Читать книгу Large Fees and How to Get Them: A book for the private use of physicians - Albert V. Harmon - Страница 6

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To a great extent Nature has a commanding influence in the equipment of the successful practicing physician—the man who actually secures the desired results in his treatment of patients, builds up and retains a good practice, and obtains a financial income of respectable proportions.

Any man of ability, with the necessary education and training, may obtain a certain amount of success as a physician and make a modest income—or drag out a miserable existence; this latter is the most probable. It is a well-established fact that the great majority of physicians are not what the world would call prosperous. This is not because they do not earn enough to secure a competence, but because they do not get it.

The doctor’s bill is almost invariably the last one paid. His practice is generally among the middle classes, people whose intentions are good, but whose incomes are limited. If there is anything left after the rent, and grocery and butcher and other bills are paid the doctor will, perhaps, get something on account, but as a rule he doesn’t.

This is mainly owing to the fact that the average physician is a poor business man; he does not place an adequate value on his services, and is slack in looking after collections. If pressed by his wife, or some friend, to be more particular in this respect, his almost invariable reply will be:

“It would not look well for me to put myself on the same plane with merchants. Mine is a profession, not a trade. Besides, I’m in duty bound to do a certain amount of charity work.”

Now charity work is all right in its place. An honest, upright practitioner will never refuse to respond to a call for his services in deserving cases because the payment of his fee is uncertain, but this does not obtain to the extent of virtually making paupers of people who are actually able to pay. And yet this is really what happens when a physician conducts his business affairs in a slipshod manner, and this is what most of them do. There is no excuse or reason for it.

But we started in to tell of Nature’s part in the equipment of the successful physician. What is the equipment? The possession of a robust, healthy physique, a sunny, cheerful disposition, and a fair knowledge of medicine, and ordinary business ability. All are essential if real success is to be attained, either in a medical sense, or in the accumulation of a respectable income.

Let us take two instances for the purpose of comparison. In one case we have a practitioner with just a fair knowledge of medicine, but in the possession of all the characteristics mentioned. His very presence in the sick chamber acts as a tonic to the patient.

Then we have a thin, undersized, nervous, dyspeptic physician; dissatisfied with himself and the world generally. He is a thorough master in medicine, and his treatment is more scientific than that of his less learned brother. His presence in the sick chamber, however, has anything but a soothing effect on the patient. On the contrary it irritates him, and the effect of the scientific treatment is nullified. This is not an exaggerated case. There are thousands of just such men in practice.

Which practitioner is going to have the greatest meed of success? The answer is easy—the one who cheers and encourages his patient by the magnetism of his presence.

Talk as we may, suggestion is a powerful factor in the practice of medicine. I do not mean by this that suggestion alone will cure illness (this statement is made without intention of affronting those who believe in Christian Science). But there is ample evidence to the effect that suggestion goes a long ways in making medical treatment effective. It is only the physician whom Nature has equipped in the manner indicated who can offer the right kind of suggestion and he does it unconsciously.

A physician of this kind is bound to become popular, and popularity begets a large practice and commensurate fees, provided the practitioner is in the right location, and has the business acumen to place the proper value on his services.

From time immemorial physicians have been imbued with the idea that they must adhere to a set scale of fees. I am speaking 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. He was assured that his instructions had been closely adhered to, both the patient and the local doctor agreeing upon this point. Finally the specialist said:

“Doctor, let me see you administer the hypodermatic part of the treatment.”

The local physician took from his overcoat pocket a hypodermic syringe without case or other protection. This he stuck into the bottle of fluid which constituted the treatment, and was about to make the injection when the specialist shouted:

“Great heavens, doctor, don’t do that! Let me see that syringe a moment.”

Holding the syringe up to the light the specialist found it extremely dirty on the inside of the glass barrel, and the needle point covered with lint. Calling the local physician into an adjoining room he said:

“My God, Doctor, it’s a wonder your patient is not dead. You are poisoning him to death. How long is it since you sterilized this syringe?”

“Why, it was sterilized when I got it, wasn’t it?” replied the local M.D. innocently.

“Yes,” answered the specialist, “and my instructions were that it should be cleansed with alcohol before and after every injection, and sterilized in boiling water at least once a week. This has not been done.”

Then and there the visiting physician opened the eyes of his country brother as to the grave importance of utter and absolute cleanliness in all branches of practice, and especially in the administration of hypodermatic treatments.

For nearly ten weeks this doctor had not cleansed the syringe. During all this time he had unconsciously been injecting into the system of his patient the most virulent of poison in the form of the decomposed lymph which remained in the syringe barrel, as well as such foreign substances as accumulated on the unprotected needle of the syringe.

And yet this “doctor” was popular and successful in a way, (in mild cases), despite his failure to keep up with the progress of modern thought. He was one of the old-fashioned full-bearded type, ignorant of germs and germ-theory, and too self-opinionated and set in his way to keep himself posted as to what is going on in the world of medicine.

I wish I were able to state honestly that, in the instance here referred to, the patient recovered, but he did not. The damage had been done, and it was too late, when the specialist was called in, to overcome it.

This is a truthful narrative. It is being duplicated in many instances owing to the ignorance and incapacity of men who, while possessing diplomas, are really unfitted for the practice of medicine. It illustrates in a sad, but forceful way, the necessity of being “up to date,” and mixing common sense with the medical lore acquired in the schools.

“Costly thy habit as thy purse can buy,” should be the rule. A physician should never dress flashily, but he should be garbed well. It creates a good impression. The time and money expended on improving the personal appearance is well invested. Patronize a competent tailor. A portly, well-conditioned man, well clothed, and of sunny, cheerful ways, will work wonders in the practice of medicine. Impressions are created largely by appearances. The man who looks affluent, who conducts himself in a good-natured, dignified manner, will succeed even though he be lacking in a thorough knowledge of his profession. The man who is slouchy and ill-kempt, and who takes no pains to be pleasant and obliging, will fail, no matter how well grounded he may be in the science of medicine. Why? Because he will repel people instead of attracting them. This same rule holds good in all lines of business, but it is specially applicable to the practice of medicine.