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.