Wednesday, June 10, 2009

Respectfully challenging

In March of 1871, the newly formed Medical Society of the Third Judicial District of Oregon published its constitution in the Oregon Medical and Surgical Reporter. Article VI treats "Of the Differences Between Physicians":

"1. Diversity of opinion and opposition of interest, may, in the medical as in other professions, sometimes occasion controversy and even contention. Whenever such cases unfortunately occur, and cannot be immediately terminated, they should be referred to the arbitration of a sufficient number of physicians, or a court-medical, or, where both parties are members of the Medical Society of their county, to the Censors."

At their September meeting, the minutes of which were subsequently published in the Oregon Medical and Surgical Reporter in October, the group put its ethic into effect in what must have been a very spirited discussion:

"Dr. [Horace] Carpenter ... presented a case of gunshot wound, to which he had been called in consultation with Dr. [P.A.] Davis, in which the operation was delayed until the patient could be brought to a suitable place for treatment; stated that the delay was absolutely necessary, that no injury was received, and that the subsequent death was due to the extensive nature of the wound, not only freely lacerating the arm, but entering the chest. Reaction never took place from the first injury, and although a post mortem examination was not made, there was every appearance of serious internal complications. These remarks had been called up by some unprofessional remarks that were stated to have been made by some members of the Society, in reference to the physicians who had been first called to the scene of suffering. He could fully exonerate them of any want of judgment or attention, and he deemed it proper for the members of the Society to examine thoroughly any case of supposed improper action on the part of any of its number, and that, by so doing, we would find ourselves incited to more careful performance of our duties and more thoughtful regard for each other, while it would be an element of decided strength to the profession."

The formal minutes present an undoubtedly toned-down version of the discussion--which is only to be expected, given Section 2 of Article VI of the constitution:

"2. As peculiar reserve must be maintained by physicians towards the public, in regard to professional matters, and as there exist numerous points in medical ethics and etiquette through which the feelings of medical men may be painfully assailed in their intercourse with each other, and which cannot be understood or appreciated by general society, neither the subject matter of such differences nor the adjudication of the arbitrators should be made public, as publicity in a case of this nature may be personally injurious to the individual concerned, and can hardly fail to bring discredit on the Faculty."

What happens at a medical meeting stays at a medical meeting...

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