“Now, doctor, these people haven’t got much money, so don’t charge them a large fee.”
The consultant thereupon cuts his fee in two.
“Well, doctor, I’ll see that you get it in a day or two,” is the reply. But the consultant never gets it. Should he protest, the family physician says, “Don’t be in such a hurry, doctor, I haven’t got anything out of the case myself, yet.”
How easy it would be for the physician who calls the consultation to see that the fee is ready when the consultant comes. Unless there is an understanding that the case is one of pure charity, the physician calling the consultation should be held responsible for the fee. The consultant himself cannot always do so, but where possible he should stipulate beforehand that a certain fee be in readiness. The family physician who does not know that such a plan is best for his own interests is stupid.
An intolerable nuisance to the consultant is the doctor who writes a friendly letter asking for “the diagnosis, prognosis and treatment” of some case under his care. Rarely does he inclose a stamp, never a fee. The consultant who answers such letters, save to inform the writer that office rent cannot be paid by such consultations, is frequently laughed at for his pains, but this should be the rule.
A more “pestiferous professional parasite,” if possible, than the foregoing, is the doctor who refers a patient from a distance, with a request to send the bill to him. Here again Dr. Lydston says: “I have sent many such bills first and last—accent on the ‘last’—but have never received a remittance, nor do I expect my reward in Heaven. In the first place, I am not so sure about getting there, and if I were, and knew that those doctor debtors were going to be there too, I—well, I’d ask for a change of venue. As for the patients who are accessories to such professional ‘hold-ups,’ a fellow wouldn’t want to chase around all over hades to collect his fees from them.”
No less an authority than Dr. John P. Lord, president of the Western Surgical Association, in an address delivered before the association, said:
“The practitioner,” he said, “will call a man of sufficient standing to enable him to name a fancy price as the consultant’s fee, which he collects, and then remits the consultant the minimum fee. The graft element is also going into medical politics and some county societies are controlled by it.”
It will be noticed that Dr. Lord does not find fault so much with the division of fees, as with the unfair manner of division. His plaint appears to be, not that division in itself is wrong, but that the man who handles the money does not treat his professional brother fairly. There’s a lot of truth in this, but the objectionable practice is mostly confined to a class of short-sighted practitioners who don’t take the future into consideration.
Another doctor, speaking on the same subject, said: “This is an age of commercialism in medicine and surgery. Graft rules the majority. There are a few old fogies, like myself, who don’t graft—but do you know why? Just because we’re too old to learn how. Oh, yes, we’d all do it if we had a chance, I presume. We’d be forced to. Those who do it claim that they have to. It may be the public’s fault, but it’s certainly hard on the public which has to do the paying and which doesn’t know whether it has stomach ache or appendicitis.