Large Fees and How to Get Them: A book for the private use of physicians. Albert V. Harmon
now of the average doctor, the man with a general practice. All patients, the laborer and the banker, the wage earner and the millionaire, are charged the same. In the country districts, the small towns and cities, this charge is usually one dollar a visit. In the larger places it is generally two dollars.
Why should this be so? The architect, the attorney, the civil engineer are all professional men in the same way that the physician is. Whoever heard of any of them adhering to a set scale of fees in the same way that doctors do? Invariably they regulate the charge for their services according to the money value involved, and the nature of the services required. The man who employs an attorney in litigation where a large money value is at stake naturally expects to pay a much larger fee than the man who employs the same attorney in a minor case. The man who wants plans for a million dollar building pays the architect greatly in excess of the one who builds a one thousand dollar house. The principle is sound and all parties concerned are satisfied.
In the eyes of the Almighty all human lives are of the same value, and it would be cruelly unjust to attempt to appraise them on a commercial basis. But this should not prevent a physician from grading his fees in proportion to the ability of his patients to pay them. What might seem like a large amount to a wage earner, would be a mere trifle to one in more affluent circumstances. The lives of both are equally dear to them, and both are willing to pay the doctor according to their respective ability.
Custom, the mother of much folly, is the only excuse for adhering to the old, antiquated system. A physician who is called out of bed on a stormy night to answer an emergency call from the home of a coal heaver would not be justified in asking more than the minimum fee. But why should he perform exactly the same service at exactly the same charge for one who is able and willing to pay ten times as much, or even more? It is not sensible, it is not fair.
“But it would be a violation of the code of ethics,” some one may say. Bah! The code of ethics be—— but that’s another story which will be told later on in this volume. The plan suggested, however, is not a violation of the code of ethics. There is nothing unethical in a physician regulating his fees to please himself, provided no injustice is done, and none of his patients is oppressed in this respect. There are certain physicians in the large cities who will not respond to a call for less than $25. There are others who perform the same services for $2. Yet both kinds are strictly ethical and are recognized by the medical authorities as such.
The reason for this wide difference is that the $25 men have used business tact in the practice of their profession, and elevated themselves to a position where, by reason of their prominence, they are justified in naming whatever fees they think they can get. And these fees are almost invariably cash.
On the other hand the $2 men are timid in a business way; they hide their light under a bushel as it were, and consequently lack widespread reputation. Their fees remain at $2 because they don’t ask any more, and their ledgers are laden with unpaid accounts.
There is no reason why a physician should not collect his bills with just as much promptness as a merchant. It is usually his own fault that they go unpaid. Statements should be sent out regularly on the first of each month, and if there is no remittance by the 15th, it can be found inconvenient to make any further calls. This, of course, is allowing that the patients are able to pay. Where real inability to meet the bill exists it becomes a matter for the physician to settle with his own conscience.
Our medical schools are full of young men who are wasting their time and doing the world at large an absolute injustice by studying medicine. They are doomed to failure before they are well started because Nature has not endowed them with necessary qualifications for successful practitioners. Their instructors realize it, but the tuition fees are needed for the support of the schools, and year after year big crops of alleged “doctors” are turned out. It might be unfair to refer to them as incompetent, and yet this is what many of them really are. Most of them know medicine theoretically and know it well, but lack the vital essentials of success.
It would be a simple matter of justice to these young men if some plan could be devised for weeding out those who are manifestly unfitted for the practice of medicine before they have wasted their time and money on medical instruction. So long as such a plan is lacking it becomes the duty of the individual to assume this responsibility himself. The mere desire to become a physician should not satisfy the aspirant for medical lore. He should question himself closely as to his fitness. His character may be the best, his ability to acquire the necessary knowledge unlimited, but unless Nature has equipped him as previously outlined, the most he can hope to attain in the medical profession is mediocrity so far as actually helping the sick, and obtaining prestige and wealth are concerned.
There are men, it is true, of high standing in the profession, who do not possess these qualifications, but they are few in number and, as a rule, are consulting, rather than practicing physicians. Other doctors call upon them for advice because of their recognized skill and learning. They give this advice wisely and well, but in the sick room would fall far short of obtaining the same results which other men, more favored by Nature, obtain by acting upon the advice they give.
Time was when the word “physician,” conveyed the idea of a man with a beard. The two were intimately connected in the public mind. In many parts of the country, especially in remote districts where modern ideas and knowledge of the germ theory have not penetrated, this relationship still exists. In such places a full beard is an efficient badge of the doctor’s calling, and is essential in establishing his professional identity among the people.
Despite the widespread knowledge of the fact that beards are nothing more nor less than nests and hatching beds in which millions of disease germs find shelter, there are to-day numerous localities in which doctors as well as the laymen cling stubbornly to the belief that a physician without a beard is “no good.”
“Go on, neighbor, don’t try to fool me. That man’s no doctor. How do I know? Why, he ain’t got no beard.”
This is no uncommon statement to encounter in rural regions, and even in some fair-sized towns. Even the doctors themselves do not appear to recognize the fact that it is possible to separate their beards from their profession, and that it would be to the benefit of their patients and the advancement of their own reputations in the end to do so.
Modern, well-educated physicians know that many, in fact nearly all the ordinary ailments, are of germ origin. They also know, for instance, that a patient suffering from typhoid, or typhus, or some like disease, is continually reproducing these germs in immense numbers. For a physician with a full beard to lean over the bedside of such a patient is to invite millions of these germs to invade his beard, and wherever he goes he carries these germs with him and spreads the disease.
It is bad enough when decent precaution is taken as the hair of the head, the mustache, and even the clothing itself will harbor too many of the bacilli. But to wear a beard is to greatly increase the accommodations for these undesirable lodgers. In this way the health and lives of thousands of people are daily jeopardized.
This is why beards should have no place on the faces of physicians, and the more highly educated and more progressive the physicians are the fewer will be the beards found among them.
Another thing is a prime requisite in successful practice and this is the most scrupulous cleanliness. This refers not only to the person and apparel of the physician, but to the instruments which he handles.
Some years ago an Iowa cattleman suffering from a chronic trouble, came to Chicago for treatment which was administered hypodermatically. He made fair progress toward recovery, and finally was in condition to return home where the treatment was continued by his family physician.
For a time the reports made by the Iowa doctor were of a glowing nature. Mr. ——was getting along nicely, and the improvement in his condition was nothing short of miraculous. Suddenly word came that there was a change for the worse, and the Chicago specialist was requested to go to Iowa and make an investigation. He did so. On arriving in the town nearest the patient’s home he first called upon the local physician and together they drove out to see Mr. ——. The latter was evidently fast approaching a collapse and the specialist was at a loss to account for the remarkable change.