The demise of professional courtesies: cui bono?

The past is another country: they do things differently there. Hartley LP. The go-between 1 ne indulgence accorded to those of us in our senior years is the ability to reflect on life' s circumstances many decades ago and compare them with those of today. My recollections of medical practice, as the son of a surgeon, stretch back to my schooldays. A lasting memory is of the many gifts, the so-called " grateful patients ". Glassware, silverware, bowls, paintings and books were the permanent items; flowers, Scotch and home-made delicacies the temporary ones. These often came from patients who had paid my father' s full fees, but more often from people for whom he had reduced his fees (generally people he considered to be impoverished) or whom he didn't charge at all (mostly friends, ministers of all religions, colleagues and medical students). I remember other courtesies. He would never see patients who lacked a detailed letter from their general practitioner, and his replies were equally detailed, often complemented by a telephone call. Asked for a second opinion, he gave it to the patient and the GP and allowed them to decide whether surgery should be done by the first surgeon consulted or by himself. He was available, day and night, to advise GPs baffled by obscure clinical presentations. If asked, he would accompany a GP to a patient' s home. This joint visit had formal rules, including rules about who entered the room first and who exited last. When surgery was needed, he invited the GP to assist. His reputation relied on the success of his surgical interventions and on the opinions of the GPs who saw his work at close quarters. Those were the 1940s and 50s: a long time ago. What would my father have made of today' s intraprofessional relations? I doubt that he would even have understood commercialism, mercantilism (including advertising and self-promotion) and competition policy. Even if he had, would he have thought that they could ever apply to the practice of medicine? Sir Robert Menzies, born a decade or so before my father, commented about the universities in language my father would have applied to medicine: Are the universities mere technical schools, or have they as one of their functions the preservation of pure learning, bringing in its train not merely riches for the imagination but a comparative sense for the mind, and leading …