible when each practitioner is compelled to
spread himself out over the whole domain of medi-
pInp a md md hnft. IL 80 81
our profession are advanced to q higher point than
they could otherwise attain. Now, although this
division of labor and this cultivation of special de-
p%artments are scarcely practicable to any great ex- 7
IN private practice in q community such as
ours, they are perfectly practicable in an institution 1
ike the Queens Hospital, and so long as the Trust
persist IN adhering TO the present system, Just so
ong Will the patients be deprived to a great extent
If the benefit of the best skill and experience in
and treatment, and the Hospital fail 10 -.
lttain the measure of usefulness of which it would /
otherwise be capable. This position can only be sue
,essfully combated by claiming that the present &
Hospital Physician is superior in each and every )
branch of medicine and surgery to any and all others
Il our local practitioners combined. IF auy person
with the present management cares TO
axe that ground, | hope he will have the COURAGE n
md manllness to do so openly and over his own sig
azure. 4
1t should be remembered, however. that it is not :
he poor natives alone who are concerned in this
natter the foreigners and the well-to-do classes of
oJ ON'S - NAANNN lEIEE ~ |
IN the relations which exist between the pbv-
lclans and the Hospital. There is no person who is Y
ot liable at any time to need the services of a pbv-
lclan, either for themselves or for some member of
neir families, and. TO again quote from my commu-
Icatlon of Nov. %, already alluded to, it is the (
manifest interest of every member of this community '
nat the men in whose hands the life and health of
and families are liable at anv moment n
placed, shall have every possible facility granted
lem for improvement in their arduous, responsible
nd difficult calling 1t is, of course, scarcely ne
:ssary to add that this can only be done through the
loption OF a more liberal and enlightened spirit in
lie conduct of our only Hospital.
1t may be said by some that the physician should
his business before he comes here. and
ot have to learn it in the Queens Hospital. Such
are the offspring of ignorance, and evince
entire misrepresentation of the subject. Rational
edlclne is pre-eminently O progressive calling. II
based on observed facts, and new facts are con-
antlY being observed and new applications of those
cts constantly discovered. -
The intelligent and conscientious physician is al vi
ays observing, always learning, always improving. Il
him once cease to be a student and settle down -
to complacent satisfaction with his present attain
ents, and he speedily falls behind the advancing
nkS OF his more progressive brethren. and ia soon q