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diff --git a/old/60101-0.txt b/old/60101-0.txt deleted file mode 100644 index 03428a3..0000000 --- a/old/60101-0.txt +++ /dev/null @@ -1,6447 +0,0 @@ -The Project Gutenberg EBook of Large Fees and how to get them, by -Albert V. Harmon and George Frank Lydston - -This eBook is for the use of anyone anywhere at no cost and with -almost no restrictions whatsoever. You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org/license - - -Title: Large Fees and how to get them - A book for the private use of physicians - -Author: Albert V. Harmon - George Frank Lydston - -Release Date: August 14, 2019 [EBook #60101] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK LARGE FEES AND HOW TO GET THEM *** - - - - -Produced by MWS, Barry Abrahamsen, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive/American Libraries.) - - - - - - - - - - LARGE FEES - AND HOW TO GET THEM - - --- - - A BOOK FOR THE PRIVATE USE - OF PHYSICIANS - - --- - - BY - ALBERT V. HARMON, M.D. - - WITH INTRODUCTORY CHAPTER BY - G. FRANK LYDSTON, M.D. - - - - W. J. JACKMAN, PUBLISHER - 121–127 PLYMOUTH COURT - CHICAGO - - ------------------------------------------------------------------------- - - - - - Copyright, 1911 - By W. J. JACKMAN - - - - ------------------------------------------------------------------------- - - - - - LARGE FEES - - AND - - HOW TO GET THEM - - - - ------------------------------------------------------------------------- - - - - - CONTENTS - - - ------- - - CHAPTER I. - - MEDICINE AS A BUSINESS. Why Medicine as 11 - Ordinarily Followed Is a Failure From the - Business Standpoint—Physicians Themselves - Mainly Responsible—Queer Ideas About - Philanthropy—Poor Business Methods—Tactics - that Pauperize One-half the - Patients—Doctors Easy Prey for - Sharpers—Evils of Medical - Colleges—“Charitable” Hospitals Injure - Regular Practitioners—Free Clinics and - Dispensaries—The Medical “Tin - God”—Absurdities of Ethics—How Some - Physicians Get Notoriety—Freaks of the - Profession—Things the Young Practitioner - Should Avoid - - - CHAPTER II. - - THE PHYSICIAN WHO SUCCEEDS. Qualifications 31 - for a Big Fee-Getting Practitioner—The Kind - of Men Who Make Money in the Practice of - Medicine—Business Mistakes in the - Profession—Why Many Doctors - Fail—Old-Fashioned Ideas as to Set Fees—No - Reason Why Physicians Should Not Use - Judgment in Placing a Monetary Value on - Their Services—Prompt Collection of Bills - an Important Item—Attorneys, Architects, - and Other Professional Men Afford Good - Examples of Business Sense—The Beard and - Its Dangers—Necessity for Scrupulous - Cleanliness—An Experience in Iowa—Reasons - Why Many Physicians Fail—Psychological - Factor an Important One - - - CHAPTER III. - - THE BUGBEAR OF ETHICS. Intimidation of Young 43 - Physicians—Overdoing the Ethical - Proposition—Spying on the Beginners - Illogical Advice—How Some Men Become - Wealthy and Famous by Doing the Very Things - They Denounce in Others—Clever Evasions of - the Code—Schemes by Which Valuable - Publicity Is Obtained—Actual Incidents - Illustrating Methods Prevalent Among - Physicians Who Keep Themselves Constantly - Before the Public—Working the - Newspapers—Employment of Press Agents—How - They Get Free Write-ups for Their - Principals—Fine Work by a Chicago Man in - Popularizing a New Treatment—The Making of - a Sensation—Newspaper Story that Made - Certain Ethical Gentlemen - Wealthy—Administration of Unknown - Preparations by High Apostles of Ethics - - - CHAPTER IV. - - LAWFUL TO ADVERTISE. Publicity Within Certain 61 - Lines Necessary and Legitimate—Progressive - Physicians Ignore Old Rule—Courts Uphold - Right of Doctors to Make Their - Qualifications Known in the Public - Press—Time Brings Radical Changes—Numerous - Reasons Why a Competent Practitioner Should - Advertise—Futility of “Ethical” - Opposition—Severe Judicial Rebuke for - Medical Society Leaders Who Attempt to - Debar and Discredit Men Who - Advertise—Finding in the Celebrated Dr. - McCoy Case—Indecent and Obnoxious - Advertising—The Proper Kind—How to Obtain - Valuable Publicity in a Dignified Manner - - - CHAPTER V. - - GETTING COUNTRY PATIENTS. Making Connection 73 - With Prospective Patients—Again, the - Intelligent Use of Newspapers—First Steps - to Be Taken in the Location of Good - Cases—Correspondence an Important - Feature—The Kind of Letters that Inspire - Confidence and Bring Patients to the - Doctor’s Office—What a Physician Should and - Should Not Say in His - Correspondence—Specimen Letters—The Danger - Line in Correspondence—Effect of the Right - Kind of Letters—Humoring the Family - Physician—Getting in Touch With the - Latter—How to Make Him a Friendly - Co-operator—Arranging for Country - Trips—Proper Method of Procedure—Working on - a Business Basis—Schedule for Receiving - Callers—Reception of Stranger - Doctors—Division of Fees to Secure Their - Support—Treatment of Country Patients—How - Big Fees Are Obtained - - - CHAPTER VI. - - RECEPTION OF OFFICE PATIENTS. Attractive 93 - Quarters the First Essential—How to Select - and Furnish Rooms—Reception of Strangers on - Arrival—Separation of Callers—Reception - Room Attendant an Important Factor—The Kind - that Wins—Hints on Treatment of - Callers—Recourse to Correspondence File - Vitally Essential—How Letters Should Be - Kept in Order to Get the Necessary - Information Speedily—Letters Frequently - Give Clues as to the Writer’s Business - Calling and Financial Responsibility—Object - in Making Callers Wait Before Physician - Receives Them—How the Reception Room - Attendant May Become a Valuable - Ally—Stenographers Should Be Kept Out of - Sight - - - CHAPTER VII. - - THE CORRESPONDENCE FILE. Proper Handling of 103 - Correspondence One of the Vital Essentials - to Success—Life Blood of the Specialist’s - Practice—Right Kind of Correspondence Clerk - an Indispensable Ally—Method of Keeping - Letters on File So as to Secure Best - Results—Sample Letters that Bring Large - Financial Returns—Methods of a Competent - Correspondence Clerk—How He Makes Money for - His Employer—Tracing the Financial Rating - of Strangers—Securing Names and Addresses - of Prospective Patients—Utilization of - Newspaper Clippings—“Follow-up” - Systems—Advantage of Using Plain Envelopes - in Writing to Strangers—Obtaining - Testimonial Letters from Patients—Use of - These Letters in Attracting New - Comers—Conducting Correspondence With - People in Small Towns—Purpose in Avoiding - Duplication of Testimonials - - - CHAPTER VIII. - - GETTING AT FINANCIAL STATUS. How to Ascertain 119 - the Monetary Resources of Callers Who - Appear Unannounced—Line of Conversation - That Will Lead Any Man to Unwittingly - Reveal His Financial Standing—Free - Examinations and How Smart Specialists Make - of Them a Big Drawing Card—Bringing a - Caller to the Point of Submitting to an - Examination—Means by Which an Impression is - Made—Benefit in Keeping an “Assistant” - Within Handy Reach—Clinching the Caller as - a Patient—Avoiding the Naming of a Definite - Time for Treatment—Reasons Why Some - Specialists Fail to Obtain Good Fees—Lack - of Tact in Getting at a Caller’s Ability to - Pay a Reasonable Fee—Crude Tactics that - Defeat the Purpose of the Physician—Danger - in Too Much Haste and Rash Promises—Modesty - Properly Applied the Great Winner - - - CHAPTER IX. - - DECIDING UPON THE FEE. Value of Psychological 131 - Influence in Acting at the Right - Moment—Just as Easy to Get Big Fees as - Small Ones—Experience of a Young - Physician—Great Difference in Patients—An - Exhibition of “Gall”—Incubus of the Old - Dollar-Fee System—When to Name the Fee and - How to Fix Upon the Amount—What the - Practitioner Should Say and Do in Order to - Secure Large Payments—How Reduction May Be - Gracefully Made When a Patient Protests - Against the Amount—Dealing With “Tight - Wads”—How to Skilfully Dangle the Bait of - Health Without Actually Promising - Results—Taboo on the Word “Cure”—Bringing - the Caller Who Hesitates Down to the Point - of Positive Action—System to Be Followed in - Deciding Upon Amount of Fee a Patient Will - Pay - - - CHAPTER X. - - GETTING FEES IN ADVANCE. How the Money May Be 141 - Secured Before Treatment Is Started—Undue - Haste, or Evident Desire to Get the Cash, - Bad Policy—Putting the Patient’s Mind in - Condition to Make Advance Payment—A - Successful Fee Getter’s Line of - Talk—Creation of Confidence in the - Physician’s Ability and Honesty the Main - Factor—Making Sure of Payment When Partial - Credit Is Extended—Method of Drawing Notes - That Are Readily Negotiable and - Non-Contestable—Inducing Patients to Sign - Iron-Clad Notes—When and How to Act—Turning - Checks and Notes Into Cash—Weeding Out the - Payers and Non-Payers—What to Say When a - Patient Objects to Signing a Note—Smart Man - Easiest to Deal With—Instance in Which a - Banker Paid a $2,500 Fee Twice—How a - $10,000 Fee, Definitely Settled Upon, Was - Lost - - - CHAPTER XI. - - GETTING ADDITIONAL FEES. Patients Who Have 153 - Paid Big Fees for Treatment Almost - Invariably Good for a Second Payment—Lines - Upon Which More Money May Be Had—Men of 50 - Years and Over Gold Mines When They Have - the Means—How to Handle Them—Dangling the - “Sexual Vigor” Bait in a Delicate and - Effective Manner—Suggestions of - Supplementary Treatments That Bring - Additional Fees—Arrangements With - Occulists, Pharmacists, Surgeons and - Instrument Dealers That Add Materially to - the Physician’s Income—How Patients Are - Induced to Patronize the Specialist’s - Allies—Secret Ciphers That Result in - Extravagant Charges—Division of the - Proceeds—Adventure With an - Undertaker—Doctors Who “Sponge” Upon Their - Professional Brethren - - - CHAPTER XII. - - PROPER HANDLING OF NOTES. Kind of Note That 171 - is Negotiable and Easily Discounted—Manner - in Which Such a Note Should be - Drawn—Defects in Ordinary Form of - Promissory Note—Ease With Which Payment May - Be Evaded or Delayed—Difficulties in the - Way of Enforcing Collection—An Iron-clad - Promise to Pay That Binds the - Maker—Avoidance of Litigation and Attendant - Expense—What to Do With Notes When Taken - for Medical Services—How to Dispose of - “Paper” to Bankers Who Know the Financial - Responsibility of the Signers—Successful - Method of a Chicago Physician Who Handles - Considerable “Paper”—The Collection Agent - Evil - - - CHAPTER XIII. - - PRESCRIBING OF REMEDIES. Why Physicians 179 - Should Dispense Their Own - Prescriptions—Trouble With Present System - of Drug-store Dispensing—Number of Drugs - Actually Required in Practice - Limited—Duplication of Prescriptions by - Pharmacists an Injustice to - Doctors—Proprietary Medicine - Fakirs—Prescribing Secret Formula - Preparations—How Many Practitioners Are - Hoodwinked—Positive Injury in Prescribing - Remedies by Trade Names—Violation of Code - in Using Preparations With Unknown - Ingredients—Value of Mystery in the - Administration of Drugs—Unwise to Let - Patients Know Too Much About Their - Prescriptions—Why All Remedies Should Be - Designated in Latin—Views of Dr. Osler on - Drug Prescribing - - - CHAPTER XIV. - - MEDICAL “STEERERS” AND THEIR WORK. Method by 187 - Which Many Physicians Obtain Patients—Men - Who Make a Business of Directing Invalids - Where to Go for Treatment—Commercial - Diplomats—Their Style of Work—Large - Incomes—How Sufferers Are Approached—The - Kind of Talk That Wins the Confidence of - the Sufferer—Directing the Victim to a - Physician—Landing the Patient in the - Doctor’s Office—The Steerer’s - Commission—How He Protects Himself and - Insures Square Treatment by the - Doctor—Opportunities for Obtaining - Patients—Leading Hotels Favorite Places of - Operation—Old Brace Faro Game Worked in New - Form—Women Steerers and Their Methods - - - CHAPTER XV. - - WHAT SHOULD THE PHYSICIAN DO? Various 195 - Remedies Proposed for Existing - Conditions—Too Many Doctors in the Land—Not - Enough Patients to Go Around—What the - Medical Colleges Are Doing—Over 5,000 - Doctors Made Every Year in the Strictly - Ethical Schools Alone—Temptations of Young - Physicians—What Men Like Dr. Evans and Dr. - King Have to Say—Prominent Practitioners - Endorse Division of Fees as an Act of - Justice—Prof. George Burman Foster on the - Profession as Allied to Business—No Reason - Why There Should Be Any Distinction Between - the Two - - - CHAPTER XVI. - - CORPORATION DOCTORS. Evils of the Contract 207 - Plan—How It Injures the Regular - Practitioner and the Contract Doctor - Himself—Miserly Economy by - Corporations—Disastrous Competition Among - Physicians—Life Insurance Examiners and - Their Lack of Business Sense—Moral as Well - as Medical Honesty Dwarfed by the - Corporation System—Contract Doctors - Expected to Hide the Truth to Retain Their - Jobs—Beggarly Salaries Paid by - Corporations—Practice Wrongfully Diverted - from Doctors Entitled to It—Collusion - Between Corporation Doctors and Claim - Agents—Sick and Injured Employees Often - Induced to Sign Away Their Rights by - Misrepresentation or Intimidation—The - Drawbacks of Promiscuous Fraternizing - - ------------------------------------------------------------------------- - - - - - PREFACE - - -There are some methods explained in this book which the author does not -endorse. They are printed because they are necessary to a thorough -understanding of the subject. Newspapers publish reports of murders, but -this does not imply endorsement of the crimes. - -Aside from these features there are many things which the practicing -physician may read and follow to his advantage. The introductory chapter -by Dr. Lydston will be found to be of special interest. - - THE AUTHOR. - - - - ------------------------------------------------------------------------- - - - - - CHAPTER I - - =MEDICINE AS A BUSINESS= - - By G. Frank Lydston, M.D. - - -As a general proposition it is safe to assert that the practice of -medicine from a business standpoint is a failure. The successful -exceptions merely prove the rule. It is also safe to assume that the -elements of financial non-success are cumulative in their action—a fact -that is easily proved by hospital and dispensary statistics. - -The practitioner of medicine, like every man who relies on his own hand -and brain for a livelihood, is entitled to a bit of earth that he and -his may call their own, at least a modest competence, and a well-earned -rest when his sun begins to set and the twilight of his life approaches. -How many doctors are in a position to enjoy or even render less awesome -their twilight days? As city doctors are all supposed to be rich—at -least by the public, that does all it can to prevent their becoming -so—it would be interesting to know what proportion of them, even in -metropolitan medical centers, own their own homes or have property -investments. A far smaller proportion than is just, I fancy. - -The assertion has been made that the general poverty of the medical -profession is due to a lack of appreciation and a contempt for the -rights of the medical man on the part of the public at large. This, -however, is a secondary matter which, being self-evident, overshadows -the primary cause—the asinine stupidity of the profession itself. As a -broad, general proposition the reputable profession as a whole has about -as much sense as the dodo, and, unless signs fail, will, sooner or -later, meet the fate of that remarkable bird. How the profession can -expect the respect and appreciation of the public when it has no respect -or appreciation for itself is difficult to conjecture. The public cannot -be expected to keep clean the nest of the medical dodo. Furthermore, the -public quite rationally values the stupid thing according to its -self-appraisement. - -Primarily, the practice of medicine is supposed to be founded on a -mawkish, blanket-like sentiment of philanthropy, which is expected to -cover both God’s and the devil’s patients—the pauper and the -dead-beat—the honest man and the rascal—the rich and poor alike. The -doctor is expected to wallow eye-deep in the milk of human kindness, -scattering it broadcast for the benefit of humanity, but he is in no -wise expected to even absorb a little of it, much less to swallow a gulp -or two occasionally for his own benefit. By way of piling Pelion upon -Ossa, the public, having discovered that the doctor sets little value on -his own services, proceeds to eye him with suspicion; the tradesman is -very careful how he trusts doctors. Of course the tradesman has his own -family physician “hung up” for a goodly sum, but—knowing doctors to be -poor business men—the tradesman often cheats them in both the quality -and price of goods. - -It is a great and goodly game that plays from both ends and catches the -victim in the middle. The tradesman has one redeeming feature, however; -he does his best to teach his doctor patrons a lesson. He either sends -his goods C.O.D., or, if the doctor be one of the favored ones, he finds -the bill in his mail bright and early on the first of the month. I often -think my tradesmen must sit up all night in order to get their bills in -bright and early on the first. If not paid by the 15th, a collector is -usually at the doctor’s office to see about it. - -Yet the professional dodo—my apologies to the shade of the “sure enough” -dodo—will not learn. He goes on and on, neglecting his accounts, mainly -because he is afraid of offending his patrons and driving them off to -some other doctor who isn’t so particular; and the worst of it is, there -are plenty of contemptible fellows who draw their own salaries promptly -when due, or present their bills for goods with frantic haste, who -consider a doctor’s bill a flagrant insult. Will nothing ever inspire -the doctor with courage enough to despise and ignore such contemptible -trash? Does he prefer the role of a lickspittle to that of an -independent and self-reliant man? - -As illustrations of the value the profession sets on its skill and -learning, the amount of gratuitous work done is striking. Our pauper—or -pauperized—patrons are divided into several classes, viz.: 1. The free -hospital, clinic and dispensary class. This is on the increase. -According to Dr. Frederick Holme Wiggin, 51 per cent of all cases of -sickness in New York City are now classed medically as paupers, as -against 1.5 per cent twenty years ago! This is appalling. Of these -alleged paupers it is safe to say that 75 per cent are able to pay full -or at least fairly good fees. Why should pauperism be shown so -prominently in the matter of medical bills, as compared with other -necessities of life? And why should the profession carry a burden that -belongs to the public? 2. Free patients of the private class: (a) those -who can pay but will not, _i.e._, dead beats, and swindlers; (b) persons -whose circumstances are such that the doctor feels in duty bound to -render no bills; (c) persons who presume upon social acquaintance with -the doctor to “hold him up” for friendly, perhaps informal, -consultations. - -It requires no great mental effort to see the terrible load the -profession is carrying—self-inflicted, and often for fallaciously -selfish motives, it is true, but none the less heavy. The college and -free hospital may be the professional “old man of the sea,” but so much -the worse for the medical Sinbad. Whatever the explanation, private -practice is on a par with dispensary practice with regard to the -impositions practiced on the doctor. It is safe to say that, of the sum -total of surgical and medical patients of all kinds and social -conditions under treatment in Chicago at the present time, over one-half -are paupers—honest or dishonest. Pay the doctor for the work involved in -this wasted and misapplied charity, and the medical profession would -plunge into a sea of prosperity that might swamp it. And it is not only -the rank and file of the profession that suffers. Ye celebrated -professor, reaching out for glory, yea, into infinite space, clutching -frantically at everything in sight, no matter how profitless—providing -the other fellow doesn’t get the case—often defeats his own ends. And -the great man dies, and is buried, and we take up a collection for his -widow, to meet his funeral expenses, and sell his library—six feet of -earth make all men of a size. _Sic transit gloria mundi._ - - And when, like dog, he’s had his day, - And his poor soul hath passed away, - Some friendly scribe in tearful mood - Will tell the world how very good - The dear departed doctor was— - And thus win for himself applause. - -One of the most potent causes of professional poverty is the mania of -the doctor for a pretense of well-doing. He exhibits this in many ways. -One of the most pernicious is an affectation of contempt for money. This -it is that often impels him to delay the rendering of his accounts. -Oftentimes his patient offers to pay all or part of his bill. With a -lordly and opulent wave of his marasmic hand the doctor says, “Oh, -that’s all right; any time’ll do.” And the triple-plated medical -imbecile goes on his way with a dignified strut that ill befits the -aching void in his epigastric region, and is decidedly out of harmony -with the befringed extremities of his trousers. And then the doctor -apologizes to himself on the ground of a philanthropy that is but the -rankest and most asinine egotism _en masque_. - -When will the doctor understand that payment deferred maketh the patient -dishonest? When will he consider the necessities of his wife and -children as outweighing the feelings of the patient who owes him money? -When will he be a man, and not a time-server and truckler to -appearances? He would take the money did he not fear the patient might -suspect that his doctor was not prosperous. He wishes the patient to -think that the doctor and his family dine with the chameleons, or are -fed by ravens. Yet the medical Elijah waiteth in vain for the -manna-bearing birds—they know him for what he is, a counterfeit prophet -who vainly yearns for the flesh-pots of Egypt—who has a ponderous and -all-consuming desire for pabulum, and a microcephalic capacity for -finance. - -Doctors are supposed to be keen judges of human nature. I often think -this is absolutely without foundation. Defective knowledge in this -direction is a very expensive luxury to the medical profession. The -confidence man and sharper cannot fool the average doctor into buying a -gold brick, perhaps, but they can come very near it. The oily-tongued -and plausible man with a scheme finds the doctor his easiest prey. The -doctor has often hard enough work to wring a few dollars out of his -field of labor, and it might be supposed that it would be difficult to -get those dollars away from him, but no, it’s only too easy. He bites at -everything that comes along—he often rises to a bare hook. Mining -stocks, irrigation and colonization schemes, expensive books that he -doesn’t want, will never need and couldn’t find time to read if he -would, histories of his town or state in which his biography and picture -will appear for $100—proprietary medicine schemes, stock in publications -of various kinds; he bites at everything going—he has _embonpoint -cerebrale_. Oh, but the doctor is easy! I have very painful memories. -The best investment I ever made was when I paid a fellow for painting a -sign for the door of my consultation room, reading: “Notice—Persons with -schemes will please keep out. I have some of my own to promote.” - -It is rather a delicate matter, perhaps, for a college professor to -touch on the evils of medical colleges in their relation to the business -aspect of medicine, but I shall nevertheless speak plainly and to the -point. While theoretically the better class of medical colleges were -founded solely for the advancement of science, it is none the less true -that self-aggrandizement has been the pedestal on which most of our -disinterested giants in the teaching arena have stood and are standing. -Remove the personal selfish interest of college teachers and most of our -schools would be compelled to close for lack of instructors. Let us be -honest with ourselves, please. Not that self-interest is reprehensible—I -hold the contrary. One may teach for salary, reputation, the love of -teaching, or a desire for self-improvement, it matters not, for if he be -of the proper timber he is the right man in the right place. -Self-interest makes better teachers on the average than philanthropy, -providing the primal material is good. - -Granting that self-interest is the mainspring of the college professor, -is he very “long-headed” from a business standpoint? I submit the -following propositions as proving that the average college professor -defeats his own ends. - -1. He devotes to teaching, time and labor over and above the exigencies -of ordinary practice, which, if devoted to cultivating the good-will of -the laity, would be much more profitable. - -2. While cultivating the acquaintance and friendship of the alumni of -his own school—a few each year—he alienates from himself the friendship -of every alumnus of every rival school, the instant he begins teaching. - -3. He assists in educating and starting in life young, active -competitors to himself. - -4. He is unreasonably expected to devote a large percentage of his time -to the gratuitous relief of medical students and physicians. He may give -his time cheerfully, but he yields up his nerve force just the same. - -5. Most college professors are less successful in the long run than the -more fortunate ones of the rank and file who have never aspired to -teaching honors. - -6. Greater demands are made on a professor’s purse than if he were in -the non-teaching ranks of medicine. He, more than all others, is -expected to put up a prosperous appearance. - -The college clinic—especially of the surgical sort—is far-reaching in -its detrimental effects on professional prosperity. Few or no questions -are asked, and the millionaire is being operated on daily, side by side -with the pauper, free. And the blame does not always lie with the -professor who runs the clinic. General practitioners bring patients to -the free clinics every day, with full cognizance of their ability to pay -well. Why doctors will persist in thus cheapening surgical art is -difficult to conjecture—but they do it just the same. - -Of course, the college clinic is supposed to be a theater of -instruction. Often, however, it is but a stage on which comedy-dramas -are enacted. A brilliant operation that nobody six feet away can see, -and an operator bellowing at his audience like the traditional bull of -Basham—in medical terms that confuse but do not enlighten, terms that -are Greek to most of the listeners—this is the little comedy-drama that -is enacted for students who have eyes but see not; who have ears but -hear not. Instruction? Bah! Take the theatric elements and the plays to -the gallery out of some college clinics and there wouldn’t be a -corporal’s guard in attendance. - -Worse than the free clinics are the so-called charitable hospitals. Much -has been said of dispensary abuses, but few have had the courage to say -anything in adverse criticism of these institutions. While nominally -founded to fill “a long-felt want”—and the number of long-felt wants, -from the hospital standpoint, is legion—these hospitals are founded on -strictly business principles, save in this respect—the people who found -them feed on their innate capacity to get something for nothing. The -first thing the founders do is to get a staff of doctors to pull the -hospital chestnuts out of the fire. The members of the staff think that -the hospital is performing the same duty for them, and everything is -serene. And so the surgeon goes on operating on twenty patients—fifteen -of whom are able to pay him a fee—in the hope that one among them all is -_willing_ to pay him a fee. - -Exaggeration? Well, I cannot swear to the accuracy of the foregoing, but -an eastern surgeon of world-wide fame once told me that for every -patient who paid him a fee he operated on nineteen for nothing; and this -man has no public clinic, either. Is it conceivable that the nineteen -free patients are all paupers? Many of them go to my friend for -operation from very long distances. Ought the railroads and hospitals to -have all the profits? Have we not all had similar experiences in a -lesser degree? With the development of charitable hospitals far in -excess of any legitimate demand, it has come to pass that surgery is -almost a thing unknown in general city practice. Even the minor -operations have left the general practitioner—to return no more so long -as there are free hospitals and dispensaries. Where is the emergency -surgery, of which, in former days, every practitioner had his share? -Railroaded off to the “charity” hospitals to be cared for gratis. - -In a recent conversation with a practitioner of thirty years’ -experience, I said, “Doctor, you used to do a great deal of general -surgery throughout this section of the city. Have the hospitals affected -your practice in that direction to any extent?” He replied, “Surgery -with me is a thing of the past. Even emergency cases are carted off to -the nearest hospital. If by chance one does fall into my hands, it is -taken away from me as soon as I have done the ‘first-aid’ work.” -Personally, I see very little use in teaching surgery to the majority of -students who intend to practice in our large cities—they will have -little use for surgical knowledge. - -Here are three cases in illustration of the way our “charitable” -hospitals antagonize the business interests of the profession: - -1.—A very wealthy farmer engaged me to perform an exceedingly important -operation. It was understood that $1,000 was to be the honorarium. He -was afterwards advised to go to a certain “religious” hospital, where he -was operated on by an eminent surgeon, who received nothing for his -services. The patient paid $15 a week for hospital accommodation, and -$25 a day to his family physician, who remained with him “for company.” -What a harmonious understanding between the patient and his family -doctor—and what a “soft mark” that surgeon was. I had the pleasure of -telling the latter of the gold mine he didn’t find, some time later, and -the shock to his system amply revenged the body surgical. - -2.—A patient who was under my care for some weeks and paid me an -excellent fee finally divulged the fact that he had meanwhile been -living at a certain hospital as an “out patient,” at an expense of $8 a -week. He had become dissatisfied with the hospital attention, he said, -and, pretending great improvement, was permitted to get about -out-of-doors. - -3.—A man on whom I operated and who paid me my full fee without argument -or question, came to me directly from one of our large hospitals, where -he had been sojourning for several months. - -That medical men in hospitals are imposed on is a trite observation. So -long, however, as it appears to be the doctor’s advantage to be on a -hospital staff, plenty of men will be found who will be glad of the -chance. As for the injury which the system inflicts on the profession at -large, that is no argument with the individual. Human nature operates -here as elsewhere. Knowing that the system is bad, we are all anxious to -become victims. - -In recommending the payment of salaries to hospital men, the Cleveland -_Medical Journal_ claimed that such a plan will remedy all the evils -incident to the professional side of hospital management. I do not agree -in the opinion that the payment of salaries to the staffs of -institutions for the care of the sick will alone correct the evils of -such institutions. The writer of the aforesaid editorial is incorrect, -also, when he says that an awakening is at hand. No, not at hand; it is -coming, though; the handwriting is on the wall. When the revolution does -come, this is what will happen: - -1.—Hospital physicians and surgeons will be paid salaries. - -2.—Hospitals will take as free patients or patients who pay the hospital -alone only such persons as rigid investigation has shown to be indigent. -All others will be compelled to pay their medical attendants, just as in -private practice. - -3.—Certificates of indigency will be required of every free patient, -such certificate being signed by the patient’s attending -physician—outside of the hospital—and at least two other persons in the -community where he or she resides. - -4.—General, and especially country, practitioners will cease to deceive -hospital doctors as to the circumstances of their patients. One medical -man should not impose on another. - -Too much trouble, eh? Well, my friends of the hospital and -dispensary—for the same charges should apply to the latter—you must -either take your medicine or the revolution will go farther and this is -what will happen: The profession at large will boycott every man who -runs a college clinic, and every hospital and dispensary man. It will -fight colleges and hospitals to the bitter end. - -The day is perhaps not far distant when doctors outside of colleges and -hospitals will run their private practices on the co-operative plan, -thus dealing a death blow to the free clinic and dispensary. Every man -of prominence will have his own private clinic and advertise it among -his patients. What is fair for twenty or thirty men is fair and ethical -for one. Each man can have his own hours for the poor; he can eliminate -the unworthy ones, and, best of all, he can refer all his dead-beat -patients to his clinic. Pride may bring fees from patients to whom -honesty is a thing unknown. The private hospital will run most of the -public hospitals off the earth. There will be no room for anything but -municipal hospitals run squarely and fairly for charity, and reputable -private hospitals run frankly for pecuniary profit, in which the -operation and the attendance fees are the chief factors. Such hospitals -will benefit, not hurt, the profession. - -One of the most vital flaws in the business sense of the general -practitioner is his penchant for hero worship. He hears of the medical -tin god from afar, and burns incense on the altar of his greatness. The -great man pats the humble doctor on the back, calls him a good boy, and -tells him just where to take all his cases. Sometimes he offers to -divide fees with him. - -The medical tin god is truly a “self-made man in love with his maker.” -He has “genius stamped upon his brow—writ there by himself.” His -evolution is interesting. It is history repeating itself: Apsethus the -Libyan wished to become a god. Despairing of doing so, he did the next -best thing—he made people believe he was a god. He captured a large -number of parrots in the Libyan forests and confined them in cages. Day -after day he taught them to repeat, “Apsethus the Libyan is a god,” over -and over again. The parrots’ lesson learned, Apsethus set them free. -They flew far away, even into Greece. And people coming to view the -strange birds, heard them say, “Apsethus the Libyan is a god; Apsethus -the Libyan is a god.” And the people cried, “Apsethus the Libyan is a -god; let us worship Apsethus the Libyan.” Thus was founded the first -post-graduate school. - -The medical Apsethus and the deluded parrots of the medical rank and -file are here, and here to stay, until both are starved out. And the -modest general practitioner looks up to the medical tin god and wonders -“upon what meat does this our Cæsar feed that he hath grown so great?” -The meat of industry? Perhaps. The meat of prodigious cerebral -development? Seldom. The meat of opportunity? Yea, yea, my struggling -brother, “and the devil take the hindmost.” But, more than all, he hath -fed on the meat that the parrots have brought him—Elijah’s ravens were -not a circumstance to those parrots. “In the kingdom of the blind the -one-eyed man is king.” - -How long will the general practitioner continue to play parrot to the -medical tin god of the charitable hospital the very existence of which -is a menace to the best interests of the profession—the profession for -which the institution has no charity? In that happy time to be there -will be no tin gods. There will be a more equable division of work and -every prosperous community will have its up-to-date private hospitals -with up-to-date men at the head of them. - -As for the post-graduate teacher—good or bad—he is already defeating his -own ends—he is exciting ambitions in the breasts of his pupils. Here and -there among them is an embryo McDowell, a Sims, or a Battey. The -backwoods country produces good, rich blood and virile brains. And the -Sims, and McDowells, and Batteys of the future will be found in -relatively small places, doing good work, and then—good-bye to the tin -god and his horn, “for whosoever bloweth not his own horn, the same -shall not be blown.” And in that day the parrot shall evolve into an -eagle, and the hawk had better have an eye to windward. Meanwhile, -hurrah for the post-graduate school and its pupils, and more power to -the tin gods. - -This business handicap is so self-evident that it is hardly necessary to -touch on it. We raise the standard of medical education year by year, -yet the mushroom colleges do not go—they are here to stay. If one-half -the colleges were wiped out of existence there would still be more than -enough to supply the demand for physicians. We have done the best we -could to breed competition by manufacturing doctors, and we are doing -all we can to make that competition first class—a queer business -proposition in force of the oversupply of doctors. We are unjust, too, -to the men we educate, by offering them inducements to enter an already -overcrowded profession—but so long as human nature is as it is I see no -way out of the dilemma. - -There was once a time when it appeared a goodly thing for the chosen few -to get together like the “three tailors of Tooley street,” and, after -establishing to their own satisfaction the fact that they were indeed -“the people,” formulated rules for the guidance of the many. These rules -were called “ethics.” And the profession has been wrestling with its -ethics ever since, trying to determine what it was all about anyhow. The -ethical garment of half a century ago no longer fits—it is frayed and -fringed, and baggy at the knees; full many a patch has been sewed on it, -in individual attempts to make it fit from year to year, until it is -now, like the Irishman’s hat, respectable by age and sentimental -association only. And the public, the ever practical and heartless -public, has also wondered what ’twas all about, and exhibits little -sympathy for a profession which, while driveling of ethics, has -“strained at gnats and swallowed camels.” - -Who does not remember when all the wiseacres with number eighteen -collars and number five hats seriously discussed the relative propriety -of “Specialty” vs. “Practice Limited,” on professional cards? How times -have changed. And then came the discussion by a learned society, of the -ethical relations of “Oculist and Aurist” to “Practice Limited to -Diseases of the Eye and Ear.” And it was decided that men who had the -former on their cards were not ethical and could not enter that society. -Ye Gods! Is the fool-killer always on a vacation? Must we always see -those long ears waving over the top of the ethical fence, built by the -fat hogs to keep all the little pigs out of the clover patch? What is -the public to think of a profession that winks its other eye at the man -who prints on his cards, “Diseases of Women Only,” but rolls up it eyes -like a dying rabbit at the sight of a card reading, “Diseases of Men -Only?” What has raised the woman with leucorrhea to a more exalted plane -than that occupied by a man with prostatorrhea, does not appear. Why so -many inconsistencies, and why such hypocrisy! - -Sir Astley Cooper had his own private “hours for the poor.” Our European -brethren print their college and hospital positions and all their titles -on their cards. Are they less ethical than we? Homeopathy is a dead duck -over there, and quackery has a hard row to hoe in Europe—queer, isn’t -it? - -Our system of ethics has not only been hypocritic, but somewhat -confusing. The young man on the threshold of medicine doesn’t know -“where he is at.” He is confronted by the unwritten law that only -celebrated men and quacks may advertise. Small fry, who haven’t the ear -of the newspapers nor a chance for a college position, are tacitly -ordered to keep their hands off. And the young fellow watches the career -of the big man, who hides every other man’s light under his own bushel, -and marvels much. Especially does he marvel at the accurate photographs, -life histories and clinical reports of his more fortunate confrères that -appear in the newspapers without their knowledge. - -Experiences differ. I haven’t yet got around to newspaper clinical -reports, but it has been my fortune to be “written up” on several -occasions. I do not recall that the newspapers drew on their -imaginations for my photograph. I wish I might think so, and that their -imaginations were distorted—the result was so uncomplimentary. - -So far as I can learn, nobody protests against being legitimately -represented in the newspapers. Why not be honest about it? The hypocrisy -of some men is sickening. Paying clandestinely for newspaper write-ups -is despicable, yet some of the very men who protest that they “really -don’t see how that could have gotten into the papers,” have paid for the -advertising in good “coin of the realm.” It is queer that the newspapers -should write up the most minute details of the wonderful exploits of -some poor fellows, together with their family histories, and publish -their photographs, without their knowledge or consent—especially queer -when we read in conclusion that “Professor John Doe is the greatest -surgeon that ever lived.” Why not come out and acknowledge that these -are paid for? This would give an equal chance to all, and especially to -young fellows who have money enough to pay for similar things. He who -has not the price should not find fault with the fellow who has, for, -“business is business.” Meanwhile, my young friends, remember that “big -mountains may do what little mountains may not do.” - -When Koch’s tuberculin was yet new, soon after it escaped, half-fledged -from the laboratory, only to be captured and made to perform like a -trick monkey for the benefit of the laity, there came a ring at the -phone of a prominent daily paper: “Hello, is this the _Daily Bazoo_?” -“Huh, huh, it are.” “Well, I’m Dr. Squirtem Galls. I wish you would send -a reporter over here at once. I want to be interviewed on Koch’s -tuberculin.” It is said that $25 changed hands, but I don’t believe it. -The gentleman would never advertise—at that rate—“no sir-ree.” My -informant was once the sporting editor of the _War Cry_, and hence -unworthy of credence. - -And what wonderful contributions the newspaper-great-men are making to -science! The daily paper is the place to study appendicitis and things. -It is not long since I learned from a distinguished surgeon friend of -mine, via a daily paper, that evidence of a blow having been received on -the head is an imperative indication for craniectomy, whether symptoms -are present or not. - -In preference to the clandestine methods now in vogue, would it not be -better for men in authority to write signed articles for the newspapers -and intelligently present medical matter to the public? But that -wouldn’t be ethical, would it? Such topics as “Advice to Young Men,” -“Letters to Young Wives” and “How to Keep Healthy,” must be left to the -quacks. We will confine ourselves to the surreptitious blowing of -surgical horns and never mind the false notes. - -Meanwhile, let us stand back and watch the procession of modest men who -never advertise—oh, no! At the head, with haughty mien, comes Professor -Keene Carver, preceded by a herald in blood-red garb, blowing a large -brass horn. Then comes the “bearded lady,” whose blonde and breezy -whiskers so delight the heart of his swell society _clientele_. And here -comes Rip Van Winkle—a middle-of-the-road “eclectic,” gathering up his -long and weedy beard to keep it from getting tangled up in the -scientific barbed wire fence along the route. And here comes another -sure-enough “regular,” evidently a medicine man—so rare nowadays. He is -riding in a swell turnout and is on his way to his clinic. How do I know -that Professor Windy Bowels is a regular? Because the gentleman who is -riding beside him to his clinic is a reporter on the Chicago _Daily -Jib-boom_. - -I presume that the suggestion that I have made of the advisability of -taking the public frankly into our confidence and giving it accurate -information so far as its comprehension goes, by signed articles, in -preference to clandestine advertising and the promulgation of fallacious -ideas of medicine and surgery, will meet with bitter opposition. I -nevertheless believe that a better education of the public is the only -way to down quackery. The opposition will come chiefly from the -surreptitious advertiser, who sees a prospect of other men getting the -advertisement that he believes to be his proprietary right. - -Then there is the tribe of the Microcephali. The howl of protest will be -long and loud from the pews occupied by these far-famed champions of -medical orthodoxy. “We won’t put _our_ discoveries or contributions in -the newspapers—not ever.” And gazing at their lemur-like front -elevations, we can well believe that they would have no trouble in -establishing a “halibi.” - -Apropos of “discoveries,” it may as well be understood that the public -is bound to get the details of them sooner or later, and, when the time -is ripe, the matter should be presented to it in a clear and -intelligible form—comprehensible to the layman. - - ------------------------------------------------------------------------- - - - - - CHAPTER II - - =THE PHYSICIAN WHO SUCCEEDS= - - -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. - - ------------------------------------------------------------------------- - - - - - CHAPTER III - - =THE BUGBEAR OF ETHICS= - - -One of the first spooks with which the young practitioner will be -confronted is the bugbear of Ethics—don’t overlook the big E. It will be -in front of him on graduation day, his preceptor will dangle it before -his eyes as he hands him his papers, and it will be continually bobbing -up after he has hung out his shingle. - -Now ethics in its place is a good thing. It is especially essential in -the medical profession in which, without a due regard for the -proprieties, many men would be tempted to go astray. And this temptation -is by no means slight at times. But there is such a thing as overdoing -the ethical proposition. It becomes monotonously annoying for a man to -have his every movement watched and judged from the ethical standpoint -by a lot of self-constituted censors. The average physician, in his -bearing toward his younger brother does not ask himself the old -question, “Am I my brother’s keeper?” Not at all. On the contrary the -worst of it is he assumes an opposite attitude and by his actions -asserts “I am my brother’s keeper.” - -In a way these men assume the right to dog and spy upon the movements of -other physicians on the plea that they are doing it for the benefit of -the profession—to see that the great Code of Ethics is not violated. -What they are really after, nine times out of ten, is to make sure that -the young, progressive practitioner who has the tact and ability to -build up a good-paying practice does not encroach upon their preserves. -This is bad enough, but there is a worse side. In nearly every instance -those who howl the loudest about violations of the code, are gross -offenders themselves. This is a bold assertion, but the proof will be -furnished later on. - -One of the things specially cited as an unpardonable violation of ethics -is the courting of newspaper and similar publicity. - -“My dear boy,” one of these old-time offenders will say, “you must not -allow your name to appear so frequently in print. It is undignified and -unethical. Our profession is one of mighty dignity and responsibility, -and you owe it to yourself and your brother physicians to avoid anything -which tends to lower or debase it. I know it is only human to seek -notoriety of this kind, and that it is valuable so far as the mere -getting of money goes, but we must be actuated by higher, nobler -motives.” - -It is practically a certainty—with rare exception—that the man who gives -this advice, is bending every energy, and using every possible means to -secure the same kind of publicity. He knows that fame and wealth come -from keeping one’s name constantly before the public. - -In every large city we will find physicians of wealth and fame, of whose -every movement the newspapers seem to have information in advance. How -do they get it? Let us analyze the conditions. - -Under his professional obligation Dr. Soakum is bound to observe and -live up to the code of ethics. He prates loud and often about the -beauties of an ethical life, and the uninitiated might well suppose that -his was a model existence in this respect. But, is it not a trifle -strange that whenever Dr. Soakum, owing to his great skill and fame, is -called out of town to attend some prominent personage in another city -the newspapermen know he has been summoned. More than this, they know -where he is going, whom he is going to see, and what train he is going -on. Strange, is it not? - -It is no uncommon occurrence to read items like the following in the -daily press: - - - Dr. Soakum, the distinguished specialist in chronic disorders, - left for San Francisco yesterday, having been summoned by wire - to attend the Hon. Million Moneybags, who is seriously ill with - chronic nephritis. The patient, whose disability at this time is - of grave import to a number of large business transactions, has - been under the care of a number of famous physicians, but his - great confidence in the skill of Dr. Soakum led to the hasty - summoning of the latter. - - Dr. Soakum, who was seen by our reporter just as he was boarding - the Overland limited confirmed the report. He added that the - time of his stay was uncertain, as the case is a most important - one, and may demand his undivided attention for some weeks. - During his absence Dr. Soakum’s vast practice will be looked - after by his associate, Dr. Bleedum. He added that he was both - surprised and annoyed to think the news had leaked out. - - -Surprised! Annoyed! Not on your life. This was only a bit of stage play, -of dramatic action, on the part of Dr. Soakum. Real surprise, real -annoyance and real anger would have resulted only from the failure of -the reporter to appear after the careful arrangements which had been -made to ensure his attendance. - -How often have many of us read items like the following in the daily -press: - - - At last there is hope for the consumptive. Dr. Killem, the - eminent specialist, whose success in the treatment of - tuberculosis has aroused wide interest in the medical - profession, has made public the details of his treatment by - means of which such wonderful results have been obtained. - - “I would have done this long ago,” said Dr. Killem to a reporter - for the _Morning Howl_, yesterday, “were it not that I desired - to be absolutely certain as to the permanent efficacy of the - treatment. Now that there is no longer room for doubt on this - point I feel at liberty to act. - - “The essential feature in my method is,”—— - - -And Dr. Killem goes on to give what he calls a professional statement, -so involved and beclouded with high-sounding terms that the poor -reporter makes a sorry mess of this part of his story. - -Strange as it may seem this is just what Dr. Killem wants. He knows his -treatment will not stand a scientific analysis by competent men, and he -avoids this by intentionally leading the reporter to misquote. And then -it gives him an opportunity to write a letter of protest to the -newspaper and thus obtain more publicity. - -“I’m chagrined,” Dr. Killem will say to his professional brethren. “That -reporter for the _Morning Howl_ has made an ass of me, but I suppose -there is no redress. I gave him a few, a very few facts, out of -kindness, and he has distorted them and made me ridiculous.” - -And all the time Dr. Killem is swelling with pride. He has “put another -one over” on the press, and obtained a lot of valuable publicity that he -could not have bought outright. Besides he would not think of doing such -a thing as to pay for advertising—it would be unethical. - -How do you suppose the newspapers get hold of such items? Reporters are -a pretty smart lot of men with noses keenly trained on the scent of -news. But none of them, so far as known, possesses the gift of being -able to tell in advance what is going to occur at a given time. Smart as -they are it would be out of the question for them to know that Dr. -Soakum had been called out of town, or that Dr. Killem had interesting -information to impart to the public, unless they got tips to this -effect, and these tips are just exactly what they get. - -None of these physicians have press agents. Perish the thought. That -would be decidedly unethical, and too clumsily convictive. No siree. -They are too smart for that. Most of them, however, especially those who -work the press continually, have private secretaries. The private -secretary work is light, and is attended to by stenographers and -book-keepers, but the title affords a handy cloak for disguising the -press agent. Ostensibly engaged as private secretaries the men who fill -these positions know full well that their one and only duty is to -“boost” the professional prowess of their employers; to keep them -constantly before the public. - -Frequently this work is done by men who have no open, direct connection -with the physicians who employ them; are not even seen around their -offices. This is the latest dodge, and is becoming more and more -general. It has one decided advantage in the fact that it is impossible -to trace any collusion between the party who gives out the news, and the -party who is benefited by the publication. It also has a further -advantage. It enables the physician to put on an air of surprise, should -he be questioned by a brother doctor, and say: - -“Smith. Who is he? He is not on my office staff, and is certainly -assuming a lot when he pretends to speak for me.” - -All of these press agents work on the same lines. They know the avidity -with which city editors grab for news, particularly if it concerns -prominent people. When the occasion arises they get into communication -with some city editor, generally by phone, and a conversation something -like the following ensues: - -“Hello, that you Brown? This is Jones. Yes, the same, old man. Thanks. -I’ve just got onto something that looks like a good tip, and I thought -you would like to have it. Dr. Soakum has been called to San Francisco -to attend old Moneybags, the trust magnate. If the old chap should die -it would raise Old Ned in the stock market. I understand that Soakum -goes this afternoon on the U. P. limited. Oh, don’t mention it. I’m glad -to be able to give you the tip. Hope you’ll be able to get a story out -of it.” - -Jones, the press agent, does not, of course, tell his city editor friend -that there’s $25 in for him (Jones) if the story is printed. He’s too -smart for that. So far as the city editor knows Jones is simply trying -to do him a favor in a news way. The press agent is also smart in -another direction—he does not call on the same city editor too often. It -might arouse suspicion. - -In nearly every city of any size there are a number of newspapers. Jones -works them in rotation, so far as Dr. Soakum is concerned. First it is -the _Morning Howl_, then the _Daily Screech_, next the _Evening Whirl_, -and so on. Between the Dr. Soakum stories Jones works in items about -other people, for the modern press agent is an enterprising chap who -represents a number of clients all eager for publicity. A good press -agent can look after the interests of a physician, a lawyer, an actor, -and a promoter at all the same time, and not overwork himself. It’s -merely a matter of giving out the right tips in the right way. If the -tip looks good the city editor and his staff does the rest. - -To preserve his standing with the newspaper fraternity Jones very -frequently, if he is a real live, first-class press agent, tips off a -bit of actual news, something in which there is no $25 for him, and -which makes the city editors rise up and call him blessed. Incidentally -it also makes them all the more willing to act upon his next tip, and -this is just what Jones wants. He is merely sowing seed for the crop he -is to reap in the near future. - -And do reputable physicians countenance this sort of thing? you may ask. -They certainly do; not all of them, it is true, but a big working -majority. The large cities are full of physicians of wealth and fame who -have been literally boosted into prominence by the newspapers. Fancy the -effect upon the public when it reads of Dr. Soakum being called to -attend so distinguished a citizen as the Hon. Million Moneybags, or -references to Dr. Killem, “the eminent authority on tuberculosis.” It -means a stream of dollars rolling into the pockets of the doctors thus -referred to, and puts them in position to name larger fees. - -There are times when as a matter of business precaution the press agent -resorts to opposite tactics. It would not look well to be lauding Dr. -Soakum all the time. So, having previously laid out the program with the -former, the press agent hunts up another physician who knows how others -are prospering through publicity and is not averse to having some of it -for himself. The program is explained to Dr. Squills, and he writes to -the newspapers, bringing to their attention some supposedly important -medical subject. It may relate to hygiene, bad management of hospitals, -unsanitary condition of street cars, the proper means of stopping the -spread of tuberculosis, anything to attract public attention. - -City editors, unless overcrowded with more important matter—and the -press agent generally selects the opportune moment—will print this kind -of “stuff” in full. Having printed it about the first thing they will do -is to send out reporters to ask the “eminent Dr. Soakum” for his opinion -on the subject. This is just what Dr. Squills was induced to break into -print for. Dr. Soakum will endorse the latter’s letter, praise it warmly -and perhaps bring out some new points which Squills has purposely -overlooked. This gives Squills a chance to come back with a statement as -to the importance of the suggestions made by Dr. Soakum, and the two old -hypocrites thus get a lot more free advertising. All of which means more -prominence, more fame, and more money. - -Some years ago—about ten at this writing—a new treatment for chronic -nervous and mental ailments was introduced. Its sponsors were men of -high standing in the profession, instructors in leading medical -colleges. That the treatment had great merit is undeniable; many -wonderful results were accomplished with it. It also had great -money-making possibilities, but the promoters did not know how to -develop this feature. - -Finally they engaged a press agent—we’ll call him Mr. Johnson, because -that is not his name. His terms were $50 a week salary, and a royalty on -the business. For three or four days Mr. Johnson did nothing except post -himself as to the scientific features of the treatment and he was soon -able to talk more glibly and intelligently about it than the physicians -in charge. Then one day he said: - -“Trot out some of your star cases. I want to look them over.” - -Mr. Johnson went over the records carefully and selected one which -seemed to give promise of producing a big free advertisement. It was -that of a well-known, well-to-do merchant in a neighboring city who a -year before had been seized with primary dementia. Homicidal tendencies -developed and his family, on the advice of prominent alienists, placed -him in a sanitarium, the physicians at which, as well as those called in -by the family, pronounced the case absolutely incurable and hopeless. - -In time the new treatment was administered. In ninety days the patient -was discharged as cured, returned to his home, and resumed charge of his -business. To this day he is well mentally and physically, and no one, -unacquainted with his history, would ever think he had been insane, and -confined as a dangerous lunatic. - -Having satisfied himself as to the accuracy of the story, Johnson’s next -move was to plan out a line of action. The story to be acceptable in a -news way, and carry plausibility with it must come from the patient’s -home town. It would never do for Johnson to offer it to the newspapers -himself. His connection with it must be carefully concealed. The first -thing he did in this direction was to ascertain who handled the -correspondence that was sent out to the big dailies from this particular -town. He found that it was virtually in the hands of a Mr. Wheeling, -city editor of a local paper. - -Armed with this knowledge Johnson took a train and went to the town in -question—it is only a few miles from Chicago—timing himself so as to -arrive there when Mr. Wheeling had finished his rush work for the day. -Arriving there he introduced himself to Wheeling as follows: - -“My name is Johnson. Pardon me for intruding upon you, but I’m a -stranger in town, with a little spare time on my hands, and being -somewhat of a newspaper man myself it seems sort of homelike to poke -around an editor’s den. It’s the best way I have of killing time and, if -it doesn’t annoy you, I’d like to pass away an hour or so chatting over -newspaper work and newspaper men.” - -Wheeling, a cordial, whole-souled chap, made Johnson welcome, and they -were soon very friendly, exchanging reminiscences, and regaling one -another with their experiences. Johnson was in no hurry to spring the -trap. He was too smart for that. He produced some good cigars and, after -they had talked for an hour or so, invited Wheeling to take dinner with -him at the hotel. Wheeling accepted, and after the meal, when fresh -cigars were lighted, Johnson proceeded to set his trap as follows: - -“Once a man has the newspaper fever he never gets it out of his blood, -at least not entirely. I’m better off now financially than I could -possibly expect to be working as a reporter or editor, and yet -frequently the old desire to cover an assignment, or write a good story, -takes hold of me, and takes hold hard. It’s galling for a man of my -disposition to run against a good story and not be able to make use of -it, but this is happening with me right along. Why this very afternoon, -in conversation with a business friend just before I met you, I heard a -story that’s a corker, and would make a big sensation if it ever got -into print. But pshaw, what’s the use of talking, I’m simply not in -position to make use of it, and might as well pass it up. It goes -against the grain though, I can assure you.” - -“Why not give me the tip?” asked Wheeling. “I’m correspondent here for -quite a list of papers, and a real live story, one that I could spread -on, would mean considerable to me.” - -“Well,” replied Johnson, “I don’t mind giving you such facts as I have, -but of course I can’t vouch for their accuracy. All I can say is that if -your investigation establishes the truth of what I have heard all the -big papers will want the story by the column, and then some.” - -Johnson then proceeded to outline the story to Wheeling, hesitating -purposely as if not quite sure of the patient’s name, and giving one -that sounded much like it, but was not the real one. The trap was -sprung. Wheeling knew the man, and at once realized that he was in line -for a big Sunday spread. It would not do to waste so good a yarn on the -daily issues in which a stick or two of space would be the limit when he -could place a column or more in each of the Sunday papers. Wheeling -furnished his correspondence at space rates, so much per column, and he -naturally wanted to make the story as full and complete as possible. - -That very night (it was Monday) he visited the home of the miraculously -cured man. The latter talked freely, corroborating all the important -details. Wheeling’s next visit was to the home of the family physician, -and there he got more corroboration. The next morning he wired the -various Sunday editors as follows: - - - Prominent business man here, after being pronounced incurably - insane by eminent specialists, and confined in asylum, fully - restored to reason by new and novel treatment. Big story. How - much? - - -He was swamped with replies. Every Sunday editor wanted more or less of -it. Most of them wanted it in full, the orders reading something like -this: - - - If sure of facts, and man is really prominent, send story in - full. No limit. Also get pictures of patient, and others - concerned. - - -The following Sunday morning every newspaper in Chicago fairly -“shrieked” forth the news of the new treatment. It was given to the -public in the form of a first-page story with the emphasis of leaded -type, “scare” heads, and pictures of the patient. The Associated Press -took it up and wired a report to all American papers, while a condensed -statement was cabled abroad. - -Nor was this all. Managing editors from New York to San Francisco, from -Toronto to New Orleans, called upon their special correspondents to rush -more particulars by wire. The managing editors of the Chicago papers -instructed their city editors to obtain statements in full from the -physicians interested, as to the scientific nature of the treatment, its -history, etc. (The names and addresses of these physicians being given -in the first story, the locating of them was easy—it was part of Mr. -Johnson’s plan.) - -What was the result? The new treatment was immediately “boosted” into -world-wide prominence. Half a million dollars would not have paid for -the publicity it obtained in one week. Indeed it would have been -impossible to buy this kind of publicity—straight news—at any price. It -made fortunes for the men interested. To-day, ten years after this -publicity, these men are still reaping its benefits. - -Now these men, it should be remembered, were and are strictly ethical. -They frown upon anything that smacks of violation of the code. They will -not sell the treatment to physicians who advertise. Their dealings are -confined to those who can show a clean bill of health in this -connection. To those who meet the demands in this respect they furnish -the treatment at $27.50 per 2-ounce vial; the cost of producing it is -about 75 cents. Nice profitable business? Well, rather. - -The lesson of all this is that it pays physicians to advertise, provided -they do it in the right way, and are clever enough to hoodwink their -professional brethren as well as the general public on the question of -ethics. The man who openly engages a real press agent and pays his money -for “display ads” in the newspapers is tabooed, his name is anathema. -The man who engages a press agent quietly to get up schemes by which the -gentlemen of the press may be worked for valuable publicity is -thoroughly ethical, and remains in good standing in the profession. - -Wherein lies the distinction? I must confess that it is too fine for me. -Of the two the honor seems to be with the doctor who proceeds to ask for -patients in a straight-forward business-like manner, and pays the -newspapers for the space they give him. On the one hand we have the man -who pays for what he gets, while on the other we have him who, in -reality, is obtaining goods under false pretences. - -Just another point about ethics. It is strictly unethical for a -physician to prescribe or administer a remedy the formula of which he -does not thoroughly understand. But thousands of them are doing it -daily. Where is the physician, for instance, who knows in reality, aside -from the proprietors, the composition of Anti-Kamnia, but does lack of -this knowledge stop its widespread use? Not at all. It’s the same way -with acetanalid and scores of other preparations. Occasionally the -proprietors of some remedies seek to ease the conscience of some extra -scrupulous practitioner by printing what appears to be a formula. But in -such cases there can be no assurance that the formula is correctly -stated, the proper quantities given, or the method of preparation -absolutely stated. In all such cases the alleged facts must be taken on -faith. - -The author has in mind one particular instance, the accuracy of which he -can vouch for because he was interested in the preparation and sale of -the remedy. A certain hypodermatic treatment was placed on the medical -market “for the use of physicians only.” To satisfy the ethical -gentlemen the formula was given, and it was given correctly. Nothing, -however, was said about the method of preservation. This was an -important item as the remedy consisted of a combination of animal -tissues and fluids which would decompose quickly, and if injected into -the human system would work havoc. To keep it in condition for use, with -its curative properties intact, it was necessary to put it through a -preservative process in the course of which various chemicals and other -substances were added. Nothing was said in the formula about this -feature, nor did the strictly ethical physicians who used it make any -enquiry about it. - -Common sense, to say nothing about medical training, should have told -them that a remedy prepared after the formula as stated must decompose -rapidly unless some preservative process was employed, but a little -thing like this did not seem to bother them. They just simply glanced at -the formula, wondered they had not thought of it themselves, and jabbed -it into their patients according to directions. - -What assurance did they have that, if the remedy was not properly -preserved it would not injure, and perhaps kill the people upon whom it -was used? What assurance did they have that, if the remedy had been put -through a preservative process, it did not contain some substance which -would be equally injurious? None whatever. Their actions were equivalent -to saying they didn’t care. - -This, to the careful, conscientious physician, would seem like coming -close to the danger mark, and so it was. To speak plainly it was little -short of criminal carelessness, and yet these practitioners were all -thoroughly ethical. The only possible excuse for them is to say they -thought they knew, but this is actually no excuse at all as, under their -obligation it was their duty to know beyond doubt what they were using. - -As Dr. Lydston asks in the opening chapter, “Why not be honest” about -this publicity matter, and, he might well have added, all the other -features of modern medical practice as well. There is no excuse for -honest practitioners leaving the use of the public press to quacks and -fakirs—and the few really good physicians who are smart enough to take -advantage of it while at the same time “pulling the wool over the eyes” -of their professional brethren. - -Such tactics as now prevail, cloaked under the guise of ethics, are -unfair to the young medic. They keep him from doing the very thing which -the self-appointed Lord High Apostles of Ethics are doing, and waxing -rich and famous thereby. - - ------------------------------------------------------------------------- - - - - - CHAPTER IV - - =LAWFUL TO ADVERTISE= - - -Just who put forth the dictum that it is unlawful, unprofessional, -unethical, for a physician to advertise is unknown. It was probably some -old codger of antiquarian ideas. At any rate the rule—and it is a -rule—is so old it reeks with decay. But, among progressive physicians, -it is fast coming to be recognized as a rule which is “more honored in -the breach than in the observance.” - -Other professional men who were once held in bonds of the same nature -are breaking away. We find in the public press the cards of attorneys, -architects and civil engineers, all callings which are legitimately -dignified with the name of “professions.” No exception is taken to these -men making their talents known, although at one time—and it is only a -few years ago—they were held in ethical bonds just as strong and binding -as those with which the medical practitioner is now enchained. - -But time changes all things. It has changed to a degree the code of -ethics which formerly obtained in the professions of law, architecture, -and civil engineering, and it is slowly, but surely, changing that of -medicine. True the wording of the various codes remain the same, but -there is a growing tendency to wink at, to overlook evasions. - -It has become a matter of convenience to the public to know where to -find a competent lawyer, or architect, or civil engineer. Hence the -appearance of their business cards in newspapers. On the same grounds -publicity by physicians is justifiable. It is more than justifiable. -Mankind can, in a pinch, get along without attorneys or architects or -engineers. That is to say it is rarely imperative their services should -be requisitioned in a hurry. The trial of a law case, the plans for a -building, or the construction of a bridge can generally be put off for a -few days at least without serious injury or inconvenience to any body. - -When a doctor is needed he is generally needed badly. It may not always -be an emergency case, but almost invariably when the services of a -physician are required, even in chronic ailments, delay only aggravates -the patient’s condition. - -If a medical man has, by special study, equipped himself to handle a -certain class of diseases more intelligently and satisfactorily than the -general practitioner it becomes his duty to let the public know about -it. If we accept the dictum of the censors of medical propriety as they -present it—that the obligation taken by the physician binds him to serve -the public to the best of his ability—then surely we can not get away -from the proposition that men of unusual ability are in duty bound to -make the public acquainted with that ability. The successful physician -does not live up to his obligation if he “hides his light under a -bushel.” - -Medical societies, the watchdogs of ethics, do not accept this doctrine. -Not only this; they try to drive out of practice, to brand with infamy, -to make an outcast and wanderer of the man who indulges in it. The “it” -in this instance refers to publicity fairly bought and honestly paid for -over the newspaper counter. But they do not always succeed. - -For years Dr. McCoy had been a surgeon at Bellevue hospital, New York, a -man of rare skill and of high standing in his profession. He was a -member of various medical societies, respected and honored. After a -long, weary experience he made up his mind that he was entitled to a -better financial reward than it was possible for him to obtain in -hospital or private practice. He came to Chicago, obtained a certificate -from the State authorities, and began advertising in the daily -newspapers as a specialist. His medical brethren were horrified. -Remonstrance being of no avail, they promptly ousted Dr. McCoy from -membership in the professional societies. - -Not content with this they went further and filed complaint with the -state authorities with the purpose of having his certificate, or license -to practice, revoked. That they would have succeeded in this if Dr. -McCoy had not taken the matter into the courts, is a certainty, as the -members of the State Board of Health who would pass upon the question -were all physicians and prominent in the societies which were seeking to -deprive McCoy of his certificate. - -A long, hard-fought battle in the courts was won by McCoy. In handing -down its verdict the final court said in effect: - -“We fail to see wherein this appellant has committed any offense against -the laws of the State. If he was competent to practice medicine at the -time he received his license he is competent to practice now. Nothing -that has been alleged against him has affected in any way his ability, -fitness, or competency as a medical practitioner. Neither has he -committed any penal offense. True he has advertised, but advertising is -not a felony; not even a misdemeanor. - -“The fact that the medical societies to which he belonged have revoked -his membership has no bearing on the case. These societies have no -official powers so far as the State is concerned. They may very properly -say who may, or who may not, hold membership with them, but they have no -authority to say who may, or who may not practice medicine. Societies of -this kind are purely social and professional; they are not endowed with -executive, administrative, or legislative power to act for the State.” - -This finding established in a forceful, indisputable manner the legal -right of a physician to advertise his skill as a healer of mankind -without affecting his ability. It was not to the liking of the sticklers -for ethics who control the medical organizations. They would have the -young medics believe—and up to the time the McCoy case was decided they -had succeeded—that they were all powerful; that their word was law, not -only as regards membership in the societies, but also as to who might, -or might not, practice medicine. They succeeded because they controlled -the State Board of Health. But the ruling of the court put an end to -this impudent assumption of authority. It laid down and made clear the -important fact that, in passing upon the competency of applicants for -licenses, medical ability and good moral character were the sole and -only points to be considered. - -There is advertising and advertising, one kind respectable and -dignified; the other outrageously bad. The author would not for a moment -countenance the use of flamboyant “ads” like those with which the “weak -men” and other quacks bombard the public through the daily press. Such -advertising as a general thing is positively indecent and dishonest. The -men who place it and the newspaper publishers who print it should be -prosecuted into the penitentiary. It is a queer thing that so-called -high-class newspapers which decline to accept lottery and get-rich-quick -“ads” on the ground of morality (we’ll say nothing of their illegality) -will openly solicit and publish the disgusting business advertisements -of medical charlatans and fakirs. - -No man who respects himself or his profession will “guarantee a cure or -money refunded,” no matter how apparently simple or mild the ailment he -undertakes to treat may be. Neither will he offer to take cases on the -“no money until you are cured” plan. These are methods which belong -exclusively in the realm of quackdom. They deceive only the ignorant, -and are used with success only among that class of people. But baits of -this kind stare one in the face from nearly every Sunday newspaper, and -from many fences. - -Then there is the fakir who calls upon you in loud type to “See Old -Doctor Squeeze-em. He’ll do you good!” It’s a safe bet he will “do” you -good if he ever gets you into his clutches; “do” you so good that you -will be lucky to have carfare left to get home with. - -These are not the methods employed by smart men who, through publicity, -obtain a good practice, and put themselves in position to command large -fees; men to whom patients will pay $100 for an hour’s consultation and -advice without hesitation, while they would begrudge $5 to a physician -of equally as much or more medical skill, but not so well versed in the -art of self publicity. - -How do these men get before the public? They pave the way according to -well-laid plans. Their every move is part of a previously laid-out -program. We are writing now of those who have not progressed to the -stage of employing regular press agents, or have not become well-known -enough to warrant regular advertising. They join some fashionable church -and mix in its affairs; take prominent part in the sociables and other -doings, and when the ladies come around with a grab bag, or “take a -chance on a nice piano,” dig down deep into their jeans. They may have -to get along on short rations for a day or two, but the money has been -invested to better advantage than if it were expended for pork and -beans. A short course of this kind gets all the women talking about what -a charming man Dr. Swell is, and so liberal. Pretty soon they begin to -boost him into prominence by insisting upon his taking charge of some of -their social affairs, and then his name gets into the papers. This is -the beginning. The oftener he is mentioned the more impressed the -newspaper men become with the belief that he must be a man of -importance, and the first thing Dr. Swell knows he is getting the most -valuable kind of publicity by the column. - -And the male part of the community? Well, it’s just as easy to “con” -them as it is the women. Dr. Swell joins lodge after lodge, society -after society, just as fast as he can raise money for the dues. He -attends the sessions faithfully, and, so far as outward appearances go, -takes a deep interest in the proceedings. He has a good word, and a -warm, hearty hand shake for all the brothers. While modest, he always -manages to have a word to say “right out in meeting” at the proper time, -even if it is no more than to voice approval of something that has been -done. Then, in time, it comes quite natural for the presiding -Squeejicks, or whatever his title may be, to frequently say, “We would -like to hear from Dr. Swell on this matter.” - -Dr. Swell is coming on. If he keeps his head down to a normal size, -treats everybody courteously, and goes along making friends at every -opportunity, the first thing he knows is that he is nominated for the -office of Worthy High Jinks. Of course he protests that there are others -better fitted, etc., but he doesn’t mean it. He is elected, and again -there is legitimate excuse for getting more publicity. All the papers -announce that: - - - “At its annual meeting last night Cockalorum Lodge No. 37840, - O.B.O.A.B., elected Dr. What A. Swell as Worthy High Jinks. - Under his regime Cockalorum Lodge will make many advancements - during the coming year. When Dr. Swell was asked to outline his - program last night he said:” - - -And here follows a lengthy interview which Dr. Swell, knowing he was -sure to be elected, had prepared in advance. From then on it is easy -sailing—if he is a smart man. He manages to keep Cockalorum Lodge doing -something all the time; not that he is so desperately in love with the -lodge, but because it means more and more publicity to Dr. Swell. As -with Cockalorum, so with the other lodges, or churches, or societies to -which he may belong. - -From being at first a mere atom of news, Dr. Swell finally becomes an -actual necessity to the newspaper fraternity. Its members have acquired -the habit of turning to him involuntarily whenever a news problem -presents itself. If the cable brings information that Emperor William -has a sore throat reporters besiege Dr. Swell. He talks learnedly (or he -should) of the nature of the trouble, and outlines the proper course of -treatment, etc. Again it is heralded to the community that: - -“On being asked concerning the nature of Emperor William’s ailment, Dr. -Swell, the eminent authority on diseases of the throat, said——” - -Is Dr. Swell coming on? Not at all. He has arrived—landed on both feet -as it were. He is There and It. From then on it is only a matter of -taking advantage of his opportunities. He may remove to a larger city -where the services of a shrewd press agent will be necessary to secure -the desired publicity, or he may stay in the smaller place where he has -gotten a good start, and keep up the good work by a judicious -distribution of coin among the newspaper boys. Not as a bribe, dear me -no. That would be too raw. It would give the doctor dead away, and kill -the game. - -There are physicians in every large city who seem to be vital to the -existence of the prominent newspapers. “See Dr. Blank,” is the order -that goes forth from the city editors on every possible occasion, -important or unimportant. Let the government chemist declare that ice -cream is impure and deleterious to health, and a hundred Dr. Blanks in -as many different cities will be interviewed at length and their views, -often worthless, spread before the public adorned with glaring -headlines. - -Let the Ahkoond of Swat sneeze and at once we are regaled with the views -of the favored doctors as to the evils of hay fever and the best means -of counteracting them. - -It is a poor schemer of a physician who can not in some manner, through -lodge, society, or other connections, make the acquaintance of at least -one city editor and, without obtrusion, make himself so valuable to the -scribe that he becomes, as it were, an unsalaried member of the staff, -ready at all times to help his dear friend the city editor out whenever -the latter wants anything in the line of medical information. - -Blame these doctors? Not at all. On the other hand I feel like patting -them on the back and saying: “Go it, boys. I admire your fine work. -You’ve got Bunko Bill beaten to a frazzle.” - -There is one doctor now famous because he is quoted almost daily in the -newspapers, who ten years ago was in hard luck financially. One day he -was introduced, or rather introduced himself, to a city editor by -calling at the latter’s office on an apparently innocuous errand. It -happened just at the time (accidentally, of course) when public interest -was aroused over the prevalence of infantile paralysis. After the doctor -had concluded the business on which he called, the editor, finding him -an intelligent, well-informed man, asked his opinion on the medical -sensation of the day. This was the doctor’s opportunity, and he took -full advantage of it. - -“That is an important matter,” he replied, “and no professional man -should discuss it hurriedly or carelessly. I have some pressing calls to -make (this was a whopper) and haven’t the time to spare just now, but -I’ll be delighted to give you my views within a few hours.” - -This was acceptable, so the doctor went to a friend’s library, read up -on the subject as thoroughly as he could in such a short time, and a few -hours later was back in the editorial sanctum. Here he talked so well -that the editor said: - -“By Jove, doctor. That’s the kind of stuff I want. Can’t you write it -out for me? I’m afraid to trust a reporter, as there would be a risk of -getting it muddled. I’ll give you a good stenographer to dictate to.” - -Barkis, which in this case was the doctor, was willing. He dictated the -matter, and the next morning was paraded on the first page in big type -as “the eminent Dr. ——” - -His fortune dated from that day. Patients came in by the score. His -newspaper friend had occasion to call on him frequently for information -on current medical topics, and he was in print so much that his name was -on everybody’s tongue. That was fame, and a kind of fame that brought -wealth. - -This particular medic had the gift of a real bunko artist. He knew how -to keep the good thing moving, and to “con” the city editor who thought -he was above being caught. - -“Really, my dear Mr. ——,” the doctor would say when asked by phone for a -statement, “really I’m too busy to do the subject justice, but I can’t -refuse you. Send a stenographer over and I’ll dictate something. By the -way, the _World_ and the _Express_ both wanted something but I had to -turn them down.” - -Did the city editor appreciate this favoritism? He certainly did, and -saw to it that the doctor got all there was coming in the way of double -leads, scare heads, and top of column positions. - - ------------------------------------------------------------------------- - - - - - CHAPTER V - - =GETTING COUNTRY PATIENTS= - - -While the kind of publicity outlined in the preceding chapter is -valuable and will make a man famous in his own city, it takes a long -time to reach the people in outside territory. It is a peculiar fact -that in medicine, as well as in other things, “distance lends -enchantment.” The person afflicted with a chronic ailment who lives in -the same town with a physician who has become famous for his successes -in that line, is more apt to postpone his call for relief than one who -lives at a distance. - -The local patient argues to himself: “There’s no immediate hurry. I’ve -been afflicted in this way ten years and I’m too busy just now to take -the time to see the doctor. He’s right here in town, and I can reach him -at any time. I’ll drop in on him some day when I’ve got more leisure.” - -A certain proportion of the physician’s town folk respond to the -publicity bait, but he must have the fat fish from outside if he is -really going to get large fees in great number. How is he going to reach -them? Here is the plan successfully worked by one doctor who has made -himself wealthy. - -He made arrangements with an advertising agency to secure the insertion -of “pure reading matter” ads in a number of country newspapers in towns -within 500 miles of Chicago. His press agent then prepared an article -reading about as follows: - - - =LOCOMOTOR ATAXIA CURED!= - - -------------------------------- - - =Remarkable Results Obtained by a Chicago Physician= - - --- - -=Prominent Man Afflicted With This Terrible Ailment For Many Years, - Restored to Sound Health After a Short Treatment.= - - - NEW YORK, June 10.—Among the passengers on the outgoing steamer - Cedric which sailed to-day for Liverpool, was Col. H. B. Thomas, - of London, who is returning to his home after being successfully - treated for locomotor ataxia. He walks freely, and is apparently - in the best of health. When asked if it was a fact that he had - been cured of locomotor ataxia, an ailment which most physicians - pronounce incurable, Col. Thomas said: - - “It certainly looks like it. This is the first time I have been - able to walk freely, or have been without pain in ten years. I - was on crutches and suffering the torments of the damned when I - came to this country to take the treatment four months ago. You - can see for yourself the condition I am in now.” - - “Where did you take treatment?” - - “With Dr. G. H. Wilkinson in Chicago. When I first got there he - had to visit me at my hotel, but after the first two weeks of - treatment I was able to walk to his office at —— Michigan Ave. - Improvement was reasonably rapid, remarkably so, considering the - obstinate nature of the ailment. Now I can walk as well as - anybody, the pains have left me, and all my bodily functions are - normal.” - - -Newspapers in the smaller towns and cities are not so particular in the -definition of the term “pure news reading matter” as their larger and -more prosperous contemporaries. They need the money. Consequently all -the publishers who received an order from the —— Advertising Agency -printed the article. - -Country people as a rule are closer readers than those in the larger -cities, and within a week everybody in the territory thus reached who -was afflicted with locomotor ataxia was talking about the wonderful case -of Col. Thomas, and writing to Dr. Wilkinson (this is not his real name) -about their own cases. - -Here again the services of the doctor’s secretary, who was correspondent -as well as press agent, were called into play. Every letter was answered -in a kindly, sympathetic manner, somewhat as follows, the stationery -used being very plain and neat, but of the best obtainable material, and -modestly engraved: - - - G. H. WILKINSON, M.D. - - SPECIALIST IN CHRONIC DISEASES - - —— Michigan Avenue - - CHICAGO, August 2, 1910. - - _Mr. John Smith, Godfrey’s Corners, Ia._ - - DEAR SIR: Replying to your letter of July 31st, I regret being - compelled to say that, in the absence of opportunity for a - complete personal examination, it would be impossible for me to - say definitely what may or may not be done for you in the way of - obtaining relief. If you can arrange to come to Chicago for a - few days I will give your case my earnest personal attention and - will then be in position to advise with you more satisfactorily. - - Judging from the description of your symptoms the case is - plainly one of locomotor ataxia but the ailment, as you are - doubtless aware, is of such an insidious nature that, aside from - the more prominent general and unmistakable indications, there - are few cases which manifest themselves exactly alike. It is as - a rule more satisfactory to both patient and physician, and more - productive of good results, when the treatment can be arranged - under the physician’s personal supervision to meet the - requirements of the individual. This may possibly require a - week, at the end of which time you may return to your home and - continue the treatment there under the direction of your family - physician. - - As regards guaranteeing a cure I must say frankly that this is - something no reputable physician will do. It is a practice - resorted to only by what are known in the profession as quacks. - The most encouragement I can give you, in the absence of a - personal examination, is that, judging from your description the - case is no worse than scores of others in which entirely - satisfactory results have been obtained. - - Should you decide to visit me please advise me by letter or wire - a short time in advance so arrangements may be made to give you - prompt attention on arrival. - - Yours respectfully, - ———— - - -The effect of such a letter on the recipient is to beget confidence in -the writer. It is frank and straightforward; it sounds honest, -especially in those parts which refer to the necessity of a personal -examination, and the declination to guarantee a cure. “That’s a real -man, not a bit stuck up,” is the comment frequently made on receipt of -one of these letters by people who had hesitated to write to such a -famous specialist. - -Few country people will take up treatment with a strange physician -without first consulting their family doctor. They are not always -governed by what he says, but they almost invariably ask his advice. If -he suggests a trial you are pretty sure to get the patient. If he -advises negatively the patient is not always lost, but it will require -more correspondence, and when the subject does arrive he will be -suspicious and hard to handle. - -When the family doctor reads a letter like the one quoted he feels -flattered that an eminent specialist should be willing to entrust the -administration of his treatment to his care. He looks upon the -proposition differently from what he would if this sentence had been -omitted. His vanity has been touched. Inclined at first to throw cold -water on the proposition, when he comes to this part he generally says: - -“Well, of course I don’t know anything about this treatment, but Dr. -Wilkinson is a man of great reputation. His success in the Thomas case -is remarkable. One thing is certain. We have exhausted every resource -here without getting results, and it can’t do any harm to see him and -get his opinion.” - -Thus encouraged the sufferer, if able to travel, will in nine cases out -of ten, arrange to visit the specialist at the latter’s office. -Sometimes the family doctor, from honest desire to become acquainted -with the details of a new and successful treatment, will volunteer to -accompany him. - -But, suppose the local physician vetoes the proposition, denounces it as -a fraud, and declines to be associated with it. Is the patient’s -business lost? Not at all. It merely calls for a little more diplomacy. -After waiting a reasonable time, say a couple of weeks, without hearing -from Mr. Smith, the latter gets another letter from Dr. Wilkinson. This -time the specialist writes as follows: - - - G. H. WILKINSON, M.D. - - SPECIALIST IN CHRONIC DISEASES - - —— Michigan Avenue - - CHICAGO, August 15, 1910. - - _Mr. John Smith, Godfrey’s Corners, Ia._ - - DEAR SIR: Not having heard from you in response to my letter of - August 2d, I am reluctantly forced to the conclusion that - conditions are such as to make your coming to Chicago - impossible. This is a matter of sincere regret to me as the case - appears to be one of peculiar interest and, as a physician, I - would like to have opportunity of advising myself more fully as - to the exact conditions. - - If you will send me the name and address of your family - physician I will write him asking for the necessary information, - and between us we may be able to do something for you at your - home. While your letter is unusually full and complete, with the - facts stated in an intelligent manner not customary with laymen, - you will readily understand that there are some complications in - nearly every case which are more readily described by a - physician, and especially one who has been watching it - faithfully for a long time. - - Hoping to hear from you promptly, I am, - - Very truly yours, - ———— - - -When Mr. Smith receives this letter about the first thing he does is to -show it to his family doctor and, no matter how much the latter was -opposed to the “new-fangled” treatment at first, his chest swells with -pride at the flattering reference to his ability. He says: - -“Yes, Mr. Smith, you may send my name and address to Dr. Wilkinson and -when I hear from him I will write him fully about your case. He is right -in saying that only a professional man can give the required information -properly.” - -And off marches Mr. Family Physician, head erect, and with the pompous -air of a drum major. Is he not about to be consulted by the famous Dr. -Wilkinson, a man known throughout the land for his wonderful successes? - -When the specialist receives the local doctor’s name and address from -Mr. Smith, he writes the doctor somewhat after this style: - - - G. H. WILKINSON, M.D. - - SPECIALIST IN CHRONIC DISEASES - - —— Michigan Avenue - - CHICAGO, August 21, 1910. - - _Thomas H. Jennings, M.D., Godfrey’s Corners, Ia._ - - DEAR DOCTOR: I have lately been consulted by mail by Mr. John - Smith, of your city, who is, I understand, a patient of yours - suffering from tabes dorsalis. The case appears to be one of - unusual interest and I will be under obligation to you - professionally if you will make me acquainted with the details. - - As you have been in charge of the case a long time it would be - presumptuous on my part to attempt to outline the facts I want. - You will know what to write about a great deal better than I - would, and I will leave the matter entirely in your hands. My - only interest in the matter now is a professional one as I - understand Mr. Smith is unable to come to Chicago. - - Trusting that you will accommodate me, and hoping that I may be - able to return the favor in kind, I am, - - Yours fraternally, - ———— - - -This does settle Mr. Family Physician for sure. For years afterward he -takes delight in letting it be known how he was “called into -consultation by the eminent Dr. Wilkinson, of Chicago, who said frankly -that I knew more about the case than he did.” To the credit of Mr. -Family Physician be it said that this latter statement was probably -correct, and it might with all truth have been extended to include the -assertion that he was doing as much or more for the patient as Dr. -Wilkinson could. - -At any rate Dr. Wilkinson receives the information he asks for, and -beyond returning a brief note of thanks to the local doctor and saying -that he will give the matter thorough attention as soon as he gets a -little respite from his rush of duties, that is the end of it for the -time being. - -But Dr. Wilkinson is not idle. He is conducting, or rather his secretary -is, a similar correspondence with scores of other physicians and -prospective patients. From the letters thus received a card system is -arranged, all the “prospects” being grouped by localities. - -One day Dr. Wilkinson finds that he has some fifty good “prospects” in -the immediate vicinity of some good town, and decides to make a round -up. He then writes, either to the prospective patients in that -neighborhood, or the physicians, if his correspondence with the latter -has been encouraging, a letter somewhat as follows: - - - G. H. WILKINSON, M.D. - - SPECIALIST IN CHRONIC DISEASES - - —— Michigan Avenue - - _Thomas H. Jennings, M.D., Godfrey’s Corners, Ia._ - - DEAR DOCTOR JENNINGS: Since the receipt of your letter relative - to the case of Mr. Smith I have been called to —— for - consultation in a serious case. I will be at the —— hotel on - Thursday next but will be very busy, and do not think it safe to - make any engagements, aside from the consultation, for that day. - If you can arrange to meet me on Friday (the following day) - between 10 and 11 a.m., I will remain over. I suggest this as it - will afford us an opportunity of discussing Mr. Smith’s case to - better advantage than it is possible to do by mail. There will, - of course, be no fee attached to this service on my part. - - Kindly let me know at once whether I may expect to have the - pleasure of meeting you so that I may arrange my time - accordingly. - - Yours fraternally, - ———— - - -Dr. Jennings is impressed by the compliment thus paid him by the eminent -specialist. So are the dozen or more other physicians to whom Dr. -Wilkinson writes, most of them hastening to make engagements to meet the -specialist at varying hours. - -If the correspondence has been entirely with the prospective patient, -and no family physician has been enlisted as an intermediary, the “come -on” letter is made to read differently. In cases of this kind the doctor -would say: - - - G. H. WILKINSON, M.D. - - SPECIALIST IN CHRONIC DISEASES - - —— Michigan Avenue - - _Mr. Thomas Ratcliffe, Eagle Mills, Ia._ - - DEAR SIR: Since writing you last I have been called to —— for - consultation in a serious case and will be at the —— hotel on - Thursday next. As I can arrange to have a little leisure I would - suggest that you meet me there at 11 a.m. so that I may be able - to make a satisfactory diagnosis of your case, and thus be in - position to advise you intelligently as to the prospects for - obtaining relief. - - I feel free to make this suggestion as there will be no fee or - charge of any kind for this service all my expenses being - guaranteed by the parties with whom I am to consult. - - Kindly let me hear from you at once as I have many demands upon - my time and wish to arrange my schedule to the best advantage. - - Yours very truly, - ———— - - -The fact that he has not been invited to visit ——, or any other town for -consultation purposes does not bother Dr. Wilkinson. It is one of those -“harmless prevarications” tolerated and even encouraged, in all -professions. It would not be dignified nor ethical for a doctor to start -out on the road on a hunt for patients. It is not improper, once having -been “called” to another city, to take advantage of the trip to do a -little professional business on the side. - -Dr. Wilkinson must have an excuse for visiting ——. The most plausible -excuse is that he has been invited there in consultation by some brother -physician whose name is withheld. - -Before the time comes for starting for —— Dr. Wilkinson has received -replies to his letters. Most of these are favorable, and the doctor is -enabled to make out a time card that will keep him profitably engaged -while in ——. This card should read: - - - =Thursday, Sept. 22, 1910.= - - 10 a.m.—Dr. Jennings about John Smith. - 11 a.m.—Thomas Ratcliffe. - 12 m.—Dr. Thompson, Cross case. - 1 p.m.—Mary Brown. - 2 p.m.—Charles Harris. - 3 p.m.—Dr. Williams, Green case. - 4 p.m.—Harry Bronson. - -Before leaving Chicago the doctor will have his secretary get out the -correspondence with each of the “prospects” and this, each lot enclosed -in its own filing packet, will be put in his suit case or hand valise. - -Arriving at —— Dr. Wilkinson will arrange with the hotel clerk to notify -him when anybody calls. At 10 a.m. Dr. Jennings will be announced. - -“Tell him,” Dr. Wilkinson will say to the bell boy, “that I am very busy -just now and must ask him to excuse me for ten minutes. I will be able -to see him promptly then.” - -This gives the doctor time to get out the Jennings correspondence and -refresh his mind as to the particulars of the Smith case. Then he sends -word to have Dr. Jennings shown up. - -“Sorry to have been compelled to keep you waiting, doctor,” and a warm -cordial handshake, greets the country physician who is at once impressed -with the fine appearance and friendly manner of his visiting brother. -There is a little preliminary talk about the trip, the country, the -weather, etc., and then the Smith case is taken up and thoroughly -discussed. - -“If I had time,” says the specialist, “I’d like to see Smith, but that’s -out of the question. Your very clear and able description of the case -has impressed me strongly. One of these days when I happen to be out -here again with more time on my hands, and the patient is still living, -I’ll ask you to take me out to see him. I understand it’s only a short -distance from here.” - -“Just thirty minutes’ ride on the Lincoln branch, doctor,” replies -Jennings. “Why can’t you run out with me this afternoon? No time like -the present, you know.” - -“The trouble is that I will be busy until 4 p.m., and then it will be -too late.” - -“Not at all. There’s a train at 4:30 and we can be at Smith’s home by 5. -Better go. Barring his ailment you’ll find Smith a good host. He’s rich -and has a fine home, and the best of everything. I know he’ll be glad to -pay liberally for your opinion whether it is favorable or unfavorable.” - -“Well, doctor, if you think there is no doubt of my being able to get -back so as to take the 10:30 train for Chicago I guess I’ll have to go -with you. Really I should not do it as I have a hard day’s work ahead of -me, but you have aroused my interest in the case and I would like to see -the patient. I’ll meet you at the depot at train time. Until then good -bye. I can’t begin to tell you how much I appreciate your call. If -conditions were different I would insist on your being my guest for the -day, but, as you well know we medical men are not our own masters.” - -Without appearing to hurry he gets rid of Dr. Jennings before it is time -to receive the next caller and, by exercising a little tact, the various -people with whom he has made engagements are kept from meeting one -another. Out of the four appointments he has made with laymen the doctor -will ordinarily obtain fees from at least two, if not all four of his -callers. Just how he does it will be explained in another chapter. - -At 4:15 Dr. Wilkinson is at the depot where he finds Dr. Jennings -waiting. On the train, the specialist delicately brings up the matter of -fees. - -“One great trouble with a treatment of this kind is the expense. The -fees must necessarily be large and it is difficult to get even wealthy -men to pay them. It is a relief to be able to discuss this part of the -subject candidly with a brother physician like yourself who has the -brain and common sense to appreciate it.” - -Once again Dr. Jennings is pleased at the confidence reposed in him, and -the more so when Dr. Wilkinson continues: - -“Of course in a case like this where the local physician interests -himself, takes his time to visit a patient with the specialist, gives -the latter the benefit of his knowledge of the case, and continues the -treatment after the specialist has gone, there should be a division of -the fee. The local physician cannot be expected to donate his services; -that would be ridiculously unfair.” - -The country doctor is more interested than ever. Should he be -super-sensitive about acceptance of a fee, and inclined to question the -ethics of the arrangement he is quieted with the assurance that it is in -common practice all over the country. In most cases, however, there is -no tendency of this kind. The local practitioner is ready, and anxious -to get his share of the money. His main concern is about the amount. -Frequently he asks: - -“What do you think we can get doctor?” - -“That depends upon the man. You know him better than I do. You say he is -wealthy, so his ability to pay is not to be questioned. We’ll fix upon -an amount that will be equitable under the circumstances. It should not -be less than $500.” - -The prospect of obtaining $250 so easily is very alluring to Dr. -Jennings. He does not realize that the specialist is using him as a -bait, making him stand sponsor as it were, for the merit and efficiency -of the treatment. Arrived at Smith’s home Dr. Jennings is warm in his -endorsement of everything Dr. Wilkinson says and does. The latter -examines the patient carefully, asks him numerous questions, frequently -referring to Dr. Jennings for information upon technical points, and -showing deference for the opinions of the family physician. Finally the -stage is reached where it is necessary to talk business. - -“If you should decide to take this treatment, Mr. Smith, I will arrange -with Dr. Jennings for its administration. It should be given twice a -day. I will furnish all the remedies and, advised by frequent letters -from Dr. Jennings as to your progress, will outline such changes from -time to time as may appear necessary.” - -This naturally leads Mr. Smith up to asking, “Do you think you can cure -me, doctor?” - -“Well, Mr. Smith, as Dr. Jennings will tell you no reputable physician -countenances the word ‘cure.’ I will say, however, that I have had many -cases, some of them apparently even worse than yours, in which entirely -satisfactory results have been obtained. Here are a couple of letters -just received which I am requested by the writers to show. They will -probably interest you.” - -Saying this the specialist brings out a couple of letters written by -patients who have been benefited. They are bona fide letters. It would -be strange if out of the large number of people treated some cases did -not yield satisfactory results. The letters read about as follows: - - - PITTSBURGH, ——, 1910. - - DEAR DOCTOR WILKINSON: Replying to your enquiry of recent date - regarding my condition I am most happy to be able to say that - marked improvement continues. The pains have entirely - disappeared, all the functions of the body are normal, and I - walk long distances every day without cane or crutch. This - result obtained in a little less than ten months of treatment is - most pleasing considering that I was sorely afflicted for over - ten years, and that my case was pronounced incurable by the best - specialists both here and abroad. Dr. Kennedy, my family - physician, says the change in my condition is miraculous. - - Don’t hesitate to show this letter to those who may be similarly - afflicted. It is a duty which I feel that I owe humanity to make - known what has been done for me. - - You will probably also hear from Dr. Kennedy within a few days. - With sincere thanks, I am, - - Most gratefully yours, - ———— - - -Drowning men clutch at straws. Mr. Smith knows that he is afflicted with -an ailment which other physicians have been unable to relieve. Here -appears to be something effective. Hope dawns, and he enquires: - -“What will it cost, doctor?” - -“That, my dear sir, is a question I was in hopes you would not ask. -Worry over the expense of treatment always tends to retard or delay -complete recovery. What is money compared with health. Why should you -set one against another? Can you measure the monetary value of health as -you would that of a ton of coal, or a ton of hay?” - -Mr. Smith begins to feel ashamed of himself, and all the more so when -his family physician chimes in and endorses what the visiting specialist -has said: - -“I guess that’s all right, doctor,” responds Smith. “You can’t measure -health against money, but I must have some idea as to the expenses. It -may be beyond my means.” - -“We’ll fix that all right,” says Dr. Wilkinson. “The usual fee for -complete treatment is $150 a month.” - -“How long will it take?” - -“That’s something no man can tell. I’ve had cases in which the desired -results were obtained in so short a time as four months, and others in -which they were deferred for fifteen months. If there is such a thing as -striking an average I should name it at ten months.” - -“That would be $1,500. That’s an awful lot of money.” - -“It’s nothing in comparison with good health. I have had many patients -who preferred to pay a lump fee in advance in order to get the worry -about money details off their minds. Under this arrangement the -treatment is continued as long as may be necessary whether it is four -months or fourteen. In such cases I accept $1,000. This not only pays -for the entire course of treatment but it saves the patient $500 should -the course be continued for ten months, which is not at all unlikely.” - -The saving of $500 appeals to Mr. Smith, and he accepts the proposition. -While he is signing the check Dr. Jennings has to pinch himself to see -if he is really awake. The idea of getting $500 for his share of an -hour’s talk is overpowering. The check delivered, Mr. Smith is assured -that the remedies will be in Dr. Jennings’ possession within the week -and that treatment will start at once. - -Once outside Dr. Jennings is impelled to ask: “How did you come to fix -the fee at $1,000, doctor? I thought you said it would be $500?” - -“I said not less than $500. But I found Mr. Smith more responsive in -this connection than most men, and it was just as easy to get $1,000 as -it would have been $500. By the way, how are we going to divide this -check?” - -There is nothing to do but for Dr. Wilkinson to remain in town over -night and for Dr. Jennings to identify him at the bank the next day. -This is done, and the money drawn and divided. Who gets the best of the -bargain? Apparently both doctors are on the same footing, but are they? -Dr. Wilkinson has $500. For this he will send once a month for a few -months a supply of treatment the actual cost of which will not exceed -$2.50 a month—perhaps $25 for ten months. Dr. Jennings, on the other -hand, must visit the patient every day, administer the treatment, keep -track of his condition, note such changes as may occur, and report them -to Dr. Wilkinson. - -Dr. Jennings must perform his duty in person, he cannot delegate it to -another. Dr. Wilkinson does most of his work, except the actual case -taking, through hired help. He has a dozen, or a hundred, Dr. Jennings -working for him all the time. - -Many specialists are averse to working in connection with family -physicians. In some instances this is because of short-sightedness on -the part of the specialist. He doesn’t like the idea of dividing his fee -with the country practitioner. In other words he is greedy and wants it -all, losing sight of the fact that in the great majority of instances -the family physician is the deciding arbiter and, without his aid, a lot -of cases would be lost. - -Then there are specialists who have not the knack of making friends with -the country doctor. The latter is naturally opposed to the specialist; -he thinks, whether justly or not, that his own method is best and looks -askance on “new-fangled” ideas in practice, especially when a good fee -is liable to go to the stranger. But, let this same country physician be -led up in the proper manner to the division of fee proposition and he -takes a different view of the situation. It seems like a lot of money to -give away, but it is a good investment. The man who accepts the division -stands committed to the treatment; he becomes a booster instead of a -knocker. If the case does not turn out well there is little chance to -find fault with the specialist. The local Dr. Jennings has been in -charge and upon his shoulders rests the responsibility. Should the -patient complain the local physician can, and very likely will say: - -“Of course it is a disappointment Mr. Smith, but the practice of -medicine is full of disappointments. There is one consolation. You have -had the benefit of the latest treatment evolved by medical science. Dr. -Wilkinson arranged the treatment to meet your special needs after I had -given him a complete history of your case, and you must admit that I -have been faithful in its administration. I’m sorry that the results -were not different, but that is something every physician has to contend -with.” - -Left without the services of the local physician as an ally the -specialist would probably be blamed for the failure, and the patient -might even refer to him as a swindler. Such things have occurred with -the result that the specialist’s chance of getting any more patients in -that neighborhood was wiped out. But, by retaining the services of the -family physician the specialist is taking out insurance against this -very happening. - -Dr. Jennings, of course, does not realize that he is being made a buffer -of. He has had, as he thinks, the scientific features of the treatment -carefully explained to him, and the theory is reasonable and in thorough -accord with that of accepted authorities. As for the division of fee—why -he certainly is entitled to pay for his services in treating Mr. Smith, -and it is much better for the latter to have Dr. Wilkinson stand this -expense than for it to fall upon Mr. Smith. - -It’s all in the viewpoint, and the viewpoint can be just what the -specialist makes it. If he is a clever man it will be favorable; if he -lacks tact and is antagonistic in nature, it will be unfavorable. As to -this latter contingency it may well be said that a tactless, -antagonistic man has no business operating in this field. Tact and -suavity and an impressive appearance count far more than a knowledge of -medicine, and will get more money every time. - -It’s worth considerable to have the good will of family physicians in -the country districts, so that when occasion arises they will say: “Dr. -Wilkinson is an able man, and perfectly square in his business methods. -We (observe the “we”) didn’t get the desired results in the Smith case, -but it must be remembered that it was an unusually serious one, and Dr. -Wilkinson said so at the time. Recovery would have been little short of -a miracle. Had the treatment been taken before the disease was so far -advanced there is every reason to believe the results would have been -different.” - - ------------------------------------------------------------------------- - - - - - CHAPTER VI - - =RECEPTION OF OFFICE PATIENTS= - - -To the physician who prefers to do a strictly office practice, making -few or no professional forays into the country, well located, neatly -furnished, attractive quarters are a necessity. Three rooms will be -sufficient for a start. These should include a reception room, waiting -parlor, and doctor’s private office. - -Size is not so important as location and furnishings. The quarters -should be in a modern building of high-class reputation as to the -character of its tenants. If the arrangement is such as to give an -entrance into the doctor’s room from the waiting parlor, and an exit -into another hall, it is preferable. This will make possible the -separation of the callers the doctor has seen from those who are still -waiting, and this prevents a lot of talk which may have a harmful -tendency. - -People, especially men, waiting to see a physician are apt to get into -conversation with one another. When there is only one door serving as -entrance and exit to the private office, and a caller, after seeing the -physician, has to come back into the waiting parlor in order to get out -there is a temptation to stop for a few moments and chat with those who -are still waiting. In this way much harm, particularly in the matter of -fees, may be done. - -It is poor policy to give people a chance to exchange confidences. They -will tell each other their opinion of the physician, the amount of the -fees, etc. If these latter do not agree in amount it causes jealousies -and distrust, and it becomes difficult in many cases for the physician -to explain to the satisfaction of Mr. Brown why he should be charged a -larger fee than Mr. Jones. - -Under the best of conditions there will be too much of this sort of -thing, but it may be greatly reduced by an arrangement of the rooms -which will admit of callers being taken into the doctor’s office at one -door and shown out at another. In one instance the waiting room of a -certain specialist was crowded when one of the callers came out from the -office after an interview. - -“Are you going to take the treatment,” was the question put to him by -one of those with whom he had been talking before he had seen the -doctor. - -“Not much,” was the answer in a loud tone. “That man’s a robber. He -wanted $500 for the treatment.” - -This frightened away a number of men nearly all of whom would have been -good for $100 apiece when interviewed by the doctor under proper -conditions. But they left without seeing him; actually scared off by the -talk of the dissatisfied caller. - -Rooms arranged as described and located in a good building will command -more rental than ordinary quarters, but the investment will be a good -one. There will be more money in paying $100 or $150 a month for rooms -of this kind than $50 for others not similarly arranged. - -Proper furnishings create a favorable impression upon callers. Neat -rugs, comfortable leather covered chairs and lounges, neat tables for -books and magazines, handsome curtains and bright, cheerful pictures on -the wall tend to make the extraction of a good-sized fee all the easier. - -No person feels like paying a big fee to a doctor of sloppy appearance -who is quartered in a shabby, poorly furnished room. Shabby surroundings -breed distrust. An appearance of prosperous solidity on the other hand -creates confidence. It is easier to get $100 from a patient in properly -furnished quarters than it is to get $5 when the doctor’s poverty stares -out from every side. - -One of the most successful specialists in the profession had retired -with a competence. He got to speculating and lost heavily. When he had -only $1,000 left he was compelled to resume practice. He rented quarters -which cost him $125 a month, and furnished them magnificently at a cost -of $1,250, paying $500 down. Various other outlays cut his cash capital -down to $100 by the time he was ready to open his offices. Did he -flinch? Not at all. He was game and knew that with any ordinary luck it -would be a paying investment. He made a second fortune which he was wise -enough to keep. - -“It was like catching flies with a bait of sugar,” he said in discussing -his method. “They swarmed in from all sides; the surroundings looked -right, and I had little trouble in landing a fair percentage of the -callers. If I had attempted to skimp in the rent or furnishings my -purpose would have been defeated from the start.” - -In taking medical treatment, as in nearly everything else, people like -to deal with the successful man, and they judge of a man’s success by -his surroundings. If he looks prosperous the battle is half won before -the attack on the caller’s pocketbook begins. - -Next to the location and furnishings of the office, and the neat, -well-dressed appearance of the physician himself, comes the question of -the selection of the proper reception room girl. Here almost as much -tact is needed as in the physician’s private office. The right kind of -girls are scarce, and when one is found she is worth much more money -than the average doctor, unacquainted with the importance of the -position, is willing to pay. A thoroughly competent girl is easily worth -from $18 to $25 a week, yet most doctors grumble at paying $10 or $12. - -It is a peculiar combination of talent, one exceedingly hard to find, -that is required. The successful attendant must be prepossessing in -appearance, a neat dresser, intelligent, sympathetic, chummy to a degree -without being “fresh,” and, above all, must have that undefinable -quality known as tact. She must have the knack of making people feel at -home and comfortable on their first and all subsequent visits, without -being fussy or over-prominent in her attentions. - -Quiet dignity and charm of manner in a reception room girl is a -combination of great value to an employer. The girl possessed of these -qualities, in addition to “tact,” can be a valuable and powerful ally of -the physician. She will exert a great influence in keeping patients good -natured and satisfied, steer the malcontents away from opportunity to -make trouble, and preserve in general the harmony that should prevail in -the professional family. - -We all know what a strong factor first impression is. The manner of our -reception by a stranger invariably sows the seed of our opinion. If the -reception is courteous and kindly without being effusive we are won; if -it is cold and indifferent, or so overly effusive that deceit is -apparent, we are repelled. Right here is where the reception room -attendant wins or loses. It makes all the difference in the world -whether the prospective patient meets the doctor for the first time -pleased with the manner in which he was received, or whether he is -fretted or annoyed at his treatment in the outer office. - -The door leading from the reception room into the waiting parlor should -always be kept closed. There is no necessity of letting the people who -are waiting to see the doctor hear what is going on in the outer room. -It often works harm. Besides this a new comer will announce himself more -freely to the attendant when alone with her than he will when a dozen or -more strangers are within hearing. - -One of the furnishings of the reception, or outer room, unless the -business warrants a separate department, may be an unobtrusive cabinet -in which the correspondence is filed. This should always be closed so -callers will not get an idea as to its contents. Men especially do not -like to know that a woman is conversant with the contents of their -letters to the doctor. - -When a stranger enters the room the attendant should always rise from -her desk, meet him half way, and enquire pleasantly: - -“What can I do for you?” - -“I’d like to see the doctor.” - -“Step into the waiting room, please, and I’ll let him know you are here. -Whom shall I announce?” - -“Thomas Carroll, of Providence, Iowa. I think he expects me as I’ve had -some correspondence with him.” - -“All right, Mr. Carroll, I will let him know you are here.” - -Taking the new comer into the waiting room the attendant should give him -a paper or periodical. The man who is reading is not so apt to get into -conversation with strangers as the one who is idle. Coming back into the -outer office the girl closes the door, goes at once to the -correspondence cabinet and takes out the packet containing Mr. Carroll’s -correspondence. This she gives to the doctor via the outside door, at -the same time announcing Mr. Carroll’s arrival. - -No doctor who is wise will receive a caller immediately upon arrival. It -creates a good impression to keep the caller waiting for a few moments -even if there is nobody ahead of him. The girl goes back to the waiting -room and says: - -“The doctor is glad to know you are here, Mr. Carroll. He is engaged -with a patient just now, but he will be through very soon, and will see -you in a few minutes.” - -This helps to kill time, and to convince the caller that the attendant -is looking after his interests. In the meantime the doctor is reading -Mr. Carroll’s letters and the answers thereto, and refreshing his memory -about the case so that when Mr. Carroll is shown in the latter will be -astonished by the doctor’s knowledge of his ailment and condition. The -letters in the meantime are put away in a drawer out of sight. - -Finally the bell rings and, if Mr. Carroll is next on the list, the girl -will say: - -“The doctor will see you now, Mr. Carroll,” and shows him into the -sanctum. What happens when doctor and caller come together is told in -another chapter. This one deals solely with the manner in which the -caller should be received by the girl in charge of the outer office. - -Should the caller become a patient the attendant who understands her -duty will begin to evince a mild ladylike interest in his case. Without -at any time becoming forward or fresh she will have a cheery word of -greeting for him on his daily arrival or departure, and finally begin to -comment in a delicate manner on the improvement in his appearance. - -“Good morning, Mr. Carroll. You’re looking better this morning. By the -way, if you want to write any letters you can dictate them to our -stenographer, and you might as well have your mail sent here. I’ll be -glad to look after it for you.” - -Such attentions mean much to an invalid stranger and are more -appreciated than they would be by a robust, healthy person. Mr. Carroll -may intimate that he thinks of going to some theater in the evening, but -doesn’t know where to go. Then the attendant should say: - -“Well, that depends upon what you like. If it’s comedy there’s the —— —— -at the Continental. Grand opera at the Richelieu; tragedy at the -Shakespeare and vaudeville at the Boston. If you want to see something -really funny go to the Continental. I’ll have our stenographer get your -ticket when he goes out to luncheon, and that will save you from being -pushed around in the crowd at the box office.” - -All this, of course, is after the lapse of a week or so when Carroll has -become a daily caller for treatment, and begins to think that the doctor -is all right himself, and that the reception room girl is just about as -near right as they make them. - -No matter how many girl stenographers the doctor may keep busy in a room -further down the hall, there should always be one young man for what may -be called “show” purposes. Men patients don’t like the idea of having -their physical troubles discussed in letters written by girls. When the -young man stenographer is brought in to take dictation from a patient -the latter not only appreciates the compliment, but feels confident that -his troubles are known only to one of his own sex. - -By all means keep the girl stenographers out of sight, and do not let -the male patients know that a woman ever saw their letters, or the -doctor’s replies to those letters. Adopt exactly the opposite tactics -with women patients—keep the man stenographer under cover. - -Despite the utmost care there will be times when the patients will get -together in the waiting room and discuss the doctor and his methods, the -merits or demerits of the treatment, compare fees, etc. One dissatisfied -patient—and every physician has them, no matter how generally successful -he may be—can create more disturbance and uneasiness in ten minutes than -the doctor can overcome in a week. - -It is right here that the reception room girl has a chance to prove her -worth. When she finds the conversation drifting into disagreeable -channels she can adroitly step in and change the subject without seeming -to have a purpose in doing so. The introduction of a timely topic by a -bright, entertaining woman will start the flow of talk in a new -direction and in the discussion that follows criticism of the doctor -will be overlooked. - -One day a chronic kicker, one of those fellows who is never satisfied no -matter how much is being done for him, met another patient in the -reception room and began to find fault with the treatment. Without -seeming to listen to the conversation, and with her mind apparently -engrossed on some other topic, the attendant said: - -“Oh my, how I wish I had a brother or a father to advise me.” - -“Why, what’s the trouble?” very naturally enquired one of the -patients—and he happened to be the “kicker.” - -The girl went to relate an entirely suppositious occurrence over which -she pretended to be badly wrought up; a business entanglement with a -concern from which she had bought some goods on the installment plan, -and about which there was a serious misunderstanding. Both men were -profuse in their tenders of advice, and in their desire to be of -assistance to the girl they forgot entirely the original topic. The girl -kept them engaged in conversation until the “kicker” departed, and the -danger was over for that day, at least. - -She reported the matter to the doctor and the latter very cleverly -arranged the “kicker’s” hours for treatment so there would be little -chance of his finding other patients in the office. - - ------------------------------------------------------------------------- - - - - - CHAPTER VII - - =THE CORRESPONDENCE FILE= - - -No specialist, or physician who conducts a general practice by publicity -methods, can hope to make a lasting success, except in rare instances, -without a well-managed correspondence department. In the beginning the -physician may attend to this himself but, as the business grows he will -need the services of a smart, competent man. Newspaper men do the best -in this position. The right kind of men command from $50 to $100 a week, -and in many cases get a working interest in the business. They are worth -every cent they get. - -The physician with a large office or out-of-town practice is too busy to -give attention to the details of correspondence. He has not the time -during office hours, and after his work for the day is done he is too -weary to dictate the many letters that should go out every day. Not only -this, but there are very few medical men who know just what to say. -Letter writing is a gift, and the men who have this gift make a business -of it. - -Every letter that comes into the office should be indexed by the card -system and then filed away by number with the copy of the reply -attached. This work, as well as the opening of the mail and the -dictation of answers, should be done in a room convenient to the -doctor’s office, but away from it far enough so that the patients will -not suspect the connection. - -A letter arrives from Hiram Oxbow, of Valparaiso, Indiana. The man in -charge of the correspondence opens it and finds that, according to the -printed heading Mr. Oxbow is conducting a cooperage plant. The letter -runs about as follows: - - - HIRAM OXBOW - - MANUFACTURER OF COOPERAGE - - VALPARAISO, IND., August 10, 1910. - - _Dr. G. H. Wilkinson, Chicago, Ill._ - - DEAR SIR: I have read of your success in the treatment of - locomotor ataxia, and would like to know whether you think you - can do anything for me. I am 45 years of age, and have been - afflicted for the last eight years. Have doctored with nearly - everybody in the country without results. Can you cure locomotor - ataxia? Please let me hear from you soon. - - Yours respectfully, - HIRAM OXBOW. - - -Sorting out all the letters of this kind the correspondence chief gives -them to one of his stenographers with instructions to look up the -financial rating of the various writers as given in Dun’s or -Bradstreet’s. Every well-equipped correspondence room will have a copy -of a commercial guide of this kind. The girl marks on the letters such -ratings as are given in the guide. Mr. Oxbow, for instance, is quoted as -A 4. - -When the answers are written each new enquirer is given an individual -card and number, the numbers running consecutively. The last number in -the file we will say is 6345. Mr. Oxbow’s number will be 6346. One of -the girls then makes out a card which reads: - - -No. 6346—Hiram Oxbow, Valparaiso, Ind. Rating A 4. - -1907 - -Aug. 11. First enquiry. Answered with No. 3. - - -Mr. Oxbow’s letter with a carbon copy of the reply thereto is then -placed in a manila paper pocket, numbered 6346, and filed in the letter -cabinet. If at any time it is desired to get the correspondence in the -Oxbow case the card, which is filed alphabetically, will give the -correspondence number and the location of the letters themselves will -then be easy. - -An entry in brief is made on the card every time Mr. Oxbow is heard from -so that the card itself will show at all times an outline of the status -of the case. Suppose that a number of letters pass, and Mr. Oxbow -finally decides to come to Chicago to see the doctor. The card will then -show entries like these: - - -No. 6346—Hiram Oxbow, Valparaiso, Ind. Rating A 4. - -1907 - -Aug. 10. First enquiry. Answered with No. 3. - -Aug. 15. Wants more particulars. Asked him to come to Chicago. - -Aug. 21. Enquires about fees. Told him it was impossible to fix amount -in advance of seeing patient. - -Aug. 26. Will be in Chicago Aug. 30th, 9 a.m. - -Every letter received from Mr. Oxbow and a copy of every reply is filed -in the same manila pocket so that when wanted they are all together, and -can be taken out in a minute. - -Suppose Mr. Oxbow is not rated in Dun or Bradstreet? It is the -correspondence chief’s business to ascertain his financial standing if -it is possible to do so. Frequently this is done through the doctor’s -bank, or the doctor may be a subscriber to some commercial agency. In -either event a confidential enquiry is made as to the responsibility of -Mr. Oxbow. The answer may say: “Good for $10,000;” or “credit good, pays -bills promptly;” or “credit poor.” In the great majority of cases -information of some kind will be secured which can be entered on the -cards for future reference. - -How are enquiries from prospective patients secured? Some of them are -made voluntarily, being induced by the enquirer having read in some city -paper about the doctor’s success in certain lines of practice—one of -those articles which the clever press agent, who is usually the -correspondence chief, has had inserted in the guise of news. Generally, -however, enquiries are drawn out by a systematic campaign through the -mails, or by resort to publication in the country papers. - -No wide-awake, progressive correspondence chief will wait for voluntary -enquiries. He will make an arrangement with a clipping bureau by which -for $5 a hundred he will be supplied with clippings from all the papers, -large and small, in his territory announcing the illness of citizens. -When the Beeville _Bugle_ publishes the news that “Abner Skeets, a -prominent resident of Beeville, has become a victim of chronic -arthritis,” the paper is not in the office of the clipping bureau over a -few hours before the correspondence chief has received the paragraph. In -this manner he comes into possession of hundreds of similar news items -every week. - -All the various publicity articles which the city papers have published -about Dr. Wilkinson and his wonderful success have been reproduced by -the zinc-etching process and thousands of slips printed in a manner -which makes them bear the appearance of having been torn out of the -original publications. - -As fast as the clippings come in Mr. Press Agent sorts them by towns and -has one of his stenographers make a card index, giving the name and -address of each prospect and the nature of his disease, as well as the -date of mailing the first clipping. Then he has plain envelopes -addressed to each prospect, and encloses in these envelopes one of the -prepared news items applicable to the ailment with which the party -addressed is afflicted. There is no printed business card on these -envelopes and, as they are invariably addressed by hand, the recipient -is under the impression that the communication has been sent by some -unknown friend who desires to let him know of this doctor’s success in -the treatment of just such cases. The recipient does not connect the -doctor with the sending of the clipping as he argues that, if it came -from a doctor, the envelope would bear his business address, and there -would be some note of explanation. Besides, there is not one chance in a -million that Dr. Wilkinson ever heard of him, or knows where he lives, -or what the nature of his trouble is. Of course it was sent by some -friend. - -This method excites the curiosity of the sufferer, and he gives careful -attention to the clipping and begins to ask himself whether it is not -worth while to write to this wonderful physician and ask his advice -about treatment. - -As fast as a batch of clippings is sent out the cards from which the -addresses were taken are moved to the back of the receptacle, and a date -card, a little higher than the others and of a different color so as to -be readily noticeable, is placed in front of them. This date card shows -when, if no reply is received to the first communication, it will be in -order to send a second. - -If the first communications are mailed on the 10th of the month, the -date card behind which these cards are placed will bear date of the -30th, thus showing that on the 30th of the month another clipping, or -some other form of literature should be sent. - -Whenever one of the parties thus addressed is heard from this card is -given a file number and transferred to the prospective list, the purport -of the enquiry and the nature of the reply being noted on it. There is -never lack of material to work on. People who have heard of the doctor -are writing to him all the time, and the clipping bureau is continually -sending in items about people in various parts of the country who have -become afflicted with serious chronic troubles. - -Every physician who practises in this manner should have a neat pamphlet -descriptive of his treatment and the results obtained in various -ailments. It is the duty of the press agent or correspondence chief to -prepare this. It should be modest in language and give an outline of the -pathology of certain diseases as well as the therapeutic effects of the -treatment in a rational, plausible manner. Exaggerated statement, or -defects in technical description will defeat its purpose. The typography -must be neat and in good taste, and the paper of high quality. - -Right here it may be stated that many physicians are penny wise and -pound foolish in the matter of literature and stationery. The best is -none too good. Neat, handsome work attracts attention, while the cheap, -slip-shod variety repels. - -If the clipping first sent has not brought an enquiry by the tenth day, -mail one of the pamphlets. The recipient will read this with interest -and note particularly what has been accomplished in cases strikingly -similar to his own. On mailing the pamphlet the fact should be entered -on the card, with date of mailing, and the card moved back another ten -days, ready to be taken up again on the 30th. By this system there is a -constant stream of mail matter going out every day, and each card -contains a record of just what printed matter has been sent to each -prospect, and when. - -Allowing that neither the newspaper item or the pamphlet bring enquiries -Mr. Press Agent will, as his third effort, address the sufferer by -letter somewhat as follows: - - - G. H. WILKINSON, M.D. - - SPECIALIST IN CHRONIC DISEASES - - —— Michigan Avenue - - CHICAGO, Sept. 9, 1910. - - _Mr. John Peters, Beeville, Wisconsin._ - - DEAR SIR: Recently, at the suggestion of a mutual friend, I - mailed to your address a copy of a pamphlet containing an - account of what has been accomplished in the treatment of cases - similar to yours by an entirely new method. This I hope you have - received and had time to read over carefully as I am confident - you will find it of interest. - - The gentleman referred to (who requests that his name be - withheld) has told me considerable about your case—just enough - to arouse professional curiosity. This is my only excuse for - intruding upon you. If you will kindly forward details, stating - length of illness, nature of symptoms, what has been - accomplished in the way of treatment, etc., I may be able to use - the information to the benefit of others similarly afflicted. - - Should I be able to offer any suggestions or advice which may - tend to improve your condition, I shall be glad to do so. For - this there will be no fee or charge of any kind—it will be - merely exchanging one favor for another. - - Yours very truly, - G. H. WILKINSON, M.D. - - -No appeal here to come in and be relieved of a big fee; no intimation -that the doctor would like to have Mr. Peters as a pay patient. On the -contrary the doctor only seeks information that may be of benefit to -other patients. At least this is the way Mr. Peters interprets it. - -“Fine fellow, that doctor,” says Mr. Peters as he reads the letter, and -he sits him down “with pen in hand” to describe his case, invariably -winding up with an enquiry as to whether the doctor thinks there is any -hope for him. The reply from Mr. Peters is forthcoming all the quicker -because the doctor has thoughtfully enclosed a plain stamped envelope -bearing the written (not printed or type-written) address, “G. H. -Wilkinson, —— Michigan Ave., Chicago.” No M.D., attached to the title, -nothing to give the inquisitive hangers-on at the post office in -Beeville a clue to the true nature of the communication. When these -busybodies happen to catch a glimpse of Mr. Peters’ letter they have no -suspicion that it is a doctor their fellow townsman is writing to. -Nothing to show it on the envelope. No doctor’s return card in the -corner, no printed or even type-written address. - -No sir-ree. Dr. Wilkinson is too smart for that. Experience has taught -him that the average man does not like to have his friends and neighbors -know that he is corresponding with a strange doctor. Hence the -“sent-securely-sealed-in-plain-package tactics.” - -It’s different in a big town or city where the facilities for becoming -acquainted with the nature of a man’s correspondence do not exist, and -the rush of business is so great that even postal cards go through the -mails unread by any one except the sender and the receiver. - -But in the rural districts where Absalom Squash and Praise-it-all -Tompkins assist Hiram Gaylord in his duties as postmaster to the extent -of closely inspecting every letter that comes in or goes out—why that’s -another story. - -“Wonder what John Peters is writing to that fellow in Chicago erbout?” -says Absalom Squash as he picks up the letter addressed to G. H. -Wilkinson and holds it up to the light in a vain effort to get an -inkling as to the contents. But this Wilkinson chap is wise. He has -provided an extra heavy envelope, white on the exterior, but blue coated -inside, to thwart just such efforts. Against the postal regulations for -anybody outside of the postmaster or his sworn assistants to handle the -mail? Of course it is. But this regulation is a dead one in nearly every -small post office in the country. - -When Mr. Squash goes home he reports to Samantha that “John Peters is -writin’ to that Chicago fellow again. John had a letter from Chicago day -before yesterday, and to-day he sent off the answer, but he didn’t write -the address himself.” - -“How’d you know ’twas from Peters, then?” - -“’Cause his boy brought it to the office,” answers Absalom triumphantly. - -Samantha is interested and runs over to her friend Abigail Simpkins to -discuss the strange occurrence. That they are unable to do more than -enjoy a little idle gossip is owing to the lack of any clew on the -envelope as to the nature of the business or occupation of the party -addressed. - -In this feature Dr. Wilkinson’s plan is a good one. In corresponding -with patients or prospective patients use plain envelopes, or if some -safeguard in the matter of return is desired, use a post-office card in -the corner such as “If not delivered in five days return to Box ——, -Chicago Post Office.” Nothing more. Should anybody make an effort to -ascertain who has rented this particular box in Chicago, or any other -city of decent size, he will be politely told by the postal officials -that it is none of his business. - -Sometimes the parties addressed die before the letter reaches them. In -cases of this kind the return card in the corner of the envelope serves -a good purpose. It is the duty of the postmaster to return it to the -address given in the card marked “Party dead.” When this happens the -correspondence chief takes the card from the file and destroys it. There -is no use wasting time, stationery and postage on dead ones. - -About five or six forms of these preliminary letters are prepared, and -each is given a number such as No. 1, No. 2, and so on. When they are to -be sent out it is not necessary for the correspondence chief to dictate -a letter to each prospect. He merely sorts out the cards which are due -to be attended to that day and turns them over to one of the girls to -send No. 1, or No. 2, or whatever letter may be in order. - -The stenographers have copies of all these letters and, as they write -them, the form number of the letter and the date of its mailing is -entered on the prospect card. After the list of letters has been -exhausted the cards are transferred to another file to be used later in -connection with the “I have been called to your town” correspondence. -This is a great labor-saving system and makes possible the transaction -of an immense amount of correspondence at the minimum of expense. - -Many invalids, especially those who have tried various forms of -treatment without obtaining relief are doubters—they insist upon “being -shown.” They insist upon some convincing evidence that this special -treatment has merit. This is easy in most instances although once in a -while the specialist runs across a hardened old cuss who would not -believe the Angel Gabriel under oath, and doesn’t hesitate to say so. - -Nearly every physician is sure to have some patients who have been -greatly benefited by his treatment and are truly grateful for the relief -obtained. The securing of the right kind of letters from these patients -is only a matter of request at the proper psychological moment. After a -friendly talk with one of these patients some day when the latter is -feeling unusually exuberant, and has deftly been led up to the stage of -declaring that he can never repay the doctor for what he has done for -him, the physician will say: - -“Oh, that’s all right, Mr. Brown. I am sincerely happy to know that the -improvement has been so great. No matter what we do, there is sure to be -scoffers and doubters. But a physician’s hands are tied. There is no way -in which he can overcome this bias except with the aid of just such men -as yourself. Now, if you could find it convenient to write a letter -stating just what has been done in your case I would keep it in my desk -to show such doubters as may drop in on me. Not as an advertisement or a -puff mind you, but merely as a means of overcoming unfair statements. -But I feel that this would be asking too much of you.” - -“Not at all, doctor. I’ll be only to glad to do it. But the fact is -doctor, I’m a poor letter writer. If you’ll prepare something I’ll sign -it.” - -This is just what the doctor wants and at the first opportunity he slips -out and passes the word to the correspondence chief. The latter prepares -a letter which the doctor copies in his own handwriting. When it is -submitted to Mr. Brown the doctor says: - -“This will look and read better on one of your own letter heads. If you -will copy it on your stationery I’ll appreciate the favor.” When finally -written and signed the letter will be about like this: - - - JAMES H. BROWN - DEALER IN HIDES AND TALLOW - Union Stock Yards - - CHICAGO, Sept. 9, 1910. - - DEAR DOCTOR WILKINSON: I am sure you will be glad to know that - the improvement in my case continues and grows, if anything, - more noticeable daily. Considering the physical wreck I was - three months ago, the change is little short of miraculous. This - is not only my opinion, but that of my friends as well. - - It is particularly gratifying to have those who called me a fool - when they heard I was going to Chicago to be treated for - locomotor ataxia now acknowledge that they were mistaken, and - congratulate me on my action. - - If I can serve you in any way don’t hesitate to call upon me. It - is my duty to let fellow-beings similarly afflicted know what - you have done for me. - - Gratefully yours, - JAMES H. BROWN. - - -In the same manner the doctor secures similar letters from other -patients. These are reproduced by the zinc-etching process, business -headings and all, and when properly printed few people can tell them -from the originals. When copies are sent out to prospective patients -accompanied by the right kind of a letter of explanation the persons -receiving them believe, as a rule, that the doctor has forwarded for -their inspection the correspondence of Mr. Brown, or some other patient, -and this impression induces many people to return them so the doctor -will not lose such valuable communications. - -The author, who has long experience in this line, has had many such -letters sent back with notes of thanks for the privilege of reading -them. One of these notes, which he still retains, reads as follows: - - - OSHKOSH, WIS., April 15, 1910. - - DEAR DOCTOR: I have read the letters you sent me, with a great - deal of interest, and will say to you frankly that they have - convinced me that there must be a lot of good in your treatment. - I am now making arrangements to come to Chicago, and will do so - as soon as I can close a deal which is now pending and get hold - of some cash. - - I return the letters as I know you must prize them highly, and - would dislike to lose them. - - Will write you a day or two before I start, as it will be - necessary to have some one meet me at the depot. - - Very truly yours, - ———— - - -Did I get this man for a patient? Yes, and he paid a good fat fee. And -the best part of it all is the fact that, after about three months of -treatment, he went back home comparatively a well man. On his first -visit to the office he was in a wheel chair—he could not walk. When he -left he was able to walk a mile or more without undue effort. - -It would defeat the purpose in using these letters from patients to send -them broadcast as circulars. Discretion must be used as to the manner of -distribution. Never send one until you have had considerable -correspondence with a prospect, and then be careful that duplicates do -not get into the small towns. The smaller the town the faster the news -travels. If John Smith, living in a hamlet of 300 population, receives -communications of this kind it is only a matter of a few days until -everybody in the place knows of it. Smith tells his wife, his wife tells -somebody else, and in this manner the news is circulated. - -Now, if Aleck Brown, living in the same town, or close by, should get -duplicates of these letters Smith and the others would soon hear of it -and, instead of being looked upon as priceless treasures submitted for -Smith’s inspection, they would naturally be classed as some new-fangled -method of circular advertising. - -Having passed several preliminary letters with Mr. Smith without getting -him to commit himself as to coming in for treatment, pick out a couple -of the letters from patients which apply the most directly to his case, -the particulars of which may be obtained from the prospect index. -Enclose these with a letter of your own addressed to Mr. Smith, and -reading about like this: - - - G. H. WILKINSON, M.D. - - SPECIALIST IN CHRONIC DISEASES - - —— Michigan Avenue - - CHICAGO, ——, 1910. - - _Mr. John Smith, Vail’s Gate, Mich._ - - DEAR SIR: In a recent letter you expressed doubt as to the merit - of any treatment that could be applied in a case like yours. In - view of the many disappointments which you have had I cannot - criticise you for holding this opinion. It is a natural one - under the circumstances. - - I am not writing this letter with a view to changing, or - attempting to alter in any way, your decision on this point. You - have probably made up your mind on the subject, and that’s the - end of it. - - Despite this I am positive that you will be interested in the - enclosed letters from former patients in which they express - their views as to the treatment, and the results obtained in - their cases. After reading these communications I shall be under - obligations if you will kindly return them to me, as I would not - like to lose them. - - Very truly yours, - G. H. WILKINSON, M.D. - - -Again a plain, stamped, hand addressed envelope is also enclosed so that -Mr. Smith may be put to no expense or trouble in sending back the -precious letters, thousands of copies of which are kept in stock in the -doctor’s office. - -All communications emanating from the office bear the pen-written -signature of the physician in charge, but he sees very few of them. He -is not even conversant with their contents, except as he may happen to -discuss the subject with his correspondence chief. It is the latter who -directs the correspondence and conducts it in the name of the physician. -He is the business getter of the concern. It is his duty to get -prospective patients coming into the office; it is the physician’s duty -to handle them after they get there, and to obtain as large a fee as -possible in each instance. - - ------------------------------------------------------------------------- - - - - - CHAPTER VIII - - =GETTING AT FINANCIAL STATUS= - - -While, with proper effort and organization, it is possible to ascertain -in advance the financial worth of nearly every prospect in the manner -already outlined, there are many instances in which this cannot be done -through any of the ordinary channels. Some people conceal their -occupation by writing under an assumed name on plain paper, so that an -enquiry through a commercial agency will reveal nothing, except, -perhaps, the statement “party unknown.” - -Others will come in on the physician unheralded, without any preliminary -correspondence. But, if the physician understands his business, he will -get at the facts just the same as if the callers had introduced -themselves with statements from their bankers showing their financial -rating. - - * * * * * - -Let us imagine the case of a man who drops into the office and enquires -for the doctor. The reception room girl will ask his name so that she -can announce his arrival. - -“The name doesn’t matter,” says the caller. “The doctor doesn’t know -me.” - -“Have you an appointment for any specific time?” - -“No. Just dropped in to see the doctor.” - -“Well, the doctor is very busy just now, but he’ll be disengaged in a -few moments. Take a seat please, and as soon as he is at liberty I’ll -let him know you are here.” - -Don’t overlook this waiting part of the program. It is important. -Creates the impression that the doctor is a busy man, and that time is -valuable. Always keep a caller waiting at least ten minutes, even if the -doctor is engaged in no more profitable occupation than reading a -magazine. When the caller is finally shown into the consultation room -the doctor receives him with dignified courtesy and apologizes for -having to keep him waiting. - -This consultation room should be so arranged that, when doctor and -caller are seated facing one another, the light should fall on the -latter’s face, the doctor being in the shade as it were. This allows of -close watch being kept on the emotions which may play across the -caller’s face, while those which the doctor may not be able to conceal -(these will be few) will pass unnoticed. - -After the conventional greetings the caller will undoubtedly outline his -case, and ask the doctor for his opinion. - -“I must know more about the conditions, Mr. —— by the way, I didn’t get -your name? Robinson. Well, as I was saying, I must know more about the -conditions, Mr. Robinson, before venturing to give an opinion. I have -many cases strikingly similar in which the results were all that could -be reasonably expected. At the same time, as a matter of frankness, I -must admit that there are others in which I have been disappointed.” - -This apparent candor on the doctor’s part wins the confidence of the -caller and he talks freely, describing his case in detail. The doctor -listens attentively, butting in with a question only when the caller -seems to lag in his talk. When the ailment and its symptoms have been -fully described the doctor says: - -“Yours appears to be a somewhat peculiar instance, Mr. Robinson. There -seems to be indications of severe mental strain or worry. Of course, I -may be mistaken, but that’s the way it looks to me. Have you had any -great domestic or business worries?” - -“No, sir. Everything is moving along smoothly, both at home, and in my -business.” - -“Frequently a man’s business, Mr. Robinson, involves a strain which he -does not realize. He becomes so accustomed to its routine that he -staggers along with worries that would crush a man not accustomed to -them. There are some occupations which are a great deal more trying in -this respect than others. One of my patients—of course it would not be -proper to mention his name—is a banker who was on the verge of insanity -when he came here, through worry over his financial affairs.” - -“Oh, there’s nothing of that kind, no worries I mean, in my case. My -business—I’m a stock dealer—is flourishing. I’m making money. Cleared -$25,000 last year, have a fine home, a good wife and family, and would -enjoy life if it were not for this annoying trouble. If it were not for -the hope that relief may be found I would be sorely tempted to kill -myself.” - -The secret is out. Unwittingly Mr. Robinson has disclosed the fact that -he is well off financially and able to pay a good fee, which information -is of more importance to the doctor than the description of the caller’s -physical ills. - -The conversation drifts back to the ailment, the caller telling of the -various treatments he has taken, and the results. Among other things, he -says: - -“I have consulted a number of eminent physicians, among them Drs. —— and -——, and they all told me that there was no real cure for the trouble. -What do you think, doctor?” - -“Naturally I dislike to set my opinion against that of the famous men -you have mentioned. They are among the ablest in the profession. Their -ability is unquestioned. Still, we may all be mistaken. In the absence -of a thorough physical examination I would not like to say positively -what the outcome of this treatment would be. It does seem, however, in -view of the success obtained in similar cases, fully as serious, if not -more so, that there is good reason to feel sanguine.” - -No promise here. No rough, “Sure thing, I can cure you,” such as the -cheap $5 fakirs indulge in. Nothing of the kind. The doctor is the very -personification of social and professional dignity. His appearance and -manner is impressive, and the kindly way in which he takes a hidden -clout at those “famous and able specialists” wins the caller to him. - -“What would be the fee for an examination, Doctor?” the caller enquires. - -“I make no charge for that service,” replies the doctor. “It is an -essential preliminary to determining whether the case is one in which -the treatment may be administered with reasonable chance of success. My -plan is to give every applicant a close examination and reject such -cases as appear hopeless. Failures don’t help a physician’s professional -reputation any, so what’s the use of wasting a man’s time and money when -it is a foregone conclusion that he is beyond help?” - -This is the clincher. If the caller had any doubt as to the doctor’s -honesty and sincerity this little spiel removes it. He is going to have -that examination made then and there, fervently praying all the time -that the doctor may find his case one which he would be justified in -taking in charge. - -But suppose the caller does not broach the subject of an examination -fee, and thus give the doctor an opportunity to make his stump speech. -It matters not. There are a dozen ways of leading up to the subject -without exciting the suspicions of the caller. - -“When would it be convenient for you to make this examination, Doctor?” -is a question that naturally follows from every nine out of ten callers. - -“There’s no time like the present, Mr. Robinson. It will take about half -an hour, and”—(here the doctor consults his watch, and opening his -engagement book runs a finger over the record) “Yes, I have just about -half an hour before the next regular patient is due. I suppose there are -some strangers waiting to see me now, but you are ahead of them. I would -make an engagement for to-morrow were it not that I shall be very busy -and will not have time to give you the proper attention.” - -Mr. Robinson steps behind the screen which stands in one corner of the -reception room, and when he is disrobed the doctor gives him a very -thorough physical examination, stopping now and then to make notes of -the case. He asks many questions relative to the ailment, and makes a -special feature of testing the sensitive, super-sensitive and -non-sensitive areas with a pair of callipers. As every medical man knows -there are exterior portions of the human body on which the least bit of -pressure will produce a “flinching” on the part of the patient; there -are others on which considerable pressure may be applied without -noticeable effect. - -“Why, did that hurt you, Mr. Robinson?” enquires the doctor as the -caller shrinks when the callipers touch a super-sensitive spot. - -“Well, yes, a little, Doctor,” is the reply. “Anything wrong there?” - -“I hope not,” is the doctor’s answer, but he shakes his head gravely, -impressing Mr. Robinson with the belief that there is more serious -trouble than the doctor cares to admit. - -After some fifteen minutes of this kind of work the doctor says: - -“This is a most peculiar case, Mr. Robinson, but there’s nothing, so far -as I can ascertain, but what may be overcome by proper treatment. At the -same time the conditions are so unusual that I would like to consult my -associate, Dr. Thompson. Two heads are better than one, you know. May I -call him in? You will then have the benefit of his opinion as well as -mine.” - -“Why certainly, Doctor.” - -Dr. Thompson, who is kept for just this purpose, and to treat outside -patients who are unable to come to the office, is summoned by electric -call, and comes in. He is a dignified, very professional-looking old -chap, neatly clad in dark Prince Albert suit, and wearing glasses—the -beau ideal of a medical authority. - -“Mr. Robinson, allow me to introduce Dr. Thompson.” - -Then to Dr. Thompson: “Doctor I have been examining Mr. Robinson and the -conditions are so unusual that I would like to have your opinion and see -how it coincides with, or differs from, mine. I think there can be no -question but what it is a pronounced instance of _tabes dorsalis_, and -yet the conditions are far out of the ordinary.” - -During his preliminary talk with Mr. Robinson the doctor has wormed out -of him the fact that his ailment is locomotor ataxia, so he is taking no -chances in committing himself to the statement that he believes the case -to be a “pronounced instance of _tabes_.” Besides, this is a convenient -manner of conveying to Dr. Thompson a “tip” as to what his verdict -should be. - -Together the two doctors go all over Mr. Robinson again, making comment -in professional language as the examination proceeds. At the end, while -Mr. Robinson is dressing, they sit down together and discuss the -conditions in a subdued tone, but loud enough so as to make sure that -Mr. Robinson will catch the import of the consultation. When the caller -rejoins them Dr. Wilkinson says: - -“I am happy to be able to say, Mr. Robinson, that Dr. Thompson agrees -with me fully as to the nature of your ailment, and also that, while the -conditions are serious, there is every reason to expect satisfactory -results, provided proper treatment is administered without further -delay.” - -Dr. Thompson endorses this in a few well-chosen words, and then excuses -himself on the plea of being very busy. He will probably retire to the -correspondence room and read a magazine until summoned to play the same -role again with the next caller, but there’s no use in telling Mr. -Robinson so. “Very busy” is always a trump card in the hands of -“eminent” physicians. - -After Dr. Thompson has left the room Dr. Wilkinson begins to straighten -out the furniture in his office, apparently as a hint to Mr. Robinson -that he is getting ready to receive another caller. But he is doing -nothing of the kind. He is merely using tactics to bring Mr. Robinson to -the crucial point of declaring that he is going to take the treatment. -Standing up, as if to bid his caller good bye, the doctor says: - -“There is one thing I would impress upon you, Mr. Robinson. Such -troubles as yours are not benefited by delay. The longer you put off -treatment the more aggravated your condition will become, and the more -difficult it will be to accomplish anything in the way of relief. You -should take treatment from some competent physician right away.” - -There is no plea here for Dr. Wilkinson’s special treatment; no -solicitation to become a patient of this particular establishment. Mr. -Robinson is still further impressed with the doctor’s fairness, and also -his professional ability as the diagnosis was the same as that made by -other physicians. He does not know that he has told the doctor of the -opinions and findings of the others, and is therefore all the more -strongly inclined to look upon Dr. Wilkinson as a most remarkable man, a -veritable past master in the profession. - -“Well, I’d like to take this treatment Doctor, if it doesn’t cost too -much, but I am unable to get away from my business just now. I must run -back home for a couple of weeks and put my affairs in shape so I can -stay here for a while. How long do you think it will take?” - -“That’s something I am unable to state definitely. In some instances, -apparently fully as bad, if not worse, than yours, the desired results -have been obtained in three months; in others these results have been -delayed for six and nine months, and in a few cases even longer.” - -“What will it cost me, Doctor?” - -(This subject—fixing the fee—is treated at length in another -chapter—IX.) - -There are some specialists who lack tact is ascertaining a caller’s -financial responsibility, or in gaining his confidence. Their work is so -coarse that it repels instead of attracts. These men rarely, if ever, -obtain any considerable number of patients among well-to-do or -intelligent people. Their practice is invariably cheap, and $50 fees are -few and far between. - -One specialist of this description opened an office in Chicago. He was a -good physician and his ability had been recognized by his appointment to -important professorships in various medical colleges and hospitals. He -failed as a specialist because he lacked tact. If Mr. Robinson had -called upon him he would have been brusquely received in a cheaply -furnished one-room office, and the money feature would have been -uppermost in the doctor’s talk. Instead of getting the caller interested -in the treatment, by means of a courteous reception, and strict -attention to an examination for which no charge was made, the itch for -money would have been so apparent that Mr. Robinson could not help but -notice it. - -Following is an almost verbatim report of the manner in which a caller -was received in the office of this physician. After a short discussion -of the case and before an examination was made, or even suggested, the -caller asked: - -“Do you think you can cure me, Doctor?” - -“I don’t think, I know,” was the surprising answer. “There’s no question -about it. In three months you’ll be as sound and well as you ever were.” - -The caller was an intelligent man, and the boldness of the statement, -taken in connection with the circumstances under which it was made—the -physician having had no opportunity to ascertain the exact -conditions—was far from reassuring. It was a bad break on the doctor’s -part, but there was worse to come. The caller had made up his mind not -to trust himself in the hands of this physician and, as an easy means of -escape, asked: - -“What will the treatment cost, Doctor?” - -“How much money are you earning? Are you working for somebody, or are -you in business for yourself?” - -“What has that got to do with it? What difference does it make to you -how much my income is, or where it comes from?” - -“We’re not treating people for nothing here. We must know that you are -able to pay the fee.” - -“But you have not told me what the fee is.” - -“No, and I don’t intend to until I know what your income is. My rule is -to get about one-quarter of a patient’s income for the time he is under -treatment.” - -“Then you have a sort of sliding scale as to fees?” - -“Certainly. If you are earning $50 a week the treatment will cost you -$12.50 a week. If you are earning $100 a week it will cost you $25 a -week.” - -It is any wonder the caller went away disgusted? And yet this doctor is -unable to understand why he cannot succeed in special practice. He can -see nothing wrong in his method of handling callers. - - ------------------------------------------------------------------------- - - - - - CHAPTER IX - - =DECIDING UPON THE FEE= - - -Having ascertained the financial status of the caller, and developed the -fact that he wants to take the treatment, the next move is to fix upon -an acceptable fee. Here, again, tact must be used. Ability to pay is not -everything. You must know your man. Take two men of equal financial -rating. To one a fee of $1,000 would be an extortion; the naming of that -amount would give him a violent attack of heart disease, and yet he -could well afford to pay what was asked. The second man, with no greater -financial resources, would write out his check for $1,000 without a -murmur, and think himself lucky to get off so cheaply. - -It’s all a matter of psychological impression. If you know your man -thoroughly, and approach him at the right moment, you can get any fee -that is within his ability to pay. And this “knowing your man,” rests -largely upon the manner in which you receive him, and the impression you -make upon him. It is a reciprocal affair. If you get his confidence to -the extent that he unbosoms himself to you freely, you “know” him; if -you don’t you are going to have hard sleddin’. - -If the profession is to be judged according to its own standards the low -estimate of the value of medical services held by the public at large is -not to be wondered at. If the physician does not place the value of his -skill and ability at a high figure, how can he blame the public for -taking advantage of the low rates he names. Surely the people are not -going to volunteer to pay more for an article than the owner asks for -it. - -A young Western physician, with the right kind of get-there spirit, -settled in New York, where he was called upon to care for a young woman, -the daughter of a multi-millionaire, who was suffering from typhoid -fever. He saved her life, after a struggle of six months, and sent in a -bill for $5,000, hoping that he might get half of it. Back came a check -for $5,000, with a letter of thanks, and a “bonus” check for $50,000 -more. This may seem improbable, but it is a fact. - -This instance is cited for a two-fold purpose: First, to show that it -does not pay to undervalue your services; and, second, that Eastern -people are, as a rule, financial resources being equal, more accustomed, -and more inclined, to pay liberally than those of the West. In -discussing this incident a Chicago physician, a well-known man, said: - -“A Chicago millionaire would have ‘kicked’ on the $5,000 bill, insisted -on its being cut to $2,500, or less, and, this being done, would have -stood suit rather than settle at his own figure.” In this connection Dr. -Lydston quotes the following case: - -One of our greatest “merchant princes” was under the care of a -specialist and, as his time was very valuable, insisted that the doctor -let him in at his private door ahead of all other patients, regardless -of the order of arrival. His bill at $10 a visit amounted to something -over $300. The “kick” registered by our “prince” might have been heard -in Alaska. Result, the bill was cut in two and the doctor has another -enemy on his list. - -Another merchant prince, who is well known on State street—we will call -him Mr. Bird, because that’s almost his name, and he is one—came to see -me one day in this wise: He had heard that I had recently operated on a -friend of his and removed a renal calculus. Would I show him the -specimen? He then gradually developed the interesting fact that he had -gall stones and had been advised to submit to an operation. What did I -think of his case, and what about his operative prospects? -Three-quarters of an hour slipped away, and my opinion in general had -been obtained, when I suggested a physical examination. - -“Oh, well,” he said, “you see, it has grown so late that I will not have -time to-day. I’ll see you day after to-morrow,” etc. - -That same evening, while riding to a case in consultation with one of my -surgeon friends, that gentleman said, “Oh, by the way, ——, I’m going to -operate on Bird to-morrow for gall stones.” And so it proved. I sent Mr. -Bird a bill for consultation and he replied that he owed me “nothing,” -had “just made a friendly call,” etc. I finally threatened suit and he -paid the bill grudgingly, and as insolently as he dared at long range. -Let me assure the reader that that $25 was a sweeter morsel than ten -times the amount from any other source. Oh, how it must have hurt my -friend Bird! I trust he will be a mine of wealth to my surgical -confrère—he has “gall” enough to run a stone quarry in his hepatic -apparatus for a hundred years to come. - -Medical fees have not yet shaken off the incubus put on them by the -dollar fee of the medical “daddies.” When the country was yet new, the -fee question was practically settled by some of our medical pioneers, -whose influence has never been dispelled. The one-dollar consultants -were over-modest. We have always been ready to concede that such fees -are an undervaluation of the consultant’s skill. The profession has ever -refused to take some men at their own valuation—but it has suffered from -the incubus just the same. Philanthropy has been advanced as an -explanation of cheap fees. Quoth the experienced and distinguished -low-priced man, “What would the poor people do if I made myself less -accessible?” They would go around the corner to that young doctor whose -shingle you see swinging to the breeze, and pay more money for better -service than you or any living man can give for the fees you charge. In -general, the public gets just about what it pays for, save where the -matter is one of absolute charity or dead-beatism. - -What does a man study law for? In order that he may be able to practice -successfully and make money. - -What does he study architecture or civil engineering, or any of the -other professions for? Always with the one purpose of making money out -of them. - -No, not always. Medicine is an exception. Judging by the ordinary -standard of fees men study medicine in order that they may make an -unappreciative public a present of their time and skill—at least most of -them do. - -No fee within the range of the patient’s ability to pay is ever too -great for medical services. The doctor is never in danger of being -overpaid. He should “temper the wind to the shorn lamb,” but appearances -are deceitful, and the doctor had best be in at the shearing, else there -will be no wool for him. “Virtue is its own reward” may sound very -pretty, but it is not consoling in view of the fact that it gets no -other in this life and its reward in the world to come is rather -problematic. - -While always seeking to get the largest fee that is within the patient’s -ability and willingness to pay the clever doctor will never let the -patient know but what the matter of a fee is a secondary consideration. -His earnest talk will be on the prospect of obtaining the desired -results. So far as the patient can judge from the doctor’s attitude and -conversation the professional features of the case have a much stronger -hold upon his mind than the financial. - -It is always best, of course, in the matter of fixing the fee to “strike -while the iron is hot.” Do it at the first consultation, if possible, -and have it out of the way. But the iron is not always hot at this first -meeting. Unless assured that you have won the entire confidence of the -patient, and that you can safely go the limit with him, don’t attempt to -name the fee right away. If you do it is a certainty that you will get -far less than could readily be had under more favorable circumstances. -In a case of this kind, should the patient press to have a fee named, -say: - -“The fee is a secondary consideration with me, Mr. ——. What I am most -interested in is knowing whether I can benefit you. If I can it will be -an easy matter to agree upon the fee. If I cannot, it would be a waste -of time to take the treatment, and I don’t want your money.” - -This is pure “bunk.” The doctor doesn’t mean a word of it. He is merely -sparring for time until he can get the patient in a more receptive -condition, but it makes a ten strike. Whatever of doubt or hesitancy may -have remained in the patient’s mind is removed. - -With the powerful remedies now at a doctor’s command it is a most -unusual case in which a decided change for the better does not follow -the first two or three days of a new treatment. When this stage is -reached the time is ripe for naming the fee. - -A gentleman suffering from locomotor ataxia came into the office of a -certain physician. He was frank in his statements. He admitted that he -was fairly well fixed financially and had travelled all over Europe in a -vain effort to find relief. He was willing to take the treatment as a -sort of forlorn hope and wanted the fee fixed, but the doctor could see -that he was still a little skeptical, and put him off in the manner -outlined. On the third day of treatment the patient said: - -“Doctor, I want to get this fee matter out of the way. I know I’m going -to get well. For the last two nights I’ve slept like a baby, something I -haven’t done before in years, and I feel better in every way.” - -This was the doctor’s opportunity and he took advantage of it, saying: - -“Well, Mr. ——, since you insist upon knowing the cost of treatment I’ll -name a fee of $1,000 in your case.” - -The man’s check book was out and a check written and signed in less than -five minutes. It was the proper psychological moment. As the patient -said later: - -“I was surprised, Doctor, at the moderate fee. If you had said $5,000 I -would have paid it just as quickly as I did the $1,000.” - -This man got well. The state of his mind had a great deal to do with his -recovery. The treatment was beneficial, but he had made up his mind that -he was going to recover, and that was a great factor. - -Allowing that the psychological moment is reached at the first meeting, -the caller being in a receptive mood and asking for the terms of -treatment, which is often the case. Don’t be modest. It is easier to -lower the terms than to raise them. If the figure you name is objected -to as being beyond the means of the caller there is always a way out. -Then is the time to say: - -“The figure I have named, $1,000, is the regular fee, Mr. ——, but I can -readily understand that to pay this amount might work a hardship in your -case. We are not doing a charity practice. We can’t afford to. And if we -were I am positive you are not the kind of a man who would take -advantage of it. You want to pay for what you get, provided it is within -your means. - -“In many respects your case is a most peculiar one, and I would like to -undertake it as there is every reason to look for wonderful results. Now -I am going to make you a proposition in strict confidence, and with the -distinct understanding that it remains a secret between the two of us. I -will make the fee $500, and, when you are restored to health, you are to -write me a letter which I may show privately to other people who are -suffering in the same way. But, under no conditions are you to tell -anybody what fee I charged.” - -Jump at the proposition? Does a hungry fish take the bait? He thinks -that he is getting something for nothing; that a special exception has -been made in the matter of a fee because the doctor is confident of -restoring him to health and wants the credit and reputation that would -attach to such a cure. - -During all this conversation the doctor has cleverly refrained from -alluding to such a thing as a cure in direct words. In no manner has he -committed himself in this respect, and yet the bait has been so -skilfully dangled that the caller can get no other impression than that -a cure is sure to be obtained. - -Then there is another class of men who will object to any fee that may -be named in the hope of getting a reduction. In most instances men of -this class are abundantly able to pay, but are “close.” If gold dollars -were offered to them at 90 cents apiece they would want the price -lowered so as to save something. When a man of this kind is encountered, -and the doctor is bent on getting the fee he has named, the best thing -to do is to make him ashamed. This may be done without offending them. -One notably successful case taker, famous the world over for his ability -to get large fees, made it a practice to say: - -“I agree with you, Mr. ——, that $1,000 seems like a large fee if we -leave the matter of perfect health out of the question. You surely don’t -expect to buy health on the same basis that you would coal or grain, or -some other merchantable commodity. You are too sensible a man for that. -When you stop to consider that this ailment is chronic—let’s see, I -think you said you had been afflicted about eight years—and that it is -going to take earnest attention on my part for a long time to restore -you to a normal condition, I think you will agree with me that, even if -we adopt a cold commercial basis of valuation, the fee is not an -extravagant one.” - -“Perhaps you’re right, Doctor, and if I could have any assurance that—” - -“Assurance. What can you have beyond what I have given you? My -professional reputation is at stake, and you have been advised as to -what has been accomplished in other cases. Surely you could have no -stronger assurance, especially that contained in the letters from -patients which I have shown you.” - -All this is said in a low, well-modulated tone, without show of special -desire to close the case, and it generally wins. If it does not there is -always the alternative of making a special reduction in this particular -case on the understanding that the terms are confidential, etc. But it -is seldom that this has to be resorted to. - -When patients go for treatment to a physician of fame, one whom the -newspapers are forever referring to as “the eminent,” or “the famous Dr. -McSwat,” they expect to pay large fees. If they could get treatment on -ordinary terms it would not be so highly esteemed. Fame is the open -sesame to big fee getting. - -If, after the talk outlined, a caller remains obdurate a star play may -often be made by the physician arising, pushing his chair back a little, -and saying: - -“I don’t wish to be discourteous, Mr. ——, but I am compelled to ask you -to excuse me. I am a very busy man, and I am afraid that some of the -people who are waiting to see me will be getting impatient. I am glad -you called, and have really enjoyed my talk with you. Drop in any time -at your convenience. I shall always be glad to see you.” - -If the caller has any real intention of taking treatment this will -generally bring him to time. In the first place it is equivalent to the -doctor saying “I am too busy to waste my time on triflers,” and this -touches his pride. In the second place he is afraid that if he does not -take advantage of the present opportunity something may arise to change -conditions before he can see the doctor again. - - ------------------------------------------------------------------------- - - - - - CHAPTER X - - =GETTING FEES IN ADVANCE= - - -It is one thing for patient and physician to agree upon a fee. It is -another thing for the physician to get the fee in advance. Still, it can -be done in most instances, but it requires diplomacy of a high order. It -is frequently, one might say almost invariably, the case that, after the -fee has been tacitly agreed upon, the patient will enquire: - -“How is this fee to be paid, Doctor?” - -“In advance,” the doctor will reply in a mild, it-doesn’t-matter manner. - -“Isn’t that rather hard on the patient, Doctor?” - -“It is the only way in which we can protect ourselves. If we extended -credit indiscriminately many patients, when assured that they were well -started on the road to recovery, would disappear, and it would require -long, expensive litigation to collect from them, even if we could get -service on them here, which is doubtful. The average man, Mr. ——, has a -queer idea about the obligation of a doctor’s bill. It is the last thing -he will pay voluntarily, even when almost miraculous benefits have been -obtained.” - -“Don’t you ever extend credit?” - -“Oh, yes. When assured of a man’s financial responsibility and honest -intention, we are glad to accommodate him in a reasonable way if it is -inconvenient for him to pay cash.” - -In this, as in naming the fee, the physician must create the impression -in the mind of the subject that payment of the fee is about the last -thing he is thinking of. There must be no anxiety, no undue haste to get -the money—at least not so that the patient can notice it. Switching the -conversation for a few moments back to the case itself, in order to get -the patient’s mind diverted, the doctor will finally say: - -“Now, in your case, Mr. ——, if it is any object to you, I can arrange -for you to pay the fee monthly. If this is satisfactory you can pay $150 -a month while you are under treatment.” - -“How long will that be, Doctor?” - -“I don’t know. Certainly six months, perhaps twelve, and possibly -longer. Nobody can tell in advance how a chronic ailment like yours will -respond to treatment. It is very seldom that we have two cases exactly -alike in this respect. If there is such a thing as striking an average I -would place it at about ten months.” - -“Would I have to remain here all that time?” - -“Oh, no. A month or so, should be sufficient. May be less. Just long -enough to allow me to get the treatment graduated to meet the -requirements of your case. Then you may return home and continue it -there. It would be better, of course, if you could stay here the entire -time, but there is no real necessity for it.” - -“On the basis of ten months it would cost me $1,500?” - -“About that. Perhaps a little less; perhaps a little more. By taking -advantage of the $1,000 proposition you will save about $500. It is -really immaterial to me which offer you accept save for one thing. No -matter how well a patient is progressing there is sure to be more or -less reaction at times. It would be marvellous if there were not. These -spells of reaction are only temporary, but the patient, not -understanding this, is inclined to become discouraged and, if he is -paying his fee by the month, may quit just at the time when, if he had -continued treatment a little longer, he would have become a well man. In -such a case he not only loses the money he has paid, but also the -certainty of recovering his health. On the other hand, if his fee is -paid, he will argue that he might as well stick it out as it isn’t going -to cost him any more. - -“Naturally I want to obtain as great an amount of success professionally -as possible. For this reason when a patient asks my advice on the -subject I tell him to pay the fee and get it off his mind. This not only -saves him money, but relieves him of financial worry so that he responds -more readily to treatment and, above all, it makes sure of his -continuing the treatment until his health is restored.” - -While endeavoring to convince the patient that the fee occupies a minor -place in your mind, do so by actions and manner, not by words. Never say -outright that you don’t care when the fee is paid, or that you are not -thinking about the fee, or anything of that kind. If the patient sees -fit to form this impression, let him do so; it strengthens the -probability of your getting the money. The average man, especially the -one who has money, is not a fool. He is quick to form conclusions. If he -can see where he can save $500 on a bill of $1,500 he is going to grasp -the opportunity without much urging, provided he is reasonably well -assured of getting value received. This assurance is entirely a matter -of confidence. If the doctor has obtained the patient’s confidence by -dignified, yet courteous (not servile) manner, and modest talk, he is -going to get the fee then and there. If he has fallen short of securing -this confidence all the arguments he can advance will not induce the -patient to unbelt. In fact, the more argument he makes the weaker his -case becomes. - -A discount of one-third is a proposition which appeals to any man of -business sense. He does not know, of course, that the physician has -named a figure much higher than he is willing to accept, with this very -purpose in view. One thousand dollars would be a lucrative fee if paid -by the month, and the doctor can well afford to accept it in advance on -the terms he names. Few people will take treatment longer than three, or -at the most four, months. They either become well in that time, or grow -discouraged and quit. - -Another thing. There is a great deal of convincing force in the -statement that payment of the fee in advance holds the patient to the -treatment. At least it looks that way to the layman. - -In most instances where a man has the funds in bank he will write a -check without further comment. Occasionally a patient will be unable to -do this, owing to a shortage of funds, and will say: - -“Well, I have decided to take the treatment, Doctor, if you can give me -a little time on part of the fee. I can pay you $500 now, but would like -about sixty days’ time on the rest.” - -“Certainly, Mr. ——. If it will be an accommodation to you I will be glad -to do it. It is contrary to our usual practice, but I feel that I am -safe in making an exception in your case.” - -The check is written and handed to the doctor who, without apparently -examining it, puts it carelessly in his pocket, and then makes an entry -in his desk diary, noting the patient’s name and address, nature of his -ailment, date, amount of fee, and size of payment. When all this is done -the first treatment is given, and engagement made for succeeding -treatments at a certain hour each day. - -Taking advantage of the time when the patient is rearranging his clothes -after treatment the doctor hurriedly fills out a sixty day note for -$500, making it payable to the order of the patient himself. Just as the -latter is ready to leave the doctor will say: - -“There’s just one thing more, Mr. ——. In order to guard against any -possible misunderstanding in the future I have drawn up a little -memorandum of our agreement as a sort of protection to you. Now, if you -will kindly place your signature there——” - -As he says this the doctor rises from his chair and motions the patient -into it, at the same time dipping a pen in the ink well and handing it -to him. - -“Yes, on that line; yes, that’s the place. Now (turning the note over so -the back is uppermost), once more across the end, so. There, now we have -the agreement in form so no one can take advantage of you. Be sure to -come promptly at 10:30 to-morrow.” - -After the first treatment most men are excited and easy to handle in -this way. They do what the doctor bids in a sort of unconscious way. -They don’t realize that they are signing a note. The doctor has referred -to it as a memorandum of agreement, and it seems only proper that there -should be a writing of this nature. - -Sharp practice? Yes. Dishonest? No. The patient has agreed to pay a fee -of $1,000. He has paid $500 down and promised to pay the rest in sixty -days. The doctor has merely induced him to put this promise on paper. If -the maker of the note is responsible (and the doctor has assured himself -of this in advance) the full $1,000 is secured then and there, less an -ordinary discount fee on $500, as a note of this kind is easily -negotiable. The doctor has taken the precaution to protect himself -instead of depending entirely upon the honesty and good intention of his -patient. - -The latter has barely left the office before both check and note, -properly endorsed, are on the way to the bank where the note is -discounted and the proceeds, with the check, deposited to the credit of -the physician. - -It may be said that this sounds too easy and simple to be true. Perhaps -it does to those who are not acquainted with the methods of the -up-to-date “case taker.” But fees, and big fees, are being obtained in -exactly this manner every day in every large city in the country. - -The physician who has a well-established office practice does not, as a -rule, resort to this method with his regular patrons at first. He -charges what seems to be a large fee, $5 to $10 each time a patient -calls, extends credit indiscriminately, and loses fully one-half of the -money represented by his book charges. If he is wise he learns by -experience, and caters to the patronage of strangers from whom he can -get his fees in advance. He gradually gets too busy to receive those who -want their fees charged. He has learned his lesson and is willing to -profit by the example set by other doctors who, while not recognized as -models in the line of ethics, know how to make the practice of medicine -pay. - -“How’s business, Doc?” asked a friend of a physician who has achieved -considerable fame as an office specialist. - -“Bully,” was the reply. “Did over $300 to-day.” - -“Get it?” - -“No, but it’s good.” - -And the poor fool actually thought so until he failed to get any -adequate returns from the many bills he sent out, or the numerous calls -made by his hired collector. Now he is making money. Why? Because every -caller, whether regular patient or stranger, who wants to consult that -doctor professionally, must “ante” his $10 with the polite secretary in -the reception room before he can get into the doctor’s office. Result, -exodus of dead beats, and others whom there was no profit in seeing. - -Prominent attorneys adopt this system. Why is it not just as ethical and -fair for physicians to employ it? If a patient agrees to pay the fee -asked by the physician there is no reason, moral or legal, why he should -not do so. And yet, unless this fee is paid in advance, or well secured, -the chances are about ten to one that the doctor will never get it. - -Sometimes the patient will discover that the “memorandum” he is signing -is a note, and may say: - -“Why this is a note, Doctor?” - -“Well, it is in note form, but you will see that it is payable to your -own order, Mr. ——,” the doctor will say. “I don’t think it will be of -much use to anybody else. It is put in this form for your own -protection.” - -This is usually sufficient, unless the patient is a city banker, or an -unusually smart man of business. Should this latter be the case, which -is not likely as men of this class invariably pay cash in advance, an -explanation is readily forthcoming to the effect that it is merely an -evidence of good faith on the maker’s part, etc. Occasions of this kind -are very rare, however, as most men are so thoroughly hypnotized at the -moment that they readily do whatever the doctor suggests. - -The smart man is as a rule the easiest to get a good fee from. His -business education has been such that he is not looking for something -for nothing. If a thing is really good he knows it must be paid for, and -that the price must be in accordance with its merits—or supposed merits. -Strong belief in actual merit is a matter of education, the doctor -acting as instructor and demonstrator. - -One holiday when the office was closed the writer and the physician with -whom he was associated in business were sitting in the doctor’s private -room discussing ways and means for getting in more patients. The main -entrance door was locked. Suddenly the knob was heard to turn and it was -evident somebody was trying to get in. Going to the door the writer -opened it and stood face to face with one of the best known and -wealthiest men in Chicago, a man noted for being extremely close in his -financial deals. Affecting not to know him the writer said: - -“What can I do for you, sir?” - -“I’d like to see Dr. ——.” - -“The office is not open for the reception of patients to-day, but the -doctor happens to be here for a moment. If you will step in and take a -seat I will ascertain if he can see you.” - -When the caller was seated the doctor was hurriedly notified as to his -identity and financial means, and word was sent out to show the -gentleman in. After a consultation of twenty minutes the caller left, -and the doctor had his check for $2,500. As he handed it to the writer -the doctor said: - -“Mr. —— did not have one of his own checks with him, and had to write -this on one of our blank forms. He doesn’t want it to go through his -bank in this shape and has asked me to hold it until he comes in -Saturday when he will exchange it for one of his own.” - -The check was put away and on Saturday when Mr. —— called the writer, -who was the treasurer of the concern, was out at luncheon. As the new -patient handed the second check to the doctor the latter was compelled -to say: - -“I’m sorry, Mr. ——, but I’m unable to give you back your first check -right away, Mr. ——, our treasurer, has it locked up in the safe, and I -cannot get it until he returns from luncheon.” - -“Oh, that’s all right,” replied Mr. ——. “Any time will do.” - -And away he went, leaving both checks, representing $5,000, and as good -as gold, in our possession. The doctor had won his confidence from the -start. - -In this particular instance there had been no advance correspondence, -and the caller was unknown to the doctor either personally or by name. -The writer happened to know him by sight and thus was able to “tip” him -off to the doctor. If it had not been for this it is probable that the -fee would not have been more than $500, and the doctor would have -congratulated himself on having done a good day’s work at that. What -makes the case even more remarkable is the fact, as previously stated, -that the man had the reputation of being very close in money matters. -Yet here was an instance in which he not only paid the fee of $2,500 in -advance without a murmur, but actually entrusted a stranger with $5,000 -of his funds. - -After two weeks of personal treatment this same man, acting on the -advice of the doctor (who was to share in the fee) had partially -arranged to pay another specialist $10,000 for the treatment of his -wife, and was on the point of closing the contract when the blundering -tactics of the second physician upset the whole thing. Negotiations were -progressing favorably, there was no dispute as to the amount of the fee, -or anything of that kind, when a single mis-step aroused his suspicions, -and the deal fell through. In talking the matter over later Mr. —— said: - -“I may be sorry, Doctor, that I did not accept Doctor ——’s proposition, -but to tell the truth he didn’t impress me favorably. Now if it were you -who were to conduct the treatment I wouldn’t hesitate a moment.” - -The joke of the thing—and it was a joke—lay in the fact that of the two -men the doctor he had no confidence in was by far the more able and -competent of the two. But he lacked tact; he didn’t know how to inspire -confidence in his patients; didn’t know how to conceal the disagreeable -truth and enlarge on the non-essentials making them appear as the more -important of the two. He was too brutally frank. The doctor who got the -$2,500 fee and retained the entire confidence of his patient to the -last, was a past master in the gentle art of what is known in slang -parlance as “bull con.” - -All of which tends to show that the getting of a big cash fee rests -entirely on the impression created by the physician. If this impression -is favorable the fee will be forthcoming; if it is not a yoke of oxen -couldn’t yank it away from the patient. - - ------------------------------------------------------------------------- - - - - - CHAPTER XI - - =GETTING ADDITIONAL FEES= - - -It is a well-understood fact among physicians that the average man of 50 -or over takes more interest and pride in his sexual virility than in any -other phase of his physical system. It is equally well known that in -almost every instance where a man has reached the age of 50 there is a -very perceptible flagging or falling off in sexual power. In many -instances it is entirely lost when the half-century mark is reached, or -soon afterward. There are few men who care to admit this even to their -family physicians, and, in consequence of this shyness, they fall ready -victims to quacks of the “Be A Man” stripe. - -When a man well past middle age comes into your office never broach the -subject of sexual trouble to him at first, no matter how strongly you -suspect it. If you do he will take treatment for that first, and that is -the end of it. Secure him on some other line of treatment first. Humor -his ideas in this respect—he has whatever ailment he may fancy he has. -If you are satisfied that he is in position to pay well, but is hard to -deal with in a financial way, it will pay you to name a modest fee for -the initial treatment, but don’t let him get away. He will afford fat, -liberal picking later on. - -Where men of ordinary means will haggle over a $250 fee for being -successfully treated for some annoying, really dangerous ailment, they -will pay $1,000 or more cheerfully on anything that seems like a -reasonable assurance of having their sexual power restored to its -pristine vigor. There is not a physician in the land with any -considerable practice who doesn’t know this. - -Having secured your fee from a patient of this kind for the regular -treatment of the trouble concerning which he came to consult you, and at -the time when the treatment is beginning to show favorable results, -spring the trap. As before stated there is generally a time when nearly -every patient responds to greater or less extent to a new treatment. -This response may be only temporary; it generally is. When the -indications of this response are seen then is the time to act. It is the -proper psychological moment. - -Direct the conversation to the marked improvement in his condition, tell -how much you are encouraged by the very noticeable change, and suggest -another thorough physical examination so that you may make the proper -record of his case. When the patient has disrobed give him the same -thorough, searching examination you did when he first came to the -office. Pay no attention to the sexual organs at first, but, when -nearing the end of the examination say casually: - -“How long have you been in that condition, Mr. ——?” - -This is a random shot, but it will strike home ninety-nine times out of -a hundred. There is very little chance of its going astray. Almost -invariably the patient will ask: - -“What condition do you refer to, Doctor?” - -“Why your sexual organs are not exactly normal, are they?” - -“Well, to tell the truth, Doctor, I am not as strong as I was a few -years ago, but suppose it’s the natural result of advancing years.” - -“You’re not an old man yet, Mr. ——. You are only 55, I think you told -me. You ought to be good for at least ten years yet, and perhaps -longer.” - -“Do you really think so, Doctor. Is there any hope in that direction?” - -“Most certainly. There is little question about the result. Modern -science has given us an entirely new method of treatment in cases of -this kind the effects of which are little short of miraculous. The one -trouble, however, is that it is expensive, so much so that I hesitate to -speak of it as a rule.” - -No power on earth can prevent that man from having that treatment -regardless of the expense. He has by this time an enlarged idea as to -the doctor’s ability. He is pleased with the results of the treatment -administered for the original ailment. He is impressed by the evident -professional skill of the doctor in “discovering” a sexual condition -which he fancied was known only to himself. He does not know that the -physician has simply made a shrewd guess; one that he is in the habit of -making several times a week, and generally with the same result. He is -in the seventh heaven of delight. The doctor has adroitly dangled before -his eyes a certainty which he had been vainly praying for. His next -question is: - -“What will it cost?” - -Direct answer to this depends upon what the doctor has learned about the -patient’s financial rating and willingness to pay. Few cases of this -kind are taken under $1,000. Allowing that the physician has decided -upon this amount as the extreme limit, he will reply: - -“It is hard to say exactly, Mr. ——. Somewhere between $1,000 and $1,500. -It depends upon what I have to expend for the remedies and permission to -use them. They come from abroad and can only be obtained with the -consent of the scientist who introduced them. That kind of men, as you -doubtless know, are not always easy to deal with.” - -“Well, the price is pretty steep, but if you are satisfied the treatment -will do the work I want it.” - -“There’s no doubt about the merits of the treatment, Mr. ——. The only -thing, as I said before, that holds me back from recommending it -generally, is its high cost. Besides I don’t, as a usual thing, care to -handle cases of that nature.” - -Smart doctor! He has got his human fly stuck on a gummed trap from which -he couldn’t extricate himself if he would, and he doesn’t want to. If -this wonderful treatment will restore his lost sexual power, and the -doctor, in whom he has strong confidence, has told him it would, he’s -going to have it. There is a little more conversation of an innocuous -sort, and then the doctor says: - -“I’ll tell you what I will do, Mr. ——. While I am not certain that the -cost of the treatment may not run as high as $1,500, you may pay me -$1,000 and I will endeavor to get the case closed for that amount. -Should it be necessary to pay the other $500 I’ll leave it to your -honor, but I am reasonably confident that I can make the necessary -arrangements for $1,000.” - -This looks good to the man who has rosy visions of a restoration to the -fire and vigor of youth, and he generally draws a check on the spot. If -his bank account will not admit of this he gives a “memorandum,” at -least that is what the doctor calls it, and the deal is closed. - -There are similar ways of getting additional fees from patients who have -already paid well for the original treatment. One man (or woman) needs -the eyes looked after and fitted with proper glasses, another should -have the teeth fixed up, another requires a special surgical appliance, -while still another should have a special prescription compounded. - -The doctor always has a list of experts to whom he directs patients on -the fee-sharing plan, and these fees are never over-modest. To the -doctor’s credit be it said that he invariably warns such patients that -if they want the best they must expect to pay well for it. It will -undoubtedly cost considerable money, but the results will justify the -expenditure. - -“Your eyes certainly need attention, Mrs. ——, and it would be a good -plan to have it done while you are here in Chicago. The longer you put -it off, the more serious the complication will become. But, whatever you -do, don’t go to one of these cheap occulist fakirs. They are liable to -ruin your eyesight.” - -“Who is a good man, Doctor?” is the natural inquiry. - -“There are a number of able, competent oculists here. Dr. Seestraight -stands at the head of his profession, and is probably the most -satisfactory of the lot. I’ll give you a card to him, if you wish. He -has always attended to my eyes, and has given satisfaction.” - -This proffer is gladly accepted and when the patient leaves the doctor’s -office she carries a note of introduction to Dr. Seestraight. It is an -innocent looking note, but it contains a hidden cipher which gives the -oculist a tip as to the fee which he may safely name. This cipher is -generally made in flourishes, under the doctor’s signature, -unintelligible to the patient, mere flourishes as it were, but perfectly -plain to Dr. Seestraight. When the latter collects his fee he sends half -of it to the physician who recommended the patient, and the incident is -closed. - -The same arrangements are made with certain pharmacists, dentists, and -surgical instrument makers. There was one physician in Chicago who made -it a practice to say to certain of his patients: - -“You are getting along very nicely, but recovery would be much more -rapid if you could take a little extra special treatment. But I hesitate -to suggest it on account of the expense and the difficulty of procuring -the proper ingredients.” - -“Darn the expense, Doctor, if the stuff will do me good. What is it, and -where can I get it.” - -“There are several ingredients, and the only place in Chicago where -there is any prospect of finding them is at Doem & Doem’s. But they -don’t always have a supply. They are foreign preparations, very -expensive, and there is such little demand for them that pharmacists -dislike to carry them in stock. I’ll write the prescription, but I can’t -vouch for your getting it compounded. At any rate if you can’t get it -filled at Doem & Doem’s, there’s no use trying any other drug store.” - -“You dwell so on the expense, Doctor, that I’m curious. What will it -cost?” - -“The expense varies somewhat. The last patient I supplied with the -prescription had to pay $23.25.” - -“That’s nothing.” - -The prescription is written and Doem & Doem find on it a cipher telling -them that the patient will stand for $25. As a member of the firm -glances it over he says to the customer: - -“This is a very rare and expensive preparation. It happens that we have -just about enough material on hand to fill it, but I feel that I should -warn you first that it will be very expensive.” - -“I expected that. Dr. —— told me that it would probably cost $23 or -$24.” - -“That would have been a fair price a few weeks ago, but since then there -has been an advance in the cost of the materials and I shall have to -charge you $25.” - -“All right. Go ahead and fill it. A dollar or so won’t stop me.” - -The customer gets an ordinary preparation which any druggist would be -glad to sell at 50 or 60 cents, while Messrs. Doem & Doem pocket $12.50, -and send a like amount to the enterprising doctor. - -Nor is this practice confined to what might be called the tradesmen in -medicine, the druggists, the surgical instrument dealers, and so on. It -is followed by what are known as high-class surgeons, men of eminence in -the profession, and even finds favor among the physicians themselves. It -is no uncommon thing for the doctors to exchange patients and divide the -fees. - -“Really, Mr. ——, you ought to consult Dr. Flubdub about that feature of -your case,” a doctor will say to a patient when he has about exhausted -him on the fee proposition. “That particular feature is a little out of -my line. It needs the attention of an expert specialist in that line, -and Dr. Flubdub has made a close study of just such cases.” - -So the patient goes to see Dr. Flubdub and the latter is ready for him. -He has been advised by phone as to what is coming about as follows: - -“Hello, is this Dr. Flubdub? Yes. This is Dr. Grab. I have just advised -a patient—Mr. ——, to see you. He seems to have a little ear trouble that -needs attention. He’ll stand for about $250.” - -Thanks to the tip given by Dr. Grab the ear specialist is able to -speedily locate and describe the trouble with which Mr. —— is afflicted. -Dr. Flubdub names his fee at $250, collects it, and sends $125 to his -worthy brother, Dr. Grab. It’s a case of two pluck one. - -When opportunity offers Dr. Flubdub returns the favor by sending -patients to Dr. Grab who, in turn divides the fee, and thus the medical -mill is kept busy. - -Some physicians are very bold in demanding a division of fees as if it -were right, rather than a honorarium. There is a letter in a certain -office in Chicago, preserved as an evidence of gall, in which the writer -says, when suggesting that he can send the recipient a patient: - -“The woman will do just about what I tell her. She is business-like, and -so am I. I think she will stand for $200. Now, if you can see any money -in that after giving me $100, I’ll send her to you; if not, why I know -plenty of others who will take the case on those terms. She is my meat, -and will go where I say. I am not charging $100 for my time, but for -steering the case to you. This is my game and I can steer the case where -I please,” etc. - -Nothing modest or backward, no hesitancy about this. The writer comes -bluntly to the point, without false delicacy or reserve. Well, to give -the devil his due, the fellow was honest in his straightforwardness. He -knew what he wanted, and didn’t hesitate to ask for it. And the doctor -who received the letter? Well, to tell the truth, he had conscientious -scruples against that sort of thing, so he lost the case. Another -physician of equal prominence got the patient, presumably on the terms -named by the writer of the letter. - -Speaking of deals between physicians and undertakers, Dr. G. Frank -Lydston says: - -“Over on the great West Side lives an undertaker friend of mine, who, in -deference to his ancient and honorable vocation, we will call Mr. Watery -Weeps. My friend Weeps has an eye to business; in faith, he has two eyes -to business—both of ‘em red; some say from ‘red eye’ homeopathically -applied. I do not believe this theory regarding Mr. Weeps’ headlights. -Their peculiar bicycle lamp glow, like their excessive humidity, is due -to his faithful, sorrowful ‘proxifying.’ In the course of my practice it -did befall that a certain pulmonopathic vassal of mine—we will designate -him as Mr. One-Lung, insomuch as he had no other lung—did feloniously, -with malice prepense and aforethought and intent to deceive, up and die. -Having a corpse on my hands, I naturally bethought me of my post-medical -friend, Weeps, who undertaketh much in that vicinity. Weeps was prompt, -and my late friend of the pulmonary solitaire was soon duly boxed and -crated, ready for shipment to his ancestral home in ‘Injianny,’ -whereupon quoth Weeps, lachrymosing his prettiest the while: - -“‘Ahem, Doctor, I am very much obliged to you for the favor you have -shown me. I hope to do a large share of your business in the future. I -expect a check for this job to-morrow, and will then extend to you the -_usual courtesies_ to the medical profession.’ - -“‘Ah,’ I replied, ‘and what might that be?’ - -“‘Why, 25 per cent. I call that pretty good, too, considering the hard -times, don’t you Doctor?’ - -“And my friend Weeps still thinks I was bluffing when I declined the -‘usual courtesies.’ Truth is strange, passing strange—stranger than -fiction.” - -Then there is another class of physicians who will not hesitate to take -advantage of a brother practitioner if they can do so to their own -benefit. This is done in several ways: One method is to misrepresent the -financial status of the patient whom he takes to an expert for -consultation. It is not long since a physician called up another by -telephone and arranged for him to see a “poor patient” who could only -pay a small fee for consultation. The doctor thus called upon discovered -that the patient, who was a wealthy stock raiser from the West, had paid -his doctor friend a good fee already, and had arranged to pay him $200 -more for the prospective operation—which the second doctor was expected -to tell his friend how to do. - -It is frequently the case that general practitioners call a consultant -without making arrangements for the fee beforehand. It is unpleasant to -spend half a day or night in consultation and then have the doctor say: - -“Now, doctor, these people haven’t got much money, so don’t charge them -a large fee.” - -The consultant thereupon cuts his fee in two. - -“Well, doctor, I’ll see that you get it in a day or two,” is the reply. -But the consultant never gets it. Should he protest, the family -physician says, “Don’t be in such a hurry, doctor, I haven’t got -anything out of the case myself, yet.” - -How easy it would be for the physician who calls the consultation to see -that the fee is ready when the consultant comes. Unless there is an -understanding that the case is one of pure charity, the physician -calling the consultation should be held responsible for the fee. The -consultant himself cannot always do so, but where possible he should -stipulate beforehand that a certain fee be in readiness. The family -physician who does not know that such a plan is best for his own -interests is stupid. - -An intolerable nuisance to the consultant is the doctor who writes a -friendly letter asking for “the diagnosis, prognosis and treatment” of -some case under his care. Rarely does he inclose a stamp, never a fee. -The consultant who answers such letters, save to inform the writer that -office rent cannot be paid by such consultations, is frequently laughed -at for his pains, but this should be the rule. - -A more “pestiferous professional parasite,” if possible, than the -foregoing, is the doctor who refers a patient from a distance, with a -request to send the bill to him. Here again Dr. Lydston says: “I have -sent many such bills first and last—accent on the ‘last’—but have never -received a remittance, nor do I expect my reward in Heaven. In the first -place, I am not so sure about getting there, and if I were, and knew -that those doctor debtors were going to be there too, I—well, I’d ask -for a change of venue. As for the patients who are accessories to such -professional ‘hold-ups,’ a fellow wouldn’t want to chase around all over -hades to collect his fees from them.” - -No less an authority than Dr. John P. Lord, president of the Western -Surgical Association, in an address delivered before the association, -said: - -“The practitioner,” he said, “will call a man of sufficient standing to -enable him to name a fancy price as the consultant’s fee, which he -collects, and then remits the consultant the minimum fee. The graft -element is also going into medical politics and some county societies -are controlled by it.” - -It will be noticed that Dr. Lord does not find fault so much with the -division of fees, as with the unfair manner of division. His plaint -appears to be, not that division in itself is wrong, but that the man -who handles the money does not treat his professional brother fairly. -There’s a lot of truth in this, but the objectionable practice is mostly -confined to a class of short-sighted practitioners who don’t take the -future into consideration. - -Another doctor, speaking on the same subject, said: “This is an age of -commercialism in medicine and surgery. Graft rules the majority. There -are a few old fogies, like myself, who don’t graft—but do you know why? -Just because we’re too old to learn how. Oh, yes, we’d all do it if we -had a chance, I presume. We’d be forced to. Those who do it claim that -they have to. It may be the public’s fault, but it’s certainly hard on -the public which has to do the paying and which doesn’t know whether it -has stomach ache or appendicitis. - -“In ancient Rome the doctors used to graft successfully. They’d place a -finger on the severed end of an artery and say to the patient: ‘Now, old -fellow, just come across with the fee, right away, or the finger will be -removed and you’ll bleed to death.’ - -“We are coming to that. We may not work it in the same way, but the idea -will be the same. Even now they—or we—want money before operations, and -will endeavor to learn something of a patient’s standing in the -community before his check will be accepted. Wouldn’t a business man do -the same thing? And if surgery is becoming a business, why isn’t it -proper? It is proper—from that standpoint. But, oh, the pity of the -passing of old ideals! - -“The whole matter seems to me a question of economics. The medical -profession is a belated profession. We cannot collect a fee by statute -under certain conditions—as when the call comes from a third party. We -must have money. What is there left to do? Graft! Or ‘commercialize.’ -That’s a nicer name for it. Let’s see now just what the public brings on -its own head. - -“There’s a man who thinks it is necessary that his leg comes off. He has -nerved himself for the operation and has announced his willingness to -pay, say $250. A conscientious surgeon examines the leg and saves it -without the use of a knife and the man recovers the use of it. In a few -days he is able to sit up and dispute the bill for $100, claiming it is -exorbitant. What do you think his argument is? This: - -“‘You didn’t have to operate. Why should it cost so much?’” - -“That may not be logic, but it’s what happens right along. That is the -grateful reply we get from many patients for saving them from -mutilation. And it is things like that which have largely influenced -surgeons, I believe, to operate when it is unnecessary. It is not right, -of course. A surgeon should be as a father and mother to a helpless, -sick soul. Still he is human and he must live. Like Robin Hood, there is -a better class of surgical robber who takes only from the rich. - -“You know, the rich are always in a precarious condition. It’s a mighty -conscientious doctor who will tell a rich man that his trouble is only -imaginary. The average physician or surgeon will fly around briskly, -‘dope’ the man up and then probably remove a perfectly good -appendix—bill $2,000. - -“I attended the son of a rich man who really had appendicitis at one -time. The operation was successful and the boy pulled through, although -I never saw a more serious case. I sent in a bill for $2,000 and -received no reply. I tried again and received no reply. Shortly -afterward I met this man on the street—you’d know his name if I were to -mention it—and he said, ‘I have no intention of paying your exorbitant -bill.’ - -“I wouldn’t sue. Never do. Bad practice. So I compromised for $500, -although he could have paid $10,000 without missing it—and the operation -was worth it. - -“There are rogues in every profession. There are brutes in the medical -profession who will demand money from a woman before she is out of the -anæsthetic—who will haggle with a dying man as to terms. And there are -many of them. I could mention names of men in Chicago that would make -you open your eyes. The really first-class doctor of the old school who -retains the old ideas of the profession should have a halo. He deserves -it. Of course he can’t live by pursuing such antiquated methods as those -of a gentleman, but then—says the rest of the world—who needs to live, -anyway?” - -The surgeon was asked about the number of cases where lives had been -lost through carelessness or stupidity on the part of surgeons. - -“Caveat emptor!” was his reply. “You know the old gag? Let the purchaser -beware. He doesn’t have to go to a poor doctor. Even some of the biggest -grafters are eminent surgeons and at the top of their profession. I do -not underestimate their ability. But heaven only knows there are ever so -many cases of recklessness or carelessness or foolishness which have -taken lives. Patients keep right on dying, you know, in spite of doctors -or because of them. - -“A good example of graft which came to my notice is this: A young -Swedish farmer called in a doctor in a small town. He had pains and -other things and looked generally shot to pieces. The young doctor -speedily discovered that the real trouble was lack of air—unsanitary -conditions in the home. - -“‘You haven’t typhoid fever, you goat,’ he told the fellow. ‘I’ll fix -you in a few days.’ - -“He opened the bedroom window first. Some one had told the farmer he -ought not to raise his window nights, and there he was sleeping in that -foul atmosphere. No wonder he felt badly. Well, anyway, in the course of -a few days my friend had him feeling better. One day he called up and -said he ‘wouldn’t be around that day. It wouldn’t be necessary—patient -better,’ and so forth. - -“Then the quack hove in sight. Some one had heard of him and he was sent -for. He gave the convalescent Swede one look and said: ‘My God, man! -You’ve got typhoid! Back into bed with you immediately or you’ll die.’ -The terrified farmer crawled back into bed and began to feel worse -immediately. Then the quack ‘doped’ him religiously for a few days and -‘completely cured him.’ My friend had been let go in the meantime. - -“The idea of the younger generation of doctors, I find, is just opposed -to the old ideal. The young man wants money and as a rule he isn’t -particular how he gets it. He hustles through school, gorges his mind -for the ‘quiz’—a ridiculous thing—and gets his diploma. No really good -man could pass a ‘quiz.’ - -“Some schools, of course, are good, and I will say that the material we -have in this country of which to make doctors cannot be improved on; -but, on the other hand, some of the schools—many of them—are so bad that -no school at all would be better. - -“I must say that I do not entirely agree with everything you have said -in your book, but I must confess there is much truth in your statements. -As for Dr. Lord’s contentions—anent grafting, fee splitting and that -sort of thing—well, almost everybody’s doing it. I know that. The number -of physicians and surgeons in Chicago who would not do it is so small -that it would be like looking for a needle in a haystack to find them.” - - ------------------------------------------------------------------------- - - - - - CHAPTER XII - - =PROPER HANDLING OF NOTES= - - -There are times when as explained in Chapter X, the full fee cannot be -obtained in cash on the spot. When this occurs the only way out of the -difficulty is to get the patient to sign a note. But never, when it can -be avoided, allow the note to be made payable to yourself. Draw it to -the order of the patient and have him endorse it. Also make it payable -at a bank, the name of which is specified. This makes it negotiable and, -if the financial standing of the maker is satisfactory, it will be -readily discounted wherever he is known. - -It is comparatively easy for the maker of a note payable to the order of -a second party to evade payment, or at least greatly delay it, on the -plea of “no value received.” It becomes doubly so in cases where the -note is drawn in favor of a physician, or the maker lives in another -state. When this occurs, and it cannot be shown that the paper has -passed into the possession of an innocent holder for a bona fide -consideration in the ordinary course of business, there will be trouble -in collecting on it should the maker repudiate the obligation. - -In such event collection, if made at all, must be enforced through the -medium of a law suit. This necessitates service on the maker. If he can -be found within the limits of the state in which the note was signed he -can be sued there, but, as a general thing, this is a forlorn hope. As a -general thing it necessitates a court action in the state where the -maker resides, and this means a hearing before a jury of his own -neighbors. In such cases a non-resident claimant has small chance of -winning, no matter how just his claim may be. And this chance is still -further reduced if he is a physician. Residents of other states do not -look with favor upon non-resident doctors. Not only this, but as a -general thing they think it their duty to assist a neighbor in evading -payment of an obligation to a doctor who is not one of them. - -Notes drawn in the manner described—made payable to the order of the -signer and endorsed by him—are not so easily repudiated. In short the -burden of proof, should a contest be made, is not on the holder but on -the maker. When such a note passes into the possession of a third party -the only question about collection is as to the financial worth of the -signer. Under this latter condition notes of this kind are iron-clad. - -When suit is brought on a note made to the order of a physician, and the -plea raised of “no value received,” the holder must prove that full -value was given and this is not always easy to do in cases of medical -treatment. The patient may have been absolutely cured but, if he chooses -to perjure himself and deny it who is going to prove the contrary? It -will be invariably held that no one is so competent to judge of -improvement, or lack of improvement, as the patient himself. - -Law suits are uncertain, expensive and often long drawn out. Frequently -even the winner is a loser. An easy way to avoid this annoyance and -outlay is to have all notes made in the manner described. - -Never hold your notes. Always discount them at the first opportunity. If -they are made by men of means living in the town or county where you -practice the local bankers will be glad to handle them at a fair rate of -discount. - -There is a specialist living in Chicago who occasionally makes -professional trips into other states. On these trips he frequently has -occasion to take a number of notes. His patients are mostly farmers, and -these rarely carry cash. Just before leaving a town he will go to the -local banker and introduce himself, saying: - -“I’ve been doing a little business in the neighborhood and, contrary to -my usual custom, have taken part of my fees in the form of notes. If you -have a few moments to spare I would be thankful for your opinion as to -their worth.” - -He does not ask to have them discounted; does not try to dispose of -them. The banker looks them over and comments on each somewhat as -follows: - -“H’m, that’s John Smith. He’s all right; good as gold. Owns 250 acres of -fine land clear, and is prompt pay. - -“Thomas Jones. Well, I’m not so sure about Jones. He’s good, but he’s -slow, and will stand you off if he can.” - -Thus he goes through the lot, commenting on the financial means and -willingness to pay of each signer. When he has concluded the doctor -gathers up the notes, replaces them in his wallet, chats for a moment -about the weather and crop conditions, gives the banker a fine cigar, -thanks him heartily for his courtesy, and turns to leave. - -Country bankers make the most, if not all of their money by discounting -the notes of their neighborhood farmers. They know the financial record -of everybody within reaching distance. Men who are notoriously hard to -collect from when the creditor is a stranger will pay the local banker -without a murmur. They don’t want to “get in bad” with him because they -want a good credit when they have occasion to borrow money. The result -is that the local banker can collect in full on notes which in the hands -of other holders would be worthless. They dislike to see notes made by -their neighbors leave their bank. Almost invariably the banker will say: - -“What are you going to do with that paper, Doctor?” - -“Take it back to Chicago, and hold it until it is due, I suppose,” -replies the doctor. “I don’t know what else to do with it.” - -“I’ll discount some of it for you, if you wish.” - -“Well, I wouldn’t mind selling it if I don’t have to pay too much of a -share.” (This in an indifferent manner, as if he didn’t care whether he -sold the notes or kept them.) - -“Let me see them again,” the banker will say, ninety-nine times out of a -hundred. - -The doctor hands them over, and the banker sorts out some of the best, -remarking, “I’ll take this lot at 8 per cent.” - -“Oh, no. I don’t care to dispose of them in that way. It’s a case of all -or none. I might better take a chance on them all than to have the best -culled out.” - -It usually ends in the banker taking the entire lot at 10 per cent. He -will collect every dollar on them, and the doctor has got rid of a lot -of paper on which he would have hard work in getting half of its face -value. This plan seldom fails when carried out in the right way. - -There is one class of notes on which the signers rarely make a contest. -These are the ones given in payment for sexual treatment. A physician -is, as a rule, safe in taking a note under these conditions as he can -usually collect the full amount. Men are delicate about this trouble and -don’t want their friends and neighbors to know what they have been -treated for. To resist payment means a law suit in which the physician -will go on the stand and, under the questioning of his attorney, bring -out the fact that John Jones, the maker of the note, gave it in payment -of treatment for prostratitis, or some other sexual ailment. Pressed for -details he lays bare the whole facts of the case to the intense -mortification of Jones. - -The doctor, of course, could decline to answer such questions on the -ground that it would be a violation of the confidence existing between a -physician and his patient, but he doesn’t want to do so. He’s there to -collect that note, and in furtherance of this purpose he has posted his -attorney in advance as to the questions to be asked. - -Most men of sense know this and will pay their notes, regardless of -whether they have been helped or not, rather than submit to the -humiliation which they know will be heaped on them when the doctor takes -the stand. - -The hardest notes to collect are those given in payment for the -treatment of ailments other than sexual disorders. But even these, if -made out in the manner outlined in the opening part of this chapter, can -be realized on in full. Suppose a man living in Iowa gives a note of -this kind to a Chicago physician. The latter discounts it immediately at -his local bank which takes it, not because the maker is known, but on -account of the doctor’s endorsement. Just before maturity the note is -forwarded to the maker’s local bank for collection. The local banker -notifies the maker that it holds the note, which will be due on such a -day. What does the maker do? Why, he antes, of course. The note is in -the hands of his local banker, a person with whom he is anxious to -preserve his credit. In such a case, with the note drawn to the order of -the signer and endorsed by him, there can be no plea of “no value -received.” Besides, the obligation is in the hands of an innocent holder -before maturity. - -Beware of collection agents who want to take your claims on a percentage -commission. Most of them will deal with you honestly at first on small -accounts, and then get away with the entire proceeds of a big claim. A -few years ago a Chicago physician gave a number of ordinary bills to a -local collection agency for which he was to receive the amount of the -collections less 25 per cent., the agency to stand all costs. The agency -did good work, made satisfactory settlements, and finally the doctor -gave them a note for $700 which he held against a man in another state. -It was to be collected on the same basis—25 per cent. After several -months of delay the agency advised the doctor that a compromise could be -made at $400. The doctor authorized its acceptance. More months rolled -by, and, being unable to get word of any kind from the agency, the -doctor wrote direct to the local banker in the town where the maker of -the note lived. The banker replied, saying that the note had been paid -in full ($700 and interest) several months before, and it was then in -his possession cancelled. - -Since then this physician has had his own collector, under bond from a -guarantee company, and gets whatever money may be taken in by him. It is -possible that the physician might have prosecuted the agency, but here -again he would have been in a dilemma. If he brought a criminal action -it would not get him any money, and if he proceeded civilly the members -of the agency were execution proof—they had nothing which could be -levied upon. In either event, in order to prove payment, he would have -to bring the banker here at his own expense—provided he was willing to -come—so he concluded to drop the matter and accept it as a costly -lesson. - - ------------------------------------------------------------------------- - - - - - CHAPTER XIII - - =PRESCRIBING OF REMEDIES= - - -The time will come when the physician who has not made an arrangement -with some pharmacist for a division of the prescription fees, will be -obliged to resort to old-time methods and dispense his own remedies. He -will have to do this, or go out of business—excuse me, I meant give up -practice. It’s high treason, unethical, to speak of a doctor as being in -business, but there’s no good reason for it. Anything that a man makes a -living at is a business, and if the doctor cannot make a living, and -something more, why he’s in the wrong rut. - -Barring the division arrangement referred to there are three things -opposed to the physician’s interest which the druggist must do, or give -up his store. These are: - -1.—Sell patent medicines. - -2.—Prescribe over the counter. - -3.—Charge exorbitantly for the medicines prescribed. - -There is nothing in all this that is illegal, but it is opposed to the -best interests of the profession. At first sight it appears an evidence -of imbecility to send prescriptions to be compounded by a competitor. -Yet you send them to the druggist, who is your most active competitor. -Not only is he one directly, but he is often the agent of some other -doctor or doctors whose merits he glibly contracts with your demerits, -for the edification of the patient. You tell him, time and again, not to -repeat your prescriptions, but to no purpose. In some cases you know -that he is giving commissions to one set of doctors, while his clerks -are getting commissions from practice sent to others, yet you stick to -him. - -Now, there’s but one solution of the problem. Every doctor who can -should dispense his own medicines. The people like it, and the -profession will soon learn to like it. The doctor can furnish medicines -cheaply and still make a profit. The patient pays a bill for services -and medicines much more cheerfully than one for services alone. - -Not the least of the good things that would result from the doctor doing -his own dispensing would be the familiarity with his working tools thus -acquired. Most men enter practice without the least knowledge of the -physical qualities of the drugs they expect to use. Many a man has -prescribed, over and over again, remedies he never saw, smelt or tasted. -The best doctor is he who is most familiar with his curative agents. -Another desirable result would be the doctor’s renunciation of -polypharmacy. He would soon learn that the number of serviceable drugs -is by no means legion. Where a number of doctors occupy an office, they -should have their own dispensary. - -When neither plan suggested is feasible, the doctor should endeavor to -find a druggist who, in consideration of having practically a monopoly -of the prescriptions of that particular physician, will dispense his -prescriptions on cipher and never without an order. It is possible to -find such druggists. Self-interest is likely to induce them to treat the -doctor fairly, when all other arguments fail. There is a peculiar -advantage in this system in the fact that the doctors’ favorite formulæ -can be kept in quantities already prepared, thus saving time and -assuring uniformity in dispensing. Under such an arrangement, too, the -druggist is able to be much more reasonable in his prices. He is also -likely to keep such special preparations as the doctor may request, thus -avoiding the temptation to substitute. - -One thing is certain in the relations of doctor and druggist, viz., the -time is not far distant when the doctor will either dispense his own -drugs or will boycott every druggist who counter-prescribes or sells -patent medicines. The profession will not go blindly on forever, -carrying grist to the other fellow’s mill. - -Next we must contend with the proprietary medicine fakir. The doctor’s -experience often breeds a lack of confidence in his remedies, and his -materia medica narrows year by year. Yet his patients clamor for relief, -and in despair the doctor receives, with open arms, the fakir who agrees -to furnish him with speedy cures. - -Behold the result. The pharmacopeia is fast drifting into the valley of -dead lumber. It is no longer necessary to know anything of materia -medica and therapeutics—the fakir attends to all that for us. We are no -longer offended by the gratuitous insult offered us by the proprietary -medicine fiend, who knocks at our door, and, with the implied -insinuation that he furnishes brains for the medical profession, -clutters our office tables up with samples, the labels on which tell us -all about diseases and the only preparations that will cure them. Pah! -How most of them smell! And what a nuisance they are. - -But the fakir has done his work well. He has evolved the ready-made -doctor—man of all work, aye, slave to the fakir. How gently flows the -current of Dr. Readymade’s professional life. No more incurable cases. -No more midnight oil—for why should he be a slave of the lamp? No more -worry. No more care. No more expenditures for books, journals and -instruments. All the doctor has to do nowadays is to read the labels on -the bottles and boxes of samples the fakir brings him. Does the patient -complain of stomach disturbance? He is given “Stomachine.” Are his -kidneys working overtime? “Kidneyol” is the proper caper. Is there a -pain lurking somewhere in his economy? Give him one of these pretty -little tablets with a hieroglyph on it, which nobody knows the -composition of—so the firm that makes them claims. Oh, the practice of -medicine is so easy nowadays. Ready-made diagnosis and treatment—what -could be simpler? - -The proprietary medicine fakir begins his little song by assuring the -physician that his wonderful preparation is for the use of the -profession only. He is trying to introduce it “along strictly ethical -lines.” He has given the preparation a fanciful name and marked it with -a special design “for the protection of the physician, who, of course, -wants to know that his patient gets just what is ordered.” What an -imbecile the doctor is. The chief objects of the special name and -hieroglyphic design are: - -(1) To induce the physician to order the preparation frequently, the -name being catchy and easy to remember. - -(2) To let the patient know what is ordered, so that he can prescribe it -for himself and friends without the aid of a doctor. - -Having popularized the preparation in this manner, the proprietary -medicine man often advertises his wares directly to the public via the -secular press. If the profession protests, the wily medicine man says: -“Well, you indorsed it; the profession uses it; hence it is a good -preparation and a benefit to humanity. Go to, you are bigoted and -narrow-minded.” - -Now, brethren, while the foregoing remarks are fresh in your minds, try -and recall the facts regarding “Scott’s Emulsion” and the “Midy -Capsule.” - -Not all proprietary medicine men take the newspaper route—they don’t -have to. The catspaw doctor does his work too well. Witness the “little -joker” anti-pain tablet already mentioned. Probably ten times as much of -this preparation is self-prescribed as is prescribed by physicians. It -unquestionably contains drugs that should be taken only under medical -advice, and yet physicians prescribe it in a manner which leads directly -to self-prescribing by the laity. Is it possible that the Pharmacopeia -offers no agent of equal or better merit? Has the manufacturer more -wisdom than all the ages past—to say nothing of the present age of -progress? Or is this an age of medical progress, anyway? - -We herewith submit the proposition that the medical catspaw is pulling -the proprietary monkey’s chestnuts out of the fire, every time he -prescribes a proprietary article “protected” by special design and under -a term that he who runs may read. The fakir laughs in his sleeve at the -profession, and small wonder. It has come to pass that he owns us, and -when his impudent agent demands a hearing at our offices we are tacitly -given to understand that our time is his by right. Perhaps it is, by -right of conquest, for the medical profession seems to be thoroughly -subjugated. The distributor of drug samples is always working in the -business interests of his firm and himself. How would it do to insist on -payment for our time from the agents of some of our irresponsible, -mushroom fake medicine factories? - -There is another side to the picture. Drug manufacturers—even some of -those engaged in the manufacture of quasi-proprietary medicines—have -done much for pharmaceutic elegance and convenience. Many of our -manufacturers are conscientiously proceeding along ethical lines. We are -glad to welcome their representatives and their preparations. But, -unfortunately, such manufacturers are a small minority. The physician -should be careful how he prescribes the preparations of even reliable -firms. Preparations with special and striking names should be prescribed -under formula, where possible, and always in such a manner that the -patient cannot prescribe the preparation for himself offhand. - -We have much for which to thank some of our manufacturers, in the way of -elegant and reliable preparations—honor to whom honor is due. We should -none the less, however, guard our own interests. The manufacturers -cannot always do so, and sometimes will not. There is no objection to -secret methods of preparation of medicine so long as the formula is -known. The physician should know what he is prescribing. It is an insult -to offer him any other class of preparations. When prescribing he should -prescribe under a term comprehending the formula of the drug, or under -his own cipher. Where the nature of the preparation is such that he -cannot do this, the doctor had better look elsewhere for a remedy. - -Again we say, if you cannot make a satisfactory division arrangement -with a competent pharmacist who will protect your prescriptions, and -treat them as confidential, dispense your own remedies. - -Never prescribe a proprietary remedy by its trade name. In so doing you -advise the patient of what he is taking and in time he will buy it -without your prescription or advice. If you are satisfied that the -preparation is a good one and really has medicinal merit—which a few of -them do—prescribe it, if you must, by formula. Don’t let the patient -know what you are giving him. - -The money in the practice of medicine is in mystery. People don’t attach -much importance or value to things that they know. It is the mysterious -that commands their attention—and money. Let a man know that you are -giving him a certain proprietary preparation and he values it only at -the established market price. Give him the same ingredients in the form -of a regular prescription, each item written out in its Latin name with -the proper hieroglyphics for quantities, and he will rate you as a -wonder worker. Add “aqua, quant. suf.,” and he is knocked daffy. - -It’s simply another form of that peculiar trait of human nature which -leads the average man to “kick” when his regular family physician -charges $5 for making a ten-mile call on a stormy night, when he will -travel the ten miles himself and cheerfully pay a specialist $25 for ten -minutes’ consultation in the latter’s office. - - ------------------------------------------------------------------------- - - - - - CHAPTER XIV - - =CORPORATION DOCTORS= - - -Of recent years many corporations, especially the large manufacturing -and railway concerns, have made it part of their policy to employ -doctors on contract. At first such jobs paid fairly well. It was to the -interest of the corporations to engage men of reputation and they had to -pay them. It sounded well, it created a favorable impression, to have it -known that the United States Steel Corporation had engaged the -celebrated Dr. Curem to attend to such of its employees as might become -sick or disabled while in service. - -Truly, a generous corporation, the public would argue. It not only looks -after its sick and injured without charge to the unfortunate, but it -gives them the benefit of the best medical and surgical talent -obtainable. But the corporations did not do this from philanthropic -motives. Not much. It was a matter of business. - -Sickness and accident among a large force of employees costs money. The -quicker it can be overcome the better off the company will be. But, the -reputation for philanthropy once established, the corporations began to -economize in their outlay for medical expenses. For this the doctors and -surgeons were largely at fault themselves. The plum was too tempting and -there was a keen competition for it, with the result that prices took a -sharp tumble. - -Physicians with a small practice who heard of other doctors getting -$5,000 a year to look after the sick and injured employees of a -corporation argued that they would like to do the work for $2,000. It -would ensure living expenses, and what they could pick up on the side in -regular practice would be profit. They didn’t know, until too late that -the demands on their time would be such that they would have little -opportunity for outside practice, and that the $2,000 they received from -the corporation would cover their entire income. So they began bidding -and wire-pulling against one another, and the corporations, wise unto -their day and generation, took advantage of the unseemly competition. - -In no one line of corporate endeavor is this competition more keen and -noticeable than in life insurance. It is not so very long ago that the -position of medical examiner for a good company was a respectable, -lucrative position. What is it now? It is safe to say that there is -hardly a company in the field to-day that pays a decent sum for its -medical examinations. The doctor is the watchdog of the company’s -treasury. He stands between it and great financial loss. He protects it -against fraud. A slight error or the least degree of negligence on his -part may cost the company thousands and thousands of dollars. The -issuance of a policy is a very important business transaction. The -doctor stands in the same relation to it as does the lawyer who examines -the abstract in a real estate deal. Contrast the fee allowed the medical -examiner in a case involving the issuance of a $100,000 life insurance -policy and that received by the lawyer who examines the abstract in a -real estate transfer involving $5,000, and my argument is complete. Some -companies expect to secure all of an expert examiner’s time—and actually -get it—for $2,000 to $3,000 a year. It might be well to contrast, also, -the commission received by the agent who writes the policy, with the -medical examiner’s fee. - -In the case of our fraternal societies the examiner’s fees are pitifully -low, so low that a busy man cannot do the work save at a great loss of -time. There are some extenuating circumstances in the case of the -co-operative societies. In the case of both old line and co-operative -insurance, however, only the overcrowded and generally poverty-stricken -condition of the medical profession can possibly explain the fact that -good men are to be had so cheaply. - -Railroad and manufacturing corporations have no difficulty in securing -doctors to look after their interests at a rate so low as to reflect on -the respectability of the profession at large. There are, for example, -instances in which doctors are rendering for $300 a year services that -should bring several thousand dollars at very ordinary fees. In addition -to this direct cheapening of professional values, the company or -corporation surgeon is expected to go on the stand as an expert and -prevaricate in the interests of his employers. As a corollary, he is -expected to testify against the interests of the poor fellow who, -perhaps, as the result of the company’s wilful neglect, has only the -wreck of a once vigorous manhood with which to oppose the company’s -immense capital. And this the doctor does in an uncomfortable proportion -of cases. - -When the charge is made that he “prevaricates” it is correct. It would -be pitiful, indeed, if the expert opinions rendered by some corporation -doctors were the result of ignorance. The corporation expert does not -always prevaricate. The truth may be the best card to play. He had -better not let the corporation catch him telling the truth, however, -when said truth is prejudicial to its interests. There is an ax, my -brethren, an ax that is ever ready. - -Speaking of corporation surgeons reminds me of the fact that practice in -the neighborhood of our large factories is rather poor picking for -everybody. There is plenty of work to be done, and there would be -considerable income derived therefrom, but the corporation surgeon gets -it all, and receives a mere pittance therefor. The corporation claims to -employ a surgeon for humanity’s sake. This is pure hypocrisy—the doctor -is employed for its own protection. Every doctor knows of cases in -which, by the co-operation of the claim agent and the surgeon, an -injured employee has been induced to sign away his manifest rights. He -is usually denied the right to select his own surgeon. To the -non-partisan medical observer, the bitter opposition of the average -juryman to corporations is in no wise remarkable. It will be argued that -there are plenty of honest corporation doctors. Grant you that, but it -is hard to see how they hold their jobs. - -Then there is a hurtful disposition to fraternize. In the good old days -the regular profession ostracized him who consulted with that horrid -bugaboo, the homeopath. It has come to pass that the regular lion has -laid him down beside the homeopathic lamb. And when they rise again the -mutton shall be no more, and the lion shall have waxed fat. The -latter-day regular has gone farther, and hobnobbed, as on equal terms, -with “osteopaths,” “Christian Scientists,” “faith healers,” and others -of their ilk. Not so? Oh, yes it is. It is not long since the -Physicians’ Club of Chicago invited representatives of these creeds to -break bread with it, and formally discuss the merits and demerits of -their theories as opposed to regular medicine. The affair was given -great publicity in the newspapers, and the wise layman, reading thereof, -laughed exceedingly merry and said, “What fools these doctors be.” - -And, from a business, politic and social standpoint, were they really so -very clever? The Physicians’ Club gave these people standing in the -public eye, and by inviting them to a joint discussion, gave them -professional recognition—a recognition they were not slow to use as a -valuable advertisement. If a dinner invitation does not constitute -social recognition, what does? This action of the Physicians’ Club did -more to further the interests of these people than they themselves could -have done in a year. Still, mistakes will happen, and the worst that can -be said of the club is that it made a serious, impolitic and -unbusiness-like blunder. - -It is much easier to direct attention to faults than it is to suggest -remedies therefor. In most of the points here made, the remedy suggests -itself. In general, the remedy lies in an improvement of professional -_esprit de corps_. With a betterment of this as a foundation, much can -be done to improve the business aspect of medicine in its higher sense. -The time will come when professional co-operation in the broadest sense -will be absolutely necessary if we would survive. - -A little of the proper spirit of trades unionism might not be a bad -thing. So far as the strictly financial aspect of legitimate practice is -concerned, the sooner we impress the public with the idea that we -appreciate our own market value and insist on its appreciation by the -public, the better it will be for the profession. Once let it be -understood that ours is a business-like and financially sound -profession, and the _hoi polloi_ will give us the respect that is our -due. The public should have frequent and pointed reminders that there is -more than a philanthropic side to our labors. The doctor’s wife and -children deserve quite as much consideration as the layman’s. - - “I know that the world, the great big world, - From the peasant up to the king, - Has a different tale from the tale I tell, - And a different song to sing. - - But for me—and I care not a single fig - If they say I am wrong or right— - I shall always go in for the weaker dog, - For the under dog in the fight. - - I know that the world, the great big world, - Will never a moment stop - To see which dog may be in fault, - But will shout for the dog on top. - - But for me, I shall never pause to ask - Which dog may be in the right, - For my heart will beat, while it beats at all, - For the under dog in the fight. - - Perchance what I’ve said were better not said, - Or ’twere better I’d said it incog; - But with heart and with glass filled chock to the brim, - Here’s luck to the under dog.” - - ------------------------------------------------------------------------- - - - - - CHAPTER XV - - =MEDICAL “STEERERS” AND THEIR WORK= - - -Every doctor has his steerers, people who drum up business for him. In -many instances it is a service willingly performed out of real affection -and confidence in the skill and ability of the physician. The latter is -unconscious of any such influence being exerted in his behalf until he -is told by some new patient, “I was advised to come to you by Mr. ——, -who says you are the only man who ever did him any good.” This is -“steering,” legitimate, unpaid-for steering. The doctor is, of course, -grateful to Mr. ——, or ought to be, but it is seldom that he gives the -matter a second thought. - -Then there is another kind of “steering,” the cold, commercial variety -in which the labors of the steerer, if they are successful, are rewarded -in coin of the realm. Nearly every advertising physician—and some who do -not advertise—has one or more of the genus “steerer” on his staff. - -There is just as much caste, just as pronounced a social distinction in -this calling as there is in the medical profession itself. The cheap -doctor has cheap, rough steerers; the doctor who is higher up in the -social scale has smooth diplomats in his employ. The object of all is -the same—to get business for their employer, and the more business they -get the larger are their incomes. - -There are some steerers who think themselves well repaid if they are -handed a dollar for each patient they land in the office of the -physician who employs them. These are the men who can approach only a -cheap class of people to whom a five dollar fee is the limit. - -The better class of steerers, the men who work for the big fee getters, -scorn a salary, or a stated amount for each patient. They prefer a -percentage, usually one-quarter of the fee secured from the patient. -There are men in Chicago who are making $150 a week in this occupation. - -Go into the rotunda of any first-class hotel in Chicago, New York, or -some other large city and affect to walk lame as if afflicted with -locomotor ataxia, or make up to resemble a confirmed invalid. It will -not be long before you will be approached by some well-dressed, -prosperous-looking individual who will say: - -“Beg pardon, sir, but you appear to be suffering from locomotor ataxia. -You will excuse me for addressing you, but I was afflicted in the same -way myself for ten years, and have a sympathetic feeling for fellow -sufferers.” - -If you are a genuine sufferer this will command your attention. Here is -a robust, healthy man who tells you that for ten years he was afflicted -with the same ailment which you have been assured by many physicians is -incurable. Naturally you want to know how the disease was overcome. The -stranger smiles, and says: - -“Why the thing is so easy it sounds ridiculous, and I dislike to tell of -it on that account. For eight years I doctored, and spent a large amount -of money, without obtaining the slightest relief. About two years ago I -read in a magazine of a new treatment with which wonderful results were -being accomplished. After so many failures I naturally didn’t have much -faith, but things couldn’t be any worse so I decided to investigate. -What I learned led me to take the treatment. There was an improvement -after the first week, and at the end of the sixth month I was just as -sound as I am to-day. That was eighteen months ago, and there are no -signs of a reaction of any kind.” - -By this time the real sufferer is deeply impressed. Here is a prosperous -stranger, once a fellow sufferer, dangling before his eyes the hope, -nay, the certainty, of cure, with no other object than that of sympathy. -It is the one chance for which he has been so long and fruitlessly -seeking. - -Pressed to tell where this wonderful treatment may be had, the -“steerer,” if he is one of the sharp ones, will be apt to say: - -“I believe the address is No. —— Michigan Avenue. Let’s see, I think I -have the doctor’s card in my pocket somewhere.” - -Meantime he searches through various pockets (knowing full well all the -time where it is) and finally locates the doctor’s card. - -“Ah, yes, here it is. ‘Dr. ——, —— Michigan Avenue.’” - -Adroitly he changes the topic at this point, shifting to the various -features of the disease itself, its excruciating pains, the -cushion-soled feet, loss of various bodily functions, and other -unfailing accompaniments of the ailment. Comparing notes the two find -that they have suffered much in the same way (all ataxia patients do) -and from that moment there is a strong bond of fellowship between them. - -The smooth steerer tells of the various treatments he had taken at great -cost and without results, glibly describes the many drugs swallowed, and -the tortures endured with mechanical appliances, such as the “hanging” -process, winding up with “but not one of them did a bit of good until I -took up the —— —— treatment.” - -The actual sufferer has met a congenial spirit, and talks freely. -Without realizing it he tells of his business affairs, his financial -condition, and similar matters. During all this the steerer makes no -suggestion that he should call on Dr. ——. Far from it. He studiously -avoids anything of the kind. The bait has been cast and the fish will -rise to it of his own accord. Having secured all the information he -wants the “steerer” will rise and excuse himself on the ground of an -important business engagement. Handing out a neatly engraved card he -says: - -“If you ever come to New York, Mr. ——, I would like to have you hunt me -up. I’d stay longer with you this afternoon, but for this pressing -engagement.” - -The card reads about like this: - - - - - MR. G. ADDINGTON WELLS - - 1027 Broadway - - Structural Iron New York City - - - -The card is a blind. “G. Addington Wells” is an assumed name. But it -sounds well. Your smooth “steerer” never pretends to live in the same -city in which he finds his victim. It might be too easy to locate him in -case he was wanted. He lives in Chicago, all right, but he assumes the -role of an Eastern business man here on business purposes. His -appearance, his general “get up,” his talk is all impressive and -calculated to beget confidence. That’s his business. He’s a fake all -through, even to the nature of the ailment with which he pretends to -have been afflicted. He was never seriously ill in his life. But he’s a -clever fakir; we must give him credit for that. He’s an artist in his -line. - -There is one man of this kind in Chicago so thoroughly posted in -medicine that he can accurately describe the symptoms and -characteristics of half a dozen chronic ailments, and in one week has -successfully played the role of having entirely recovered from each. If -he meets a tabetic sufferer he has been successfully treated for tabes, -and will converse intelligently about tabetic conditions. Chronic -arthritis, nephritis, paralysis agitans, lateral sclerosis; they are all -known to this chap. He’s had them all—in his mind—when he wants to -impress a sufferer, and he seldom makes a mistake. - -Almost invariably as the “steerer” is about to leave the sufferer will -say: “If I can stand the trip I’ll go down and see this Dr. —— this -afternoon. How far is it from here?” - -“Well, it’s quite a journey for a man in your condition, but I’ll tell -you what I’ll do. If you want to go now you can ride in my cab. I’m -going that way and I’ll drop you out at the doctor’s. He will see that -you get back to the hotel all right.” - -This suits the sufferer, who is pleased with the attention shown him by -the “steerer.” The latter excuses himself for a moment while he -“telephones for a cab.” He goes into the telephone booth but, instead of -calling for a cab, he rings up the doctor. - -“Hello, is this Dr. ——? Yes. This is Wells. Just landed a good one at -the La Salle. Will bring him down in about twenty minutes. Name is -Smith, banker at Pontiac. Well fixed.” - -Then he rejoins the sufferer, escorts him carefully to the sidewalk and -places him in a taxicab. The doctor’s office is not far off, but the -chauffeur takes the longest way, and during the ride the “steerer” tells -of having lived in New York all his life with the exception of the six -months he was under treatment in Chicago, and dilates upon the wonders -of the Eastern metropolis. On reaching the doctor’s the “steerer” looks -at his watch, saying: - -“I’ve got ten minutes to spare so I’ll go up to the doctor’s office with -you.” - -The sufferer is glad of this assistance, and when they reach the office -is impressed by the dignified appearance of the specialist who greets -“Wells” warmly. - -“How do you do, Mr. Wells. I was afraid you had forgotten me.” - -“Oh, no, Doctor, I couldn’t do that, after all you have done for me. -But, really I can’t stop to talk now. I’ll see you again before I leave -town. Dr. ——, this is Mr. Smith of Pontiac, who is suffering the same as -I was. If you do as well for him as you did for me I think he will have -reason to be glad he came here. Good day, gentlemen. Excuse me for my -haste, but I must get away.” - -“Fine man, that Wells,” says the doctor to Mr. Smith, after the -“steerer” has gone. - -“Yes, indeed,” replies Smith. “Mighty glad I met him. He has given me a -lot of valuable advice and aid.” - -“One of the toughest cases I ever had,” continues the doctor, “but I -pulled him through all right, and I’m proud of it.” - -By this time Mr. Smith is an easy subject to handle. “Wells” has paved -the way, and the doctor does the rest. Smith pays a good-sized fee, say -$1,000, and begins treatment. - -Later in the day the “steerer” calls on the doctor again and gets his -bit—$250. Any chance for the doctor to hold out on him? Not a chance in -the world. In the first place he is too valuable a man to lose and it is -to the doctor’s interest to treat him fairly. Besides this the “steerer” -is in position to protect himself. If he has any doubts about the size -of the fee he will drop in on Mr. Smith again at the hotel the same -evening “just for a moment’s chat before I leave the city.” - -“How did you get along with the doctor, Mr. Smith?” he will ask. - -“Very nicely. He seems to be a good man, and apparently understands his -business. But he’s pretty steep in his fees.” - -“Yes; he’s a good man, and an A No. 1 physician. As for fees, all these -big specialists charge pretty well, but we shouldn’t mind that if we get -relief. I paid him $1,000.” - -“That’s just what he charged me,” says Mr. Smith. - -After a few moments chat the “steerer” leaves, satisfied that the doctor -has given him the agreed-upon commission. If, on the other hand, he -finds that the doctor has “held out” on him he hunts him up and -remonstrates. Should this be of no avail the “steerer” severs business -relations with that particular specialist, and makes a compact with one -of his competitors. Good “steerers” are always in demand and the doctor -who picks up an artist in this line is pretty sure to use him well so as -to make sure of retaining him. - -It is not every day that the steerer can pick up a patient that will net -him $250. Sometimes his “bit” will not be more than $12.50 or $25, but -it is safe to say that a smooth man who thoroughly understands the -business can easily average $150 a week. He takes life easy, dresses -well, and lives on the fat of the land. Few patients after paying a big -fee to the doctor feel like staying at an expensive hotel for any length -of time. Besides this the doctor generally manipulates matters so that -the patient finds it to his interest to board at some place recommended -by the physician. This clears the road for the steerer at the hotels and -leaves him free to operate among them without fear of running into any -of his victims. In a city where there are a number of large hotels it is -an easy matter for the steerer to so regulate his movements as to avoid -suspicion by being seen around any one house too often or continuously. - -There are women “steerers” also, but they work in a much different -manner from the men. In nearly every community there are women of -business instinct who are not averse to earning some “easy” money. One -of these women will make an arrangement with Dr. Sweatem by which she is -to receive a commission on all the patients she may send him. Her -commission is not so large as that given the men steerers because she -does not work among strangers, or personally take such patients as she -may secure to the doctor’s office. Still it is a handsome sum—generally -10 or 15 per cent of the fee—enough to give an active, influential woman -a very respectable income. - -The woman “steerer” makes it her business to join various clubs and -churches, take part in all women movements, and to get acquainted with -as many of her sex as possible. She especially cultivates the -acquaintance of well-to-do women who are real sufferers, or imagine -themselves to be afflicted in some manner. She encourages them to talk -about their physical troubles, is kindly sympathetic, and, at the proper -moment makes delicate suggestion that it would be well for the sufferer -to see Dr. Sweatem. - -“He’s such a grand man. Seems to know just what to do, and has been so -successful in treating a lot of my friends. I wouldn’t think of going to -anyone but him myself.” - -Thus the seed is sown, and in time bears fruit. The well-to-do sufferer -goes to see Dr. Sweatem and is relieved of a good fee, if nothing else. -The doctor in the meantime has been advised over the phone by the woman -“steerer” that Mrs. —— is coming to see him, and informed as to her -financial condition, as well as the nature of the ailment with which she -thinks she is afflicted. Armed with this information he knows just what -to do when Mrs. —— arrives at his office, and the patient is deeply -impressed by the manner in which he so accurately diagnosed her case at -the first interview. - -Another point of information always conveyed in advance to the doctor is -the age of the prospective caller. Thus advised, when the interview does -take place he is in position to say: - -“A woman of your age—let’s see, you’re not over 32, are you, Mrs. ——? —— -ought to,” etc. - -“Oh, yes, Doctor, I’m 40,” will be the answer. - -“You surprise me. I would never think it.” - -Foxy doctor. He knows all the time her exact age because the “steerer” -has told him, but he’s too smooth to give himself away. And thus he -makes another ally, and easily-duped patient. As for Mrs. ——, she is -enthusiastic. She reports her visit to the “steerer,” saying: - -“I’m glad you advised me to go. He’s a splendid doctor; perfectly -lovely, and I know he’s going to do me good.” - -And he does. Not only that, but the chances are that her enthusiasm will -give Dr. Sweatem opportunity to “do” the patient’s intimate friends and -relatives also. - - ------------------------------------------------------------------------- - - - - - CHAPTER XVI - - =WHAT SHOULD THE PHYSICIAN DO?= - - -All this leads up to the question “What is the young physician to do?” -The majority of them can remain strictly ethical and drag out a -miserable existence, so far as getting a livelihood from the practice of -their profession is concerned, because they never should have studied -medicine in the first place. Those who are equipped by nature and -education for successful practice, may gain a competence by imitating -some of their elders (those who howl the loudest about violation of -ethics) and throw down the bars. Just how far they may graze in the -non-ethical pasture is a matter for each practitioner to judge for -himself. - -According to the _Journal of the American Medical Association_, the -organ of the strictly ethical cult, there are 140 “acceptable” medical -colleges in the United States, turning out on an average of 5,000 young -doctors annually, to say nothing of those graduated from other schools. -The census of 1900 gave the number of physicians in the United States, -including Alaska and Hawaii, as 132,439, an average of one to each 122.5 -families. But these are not distributed pro rata. Naturally the doctors -are most numerous in the thickly settled parts of the country. Hawaii -has one physician to every 1,412 persons, and Utah one to every 907. The -ratio in the entire United States is one to every 575.7 people. In the -District of Columbia, however, which is virtually co-extensive with the -limits of the city of Washington, so far as population is concerned, -official figures show one doctor to every 297 residents. Chicago, with a -population of 2,185,283 people, has 4,432 doctors, one to each 515 -people. - -The plain fact is that the medical schools are grinding out alleged -“doctors” too fast, and without proper regard for individual -qualifications. But there is some sign of improvement. The better class -of colleges, notably Rush Medical and the College of Physicians and -Surgeons, have called a halt, and are insisting upon a higher grade of -attainments for admission, and upon a more thorough and searching -examination at graduation time. Last year the College of Physicians and -Surgeons alone turned away 150 applicants as not being fitted for a -medical career. This new system has had the effect of greatly reducing -the number of candidates for medical diplomas. In 1900–1901 Rush Medical -had 1,055 students on its rolls; in 1909–1910 the number was only 584. -The decrease at the College of Physicians and Surgeons, while not so -marked, was still a healthy one. In 1900–1901 this college had 676 -students; in 1909–1910 the number had dropped to 529. - -But, despite this reduction, the number graduated every year is still -much too large. There are at least 2,000 alleged “doctors” turned loose -every year whose medical services could well be dispensed with—with -profit to themselves, and more safety to the community. Taking the -average of one physician to every 122.5 families it follows that, in -order for each doctor to earn the modest income of $2,000 a year each -family must contribute $16.31 in fees every year. This is preposterous. - -Again we are brought face to face with the question, “What is the young -physician going to do?” As said before, he can kick down the bars of the -ethical field and emancipate himself, if he has brains, courage, and a -winning address. Or, he may assist in the formation of a sort of labor -union for the maintenance of fees and the black-listing of dead beats. -This latter course, however, is not likely to prove effective, as there -are too many needy ones in the profession ready to remain outside of -such a union and grab what they can. - -Dr. W. A. Evans, commissioner of health for the city of Chicago and for -twenty years in touch with the medical profession, says that hundreds of -physicians in Chicago are virtually without means to support their -families. What a man situated like this often does do in the -circumstances may work disaster even upon the general public. He may -help put the records of the health department to the bad. Here is an -example in point. - -“A young doctor is called into a family which lives in the rear of a -man’s place of business, above the store or next door to it. The -competent young physician discovers a patient suffering from diphtheria, -scarlet fever, maybe smallpox. The law requires the posting of placards -and the isolation of these victims of contagious diseases. But at once -the family in such close connection with the place of business -recognizes what such a placard may mean to the business by which the -family of the patient lives. - -“Will you imagine the pressure that may be brought to bear on this -physician whose own family is so dependent upon him? Isn’t it reasonable -that with sufficient compensation offered him he is likely to cover up -the infectious case? Or if the family has not thought of offering the -inducement, the young doctor himself may propose it and ask the limit of -compensation.” - -Educated, brainy physicians of high standing, are beginning to balk at -some of the ethical commandments which bar the way to a doctor’s -increasing his income. When Dr. Oscar A. King was asked what he thought -about the division of fees, he said: - -“Why not? The physician who has diagnosed the trouble and finds that an -operation is necessary may have paid only two or three visits to the -patient at $2 or $3 a visit. The result is that, honestly, he must give -his patient over to a surgeon. ‘What surgeon?’ is asked most frequently -by the patient. Honestly the doctor names a man who has taken many cases -from him and most successfully. But where the physician gets $8 or $10, -the surgeon may get $150, $300, or $500. And—except for the -physician—the surgeon never would have heard of the patient.” - -“It’s all fair enough if openly above board,” said Dr. Evans, in reply -to the same question. “It would be a most logical thing in business, -only that the public is not prepared to compare business with the -professions of medicine and surgery. When it comes home that both doctor -and surgeon must be assured of a living, however, the fact is a jar to -the purely ethical.” - -Another physician said: “I have just had an experience along the line of -the split fee. An old doctor friend of mine discovered the presence of -gall stones in his patient. It is a difficult thing to diagnose with -certainty. My friend, however, made no mistake and received $25 from the -wealthy patient. The surgeon who operated in the comparatively simple -case got a fee of $500. It would have been only fair for the physician -to have received part of that $500 fee, and I think he was a chump if he -did not get it.” - -“But you can’t put a profession on a business basis,” shriek the high -moguls of ethics. Why not? On this subject Prof. George Burman Foster, -of the University of Chicago, speaks plainly, as follows: - -“What is the difference between a profession and a business? Is it, as -was once thought, that the former is fulfilled by the mind and the -latter by the body? But, for example, dentistry is quite manual and -engineering or carpentry quite mental as well. Besides, the old idea of -a dualism between mind and body is no longer held by the modern man. -Then is the difference that the profession is ‘learned’ but the business -is not? - -“But we have men who are not college graduates entering the professions, -while business of a higher order is clamoring for college graduates. -Besides, we have changed our notion of what constitutes ‘learning’ and -concluded that the man who by experience has learned ‘life’ may know -quite as much as the man who has learned books in the school. But is the -difference, then, that the professional man receives a special -professional training, while the business man does not? But farmers are -going to agricultural schools, while the majority of preachers still do -not go to a theological school! - -“Shall we say that the professional man is distinguished by eminent -character and ability, while the business man is not? Hardly. We know -that while the business principle is pagan and not Christian to-day, -still the average business man is quite as good as the average -professional man, no matter what the profession may be. - -“Who deserves more honor—the farmer who provides us with our daily -bread, or the dentist who keeps our teeth so that we can eat it, or the -physician our stomach so that we can digest it? - -“The best sign of our time is the growing sense of the worth of the -profane, of the secular, and a growing depreciation of what once was -called ‘sacred’ and ‘holy.’ To be sure, of the professions the -‘clerical’ is still regarded as ‘sacred;’ but since the religion of the -future is to be a secular religion, the ‘sacredness’ of the ministerial -office will in time pass away. - -“The students in our schools to-day are taught this. They see that the -distinction between profession and business is at last only traditional. -They are bent on fulfilling the task which is in accord with the -incentive and legislation of their special natures and characters. They -know of something above the old honor of the profession and the new -money of the business—namely: the unfolding of moral personality and the -service of their brothers. - -“They seek the calling, disregarding the old distinctions, which is -adapted to the growth of their peculiar self and to the service of the -brother. Hence, the wall of partition has been broken down by interests -that are above profession and above business.” - - ------------------------------------------------------------------------- - - - - - ● Transcriber’s Notes: - ○ Missing or obscured punctuation was silently corrected. - ○ Typographical errors were silently corrected. - ○ Inconsistent spelling and hyphenation were made consistent only - when a predominant form was found in this book. - ○ Text that was in italics is enclosed by underscores (_italics_); - text that was bold by “equal” signs (=bold=). - - - - - - - -End of the Project Gutenberg EBook of Large Fees and how to get them, by -Albert V. 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