Читать книгу Life is an Adventure - R. J. Manion - Страница 19

Table of Contents

The practice of medicine in Great Britain is divided distinctly between surgeons, who keep the title “Mr.”, and physicians, who take the title “Dr.” So far as the titles are concerned this does not obtain in Canada, but in our larger cities specialization has advanced to the extent that there is a distinct division, not always lived up to, between physicians and surgeons. In the smaller cities such as my own there was at that time no specialization whatsoever. We were all general practitioners, attending all cases of whatever kind that came to us, whether they were surgical, medical, obstetric, or what not, and as a consequence those who attended their work conscientiously, who visited the clinics in large cities from time to time, and who really studied their cases and their books, became broad-minded and able doctors of medicine in its widest sense.

In this connection I recall bringing a specialist from Chicago to my home city to see my father who was dangerously ill. This specialist went about with me for a couple of days on my many cases, as I was exceedingly busy at the time, and he remarked that it seemed strange to him (who limited himself to the study and treatment of only two organs in the body) to see me attending various medical cases, and a little later the same day performing a minor and a major operation. Incidentally, this specialist was a very interesting character, though rather unscrupulous in his methods of gathering in the shekels. My father was suffering from what I had diagnosed as cancer of the bladder, but repulsed my suggestion that he go to the Mayo Clinic or to Chicago for treatment, remarking that he noticed that most of those who went away to be treated did not come back. A medical friend of mine was doing some post-graduate work in Chicago, and we wired him to send the best genito-urinary specialist in that city up to see my father. He recommended Dr. B— who, he said, would make the trip for fifteen hundred dollars. However, having made the trip, he submitted a bill for two thousand. My father had no objection to the fee as stipulated, but did object quite justly to the increase. He paid it after having received a very optimistic prognosis, though the specialist changed his prognosis as soon as he had arrived back in Chicago with his fee in his pocket; and the cancer carried my father off four months later.

Dr. B— made a few other fees while he was there, because Chicago specialists were not common in my small city, and a number of my patients wished to have him look them over, though their condition had no relation to the specialty which he practised. One man, whose daughter had a tumour of the leg, called him to see the young lady. He agreed with my diagnosis; collected fifty dollars; and I took out the tumour the same morning, for which operation I have never received a cent. Another patient, a well-to-do Irishman, called the Chicagoan to examine him for a pain in his side. My specialist friend, learning that he was well-to-do, gave him a most thorough examination, some very indefinite and useless advice, and charged him two hundred dollars. Going home that evening, after visiting my father, I called in on my Irish friend, who lived almost next door, to tell him what the Chicago surgeon thought of his case. The specialist had hurt him a good deal during the examination.

“By gad, Doc,” the Irishman said, “that examination was a terrible shock to me.” I laughingly replied that it was nothing to the shock he would get in learning the specialist’s fee; then told him the fee was two hundred.

“Just what I expected,” he said.

“Well, John,” I said, “you are a damn nice fellow. You call me at any hour of the night to attend your children or yourself, and, if I charge you five or ten dollars for climbing out of bed and spending half the night here, you think you are robbed. Yet you say it is just what you expected when this man charges you two hundred dollars for an examination!”

“Well, Doc, you know,” he said, “this chap is from Chicago; and he is a specialist; and he can do things that you general practitioners cannot do; and therefore his charge is just about what I expected.”

This little incident throws a light upon the psychology of fee-charging in medicine. Medical men are often accused of charging “all the traffic will bear”—putting heavy fees upon those who can pay for the same treatment which they give to someone else for nothing. This is quite a proper policy. Doctors necessarily cannot refuse to attend the poorest of people, and since perhaps a third of their work is done for nothing, they must get good fees from those able to pay. Even the fairest-minded physician or surgeon usually works on this theory, for medical men doing general practice lead a very difficult life. They are called out at irregular hours; a good deal of their work is of a repulsive character; and they are subjected at all times to the charge of ignorant patients that they were maltreated. Consequently, when they get good results with wealthy patients, it is only fair that these rich should pay in proportion to their wealth. It is the same principle as in taxation. It may be debatable, but one can illustrate the difficulties that surgeons are up against with a certain patient of my own.

He was a small contractor who broke his leg while at work. I was the family doctor, and sent him to the hospital where the fracture was reduced, and the leg put into the usual form of splint for that type of injury. The treatment of fractures is largely mechanical, the object being to get the bones into their natural position, and immobilize them in that position. Providing these principles are adhered to, with proper after-care, nature gives a result which is usually perfect. Fractures, however, are the bane of a surgeon’s life. They require constant attention to keep them in their proper position, and if the fracture fails to heal properly the patient becomes a walking monument to the inefficiency of the attending surgeon; added to which there is always the danger of a suit for malpractice. Many surgeons for these reasons refuse to treat fractures at all, but a general practitioner in a small city cannot refuse. I have had the good fortune throughout my practice to have had sufficiently good results to keep me out of trouble. This case was no exception so far as what is called a “functional” result goes, that is, the leg functioned as well after the fracture had healed as it ever had; but as this case occurred before the X-ray was used to any great extent, and we were without one in my small city, I had set the fracture by manipulation. The tibia (that is, the shinbone) healed in such manner that there was a slight unevenness as one ran his fingers down over the sharp edge of the shin, which in no way interfered with a perfect functional result, although under present conditions with an X-ray examination from day to day this unevenness might have been completely avoided—or it might not. Many months after the fracture had healed, and the man was back at his work and walking as well as ever, it occurred to me that though he had been sent a couple of accounts he had not paid anything on them. Meeting him one day on the street, I good-naturedly reminded him that I had done a good deal of work for him and his family, and was a little hard up, adding that a little money on his account would not be hard to take.

“Well, you know, Doctor,” he said, “this is not altogether a perfect result you have given me”; and he took my hand and ran it down over the shinbone, where could be felt a protuberance of perhaps a quarter of an inch. “You know,” he added, “if I showed that to a jury, they would think it was a pretty bad result.”

Blustering a little angrily at his ingratitude, I told him he was expected to pay his account, but never again sent the bill and have yet to receive a cent on the account, though he is still a fairly successful contractor, with two normal legs. He was, of course, merely unscrupulous enough to profit by the knowledge that if sued, and in retaliation he should bring me before a jury for malpractice, the jury might falsely conclude that a fracture which was palpable afterwards had been a bad result, and might well give him a judgment against me. In reality he knew and I knew that he had as perfectly useful a leg as he had ever possessed. But no doctor can afford to take a chance of being drawn into suits for malpractice, no matter how unjust those suits may be, since human nature is prone to think the worst about anybody anyway, and besides, malpractice suits do not help a doctor’s reputation.