many of cullen's consultations were done through written letters sent by patients from scottish cities and towns. cullen managed his consultations with great efficiency; he usually read the letters early in the morning and his secretary-amanuensis would record and mail back his responses. he then went around edinburgh to visit patients. this form of epistolary consultations was often limited by the literacy and socioeconomic status of the patients. patients who would write letters to cullen were usually in the upper and middle class. besides letters from patients, he also consulted physicians, often students he had taught. based on how his letters were written, cullen was most likely a "tactful and compassionate practitioner." like many physicians in his time, cullen would often prescribe therapeutics "to support the patient's endangered constitution and assist the body's natural healing tendencies." this is because medical practitioners at the time mostly believed that diseases and illnesses were unique to different patients depending on their constitutions.