“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.”