Large Fees and How to Get Them: A book for the private use of physicians

by Albert V. Harmon

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.