^^ the Doctor and His Dollars <W

Page 336 Outlook and Irtdependent ^^ The Doctor and His Dollars <w 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 PRODUCED BY UNZ.ORG ELECTRONIC REPRODUCTION PROHIBITED July 15, 1931 Page 837 fill 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. <iba.rge of $5,000 for removing a rich my mind, the greatest step in the right Excepting general practitioners, there man's appendix: "I saved his life," the direction would be a voluntary reduc is very little standardization with regard doctor said, "and isn't his life worth tion in the fees charged by leading sur to medical fees.

Load more