Page 336 Outlook and Irtdependent ^^ The Doctor and His Dollars

MUST warn you to be prepared," By DR. FREDERIC DAMRAU a colossal fee. The nature of the service says the doctor in an undertone to is so spectacular that the public have I the nearest relative. "Things have A scribbled note and a few steps attached tremendous significance to it. taken a serious turn." across the corridor entitle the bearer to As a matter of fact, a much higher de­ In this crisis, help is badly needed. an additional consultation. Sometimes gree of learning is often required to And the most logical assistance takes the one patient receives three or more ex­ make a correct diagnosis than to remove form of a qualified consultant to advise pert consultations in a single afternoon. the trouble with the knife. the family physician in the treatment of The result is that the physician in If I had mastoiditis and were allowed his patient. But here is where the ugly charge of his case is in a position to a choice between an eminent ear spe­ dragon, expense, spreads devastation in treat him more intelligently than many cialist and his assistant, one of whom the household of average means. A of his private patients. was to make the decision for or against financial panic results. As an enterprise of scientific philan­ operation and the other to perform the Lucky is the family that has a good thropy, I greatly admire the organiza­ operation itself, I should without hesi­ general practitioner to guide it through tion of the free clinics, but I am con­ tation say, "Let che professor decide these trying hours, but no one physician vinced that their existence on the pres­ whether the operation is necessary, and is all-knowing, because the field of ent large scale is a gross injustice to the let his assistant do it, if it has to be medicine is entirely too broad. Conse­ medical profession and a menace to the done." But the man behind the knife quently, when he feels that more expert great middle classes, who are too self- occupies the limelight. He receives the advice is needed, the conscientious family respecting to take service for nothing credit for saving the patient's life, and doctor recommends that a consultant be but cannot afford de luxe fees. The doc­ also pockets the substantial check. .^ called in. Should the illness be due to tor working in the free clinic, it must Two glaring examples of the greed mastoid inflammation, for example, a not be forgotten, usually has a family of some surgeons—fortunately there .are qualified ear specialist should be asked to support. During the few hours of not many of this type—^were cited by to examine the patient with the family work that remain after clinic and hos­ Dr. Malcolm LaSalle Harris, of Chi­ doctor to determine whether operation pital periods, he must earn enough cago, President of the American Medical is necessary and to perform it, if re­ money to meet the expenses of the entire Association, in an article in the Journal quired. But picture the consternation in day. That is the underlying reason why of the American Medical Association. the family if the specialist should ask the services of specialists and surgeons A working girl supporting herself and a hundred dollars for his consultation who contribute much of their time to her mother on thirty dollars a week was and perhaps a thousand for the opera­ hospital work are so expensive. If four . rushed to the hospital and operated upon tion! Should the patient be wealthy, the out of five patients do not pay, the fifth for acute appendicitis. While she was situation causes no embarrassment. The must foot the bill for the whole five. convalescing, the surgeon presented a family physician is asked to bring in That is why the great middle classes bill for $1,500 for the operation. When the most distinguished consultants—^not cannot afford the services of the most she explained that she could not pos­ one, but several—and "to spare no ex­ skillful consultants. sibly pay this amount, he told her that pense." she would not be allowed to leave the Strange as it may seem, the penniless ANY of our leading consultants di­ hospital until the money was produced, enjoy the same ready access to phy­ M vide their time between the poor and it was not until the services of a sicians of renown. They have but to and the rich. The poor they serve for lawyer were enlisted that she was able,to apply to the free clinic, where they will nothing; the rich for fees that border on gain her liberty. at once receive careful attention from high finance. The great middle class re­ In the second case mentioned by Dr. medical men of far above the average mains outside this system altogether. Harris, the surgeon approached the ability. Any one who is familiar with The person of average means must be patient's wife immediately after the free clinics must concede the efficiency content with a medical consultant of operation, saying that it was customary of these organizations from the stand­ average calibre, even though life hangs for him to collect his fee of $5,000 be­ point of medical service to the public. in the balance. In this respect, he is fre­ fore leaving the hospital. He omitted They are so efficient that they enrolled quently less fortunate than the pauper to tell her, however, that she was a 10,000,000 non-paying patients (many in the ward of a charitable hospital. It widow, her husband having died on the of whom owned automobiles and ex­ is expensive to be born and extravagant table. Surgeons of his type all realize pensive radios) in one year and are to die, but recovery from a long illness that, when the operation is unsuccess­ rapidly making the practice of medicine frequently spells financial ruin. ful, collection must be made imme­ the short road to the almshouse. Phy­ By virtue of the confidence which diately or not at all. When the truth sicians working in the clinics receive no must be reposed in the medical adviser, was learned, the widow turned the bill salary, profit or commercial advantage the practice of medicine offers a golden over to her attorney, who asked the doc­ whatsoever for their time and gasoline. opportunity to the unscrupulous and tor whether he had not made a mistake. On the contrary, when the hospital drive rapacious. Fortunately, the high stand­ The reply was that there had indeed comes around every once in so often, ard of medical ethics makes examples been a mistake, that an expense item of they are asked to contribute a modest of such rapacity unusual, considering sixty-two dollars for dressings had been five hundred or a thousand dollars to the fact that there are 150,000 phy­ overlooked, and that the amended bill keep up the work of competing against sicians in the United States. Of course, was for $5,062! ,,, ,; their own pocketbooks. Hence, the doc­ there are black sheep in rnedicine as in The public itself is largely respp|ii-| tors who are attracted to clinic work are all other learned callings, but, because sible for the crushing fees of sopje sur­ only those who have an earnest interest of the sacred obligations of the profes­ geons and specialists. Many people rate-: in medicine and wish to perfect them­ sion, they are relatively few. The sur­ the doctor entirely by the fee he charges^, selves in their particular specialties. gical operation offers the best excuse for encouraging the speei-list to charge high

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Eviring Galloway MODERN NEW YORK HOSPITALS To (he kft the Cornell Medical Associationon the upper east side; to the right the New York City Medical Center on Washington Heights

fees in order to maintain his standing. their patients' financial standing. Many prevalent habit of not paying medical Except in occasional instances, the a man with a big bank account lives in bills have made the practice of medicine liberally paid surgeon is not a profiteer a hovel, and very many persons pay a a precarious existence. Any direct in^ at heart. He is the outgrowth of a stand­ rent that their pocketbooks can-iliafford. terference with physicians' incomes ard by which doctors are judged by the But there is a more fundamental rea­ would simply compel them to give up fees they can "get away with," of a son why the doctor's fee should be more medicine and apply themselves to other practice that gives all the profit to the nearly standardized. Physicians are vocations, as many have already done. surgeon because his work is so spectacu­ selling service, not a guaranteed result Whatever readjustment is made with lar, and of a misdirected form of philan­ of that service. To make my point clear, regard to medical fees must come as a thropy which compels him to operate let me cite an argument which I once result of a mutual understanding be­ upon four patients without compensa­ heard from a surgeon in defense of a tween the profession and the public. To tion and charge the fifth for all of them. scribed, just like Jules Verne!"

PRODUCED BY UNZ.ORG ELECTRONIC REPRODUCTION PROHIBITED July 15, 1931 Page 339 Ernest Whitcombe are in their middle ^>k The Spotlight on Sports <^ forties; Charley Whitcombe, Compston and Havers have left thirty well behind; only Esterbrook, Hodson and Davies are young in an athletic sense. One London critic unkindly referred to the British side as a "team of has- beens." Unhappily, with Alliss, Boomer and Cotton ineligible, the only alter­ native to the "has-beens" were some "never-wasers."

^^^Cochet's Defeat

HENRI COCHET'S surprising defeat at the hands of a British second stringer in an early Wimbledon round raises hopes that our youthful crusaders may succeed where Tilden and Co. have ^^Hot Golf Compston, a giant of a man with a face failed in recent years. chipped from granite, a prognathic jaw, Coehet has been a sick man since '1LIMATE played freakish pranks and a Lon Chaney scowl, was the lone March. His defeat can be discounted on at the expense of sports en­ Britisher to strike an individualistic note that score, but there is no assurance that thusiasts this last fortnight. The in the matter of dress. In deference to he will be in physical condition to do cthermomete r by the umpire's chair on his stilt-like shanks, Compston wore long himself justice in the Davis Cup chal­ Wimbledon's center court registered trousers. A dark blue scarf, knotted lenge round. Personally, I have too much fifty-eight degrees. Chill-hardened Lon­ loosely about his throat, contrasted respect for the recuperative powers of doners shivered in summer chiffons. pleasantly with his baby blue shirt. He the wiry little chap from Lyons to in­ Teeth chattered like castanets. Hawkers looked like one of those pirates you see dulge in any premature gloating. did a land-ofEce business in cheap woolen at any fancy costume ball. A Tarzan of Assuming that America beats Great blankets. It was no day for . the links this throwback to Neanderthal Britain (a contingency by no means as­ Meanwhile, at Columbus, Ohio, the Man and a great favorite with the sured), France will need Coehet at his British professional golf team was wilt­ feminine portion of the gallery. best to turn back our fresh, impetuous ing in the midst of a humid heat wave. Long white flannels, once monopolized youngsters. 's vitality For simmering, muggy, midsummer by tennis players, are growing popular seems inexhaustible, but it is asking a weather our Middle West can give the in golf. Such natty dressers as Farrell, lot of the airplane riding pump salesman, Amazon Valley several degrees of start. Hagen, Wood and Burke appeared in to bear the brunt of two singles matches "My word," said George Duncan as these "slacks." It is rumored that a as well as the doubles. With dynamic he sank limply down on a locker-room tailoring concern induced these dandies and cagey Sidney Wood bench, "this has Africa beaten." He and to wear flannels in the hope of starting shouldering the single matches, the tem­ his sweltering mates were on the verge a vogue. peramental and the erratic of prostration. Gulping ice water by the are free to play them­ quart had made them ill. British tummies ^^England's Old Guard selves out in the doubles. Youth and phy­ are not attuned to that harsh, unsatisfy­ sical condition ride on our side. Will ing Yankee beverage. "WIFFY" COX and Billy Burke should those factors offset tournament poise Climate alone didn't beat the British­ be immune to high temperatures, for and matured strategy.^ ers at Scioto, though that ninety-eight- they served apprenticeships in boiler A tennis hoodoo dogs France's Davis degree temperature kept them from rooms before turning to golf. Burke, a Cup defenders. Lung trouble shelved making a respectable showing. Walter good-looking Slovak whose real name is Rene Lacoste when the cold, calculating Hagen's men seemed to revel in the Burkowski, was once a puddler in a "crocodile of the courts" had reduced grilling heat. Gene Sarazen, of Latin blast furnace. Whimsical "Wiffy" Cox, tennis to a geometric science. Now extraction, actually wore a woolen jersey who wants you to smile if you call him Coehet, quixotic genius of the racket, is —said it kept the sun from getting Wilfred, shoveled coal in the stokehold slow in shaking off the effects of appen­ through to his skin. of the battleship Texas. A hundred in dicitis. The British discarded their traditional the shade seems refreshing to these hard- tweed jackets. Shirt-sleeved golf feels baked fire-eaters. w^Trousers for Ladies strange to those accustomed to the tell­ Environment has been the decisive tale tug of a coat at the top of the factor in this Ryder Cup series. Our SENORITA LILI DE ALVAREZ braved the swing. Captain Charles Whitcombe's Yankee professionals have yet to win a fashion arbiters of Wimbledon and men visited the pro's shop in a body and Ryder match on British soil. The British escaped without being scolded by those bought panama hats with translucent have lost both their American appear­ august and mysterious beings who censor green eyeshades which cast weird, ances. A strange course, unfamiliar cli­ feminine tennis apparel. The vivacious greenish lights on their prominent Eng­ mate and the unaccustomed ball would Spanish girl flaunted her pyjama cos­ lish noses, accentuating their cadaverous have halted a far stronger British than tume, with its subtly divided skirts, on complexions. this one. the center court, hallowed by Victorian They wore drab, dust-colored clothes, The invaders, taken collectively, gave traditions. with baggy plus fours, pleated at the the impression of being too old for their Eager spectators felt cheated when waist in the Bond Street manner. Archie job. Duncan, Mitchell, Robson and Senorita de Alvarez was quickly elimi- PRODUCED BY UNZ.ORG ELECTRONIC REPRODUCTION PROHIBITED