DELIVERING THE GOODS.
Apropos of the article in the editorial section of our preceding number, we present to our readers the following excerpt of another article of Dr. Stuart Close under caption “Delivering the Goods.” It is a thought provoking article that should awaken the conscience of those homoeopathic practitioners in this country who struggle for cheaply multiplying the number of patients with wily service and careless attention; and it should also enable the lay patient to appraise the quality and value of the service he receives from his physician.
Dr. Close has analyzed his subject most thoroughly. We regret we have so space available to reproduce the complete article. But, we trust the portion quoted below has enough food-value for many physicians and for the whole bulk of the laity:–
“It is pretty well understood and agreed among men of affairs that three intangible things are necessary to success in any undertaking–sound principles, an enlightened policy and a good workable program and that these three must agree. Great care is taken by them to make sure that each of these necessary factors is definitely worked out, clearly expressed and thoroughly understood before anything else is done.
“Having laid the foundation, secured capital and created an organization and capitalization and that the only service which will succeed and pay dividends in the long run is honest, efficient and useful service. They never forget that the public– their patrons–are “investors” seeking for “dividends” as well as themselves, and that they will not continue long as patrons if they do not receive the in some form of satisfactory results.
“It would be well if more medical men followed the example of the leaders in modern “big business” in these respects. Medicine has a business side, but physicians are notoriously poor business men. Not only do their names occupy a disproportionately large space in the “sucker list” of nearly every fake enterprise- -oil schemes, wild cat mines, pharmaceutical fad factories, city lot swindles, etc., but their business is too often conducted with singular disregard of the principles and policies which make for legitimate professional and financial success.
“Although great progress has been made by many physicians in raising their standards of business and professional ethics, in adopting and maintaining policies based upon the idea of honest and efficient service and in educating the people along these lines, there are still too many who give no evidence of having ever heard of such ideas, or of having been influenced by them if they have heard of them.
“It is significant that the most flagrant examples of these derelictions are found among the men who have the largest followings, who are the most popular with the laity and who se reputation, even in the profession, is often high, as already illustrated. But there are many younger and less prominent men who are headed in the same direction.
“It is unfortunate that the work of “popular” doctors does not have some of the pitiless light of publicity thrown upon it that the work of lawyers receives. If doctors and surgeons were compelled to examine and treat or operate upon their cases in public, before a judge and jury, and with keen witted opposing counsel upon the other side, some of them would adopt different methods and conduct themselves quite differently. Bluff and cajolery would not carry them for under such conditions and they would not be able so often to “bury their mistakes six feet underground”.
“Here, by the way, are the makings of a pretty play. Imagine what a satirist like G. Bernard Shaw and competent actors would do with one of these “popular” doctors, compelled to transfer his consulting room and patients to a public courtroom and go through his regular routine under such conditions.
“That the fees a physician habitually charges have a powerful influence not only in determining the character and value of the work he does, but in moulding his personal character, is not difficult to see.
“Every honorable man desires to be well and justly compensated fro his labor, to live well and usefully and to accumulate at least a competency for his declining years.
“Money is the accepted measure of value and medium of exchange. Every man, consciously or unconsciously, sets a money value upon his time and labor will strive to get the equivalent for it in money, goods or privileges.
“No honorable man will demand or take money he has not earned unless it be a gift expressing gratitude or affection and that usually has been well earned.
“If a physician, through poor judgment or mistaken policy, sets his fixed fees or rate of compensation too low and has not the wisdom or courage to raise them to the proper level, he will either suffer poverty, or (more frequently) as the number of his patients increases, instinctively or deliberately shorten the time devote to each patient until he feels that it is commensurate with the fixed fee he has elected to receive.
“This leads to the curtailment and deterioration of service, and, if persisted in, the loss of that fine sense of honor which prompts a man to give the best there is in him. Good work cannot be skimped nor done carelessly and in haste in medicine or in any other field. Time is an important factor.
“If, on the contrary, a physician sets his fees too high, or out of proportion to the real value of his services, judged by a fair standard determined by the consensus of professional opinion, he is entering into temptation and violating professional ethics. He can only get them by pretending that he has skill, experience and ability which he does not possess ; by deception and misrepresentations or fraud.
To do this is demoralizing and, in the end, ruinous. He may flourish for a time, but in the end he will pay the penalty. Incidentally he is bringing discredit upon medicine, the noblest of all professions. Let every physician, therefore, earnestly take these things into consideration, Let him regard it, if he pleases, simply as a business proposition, to be worked out in accordance with the principles which have been determined by the consensus of opinion of honorable and successful business men. In doing that he cannot go far wrong.
“Let him (theoretically) “capitalize” himself– put a value upon his knowledge, skill, reputation, experience, cash investment in education and equipment and “good will”–at such an amount as he believes he can honestly earn legal interest upon five years ahead and upon that basis compute the value of his time per hour. Let him establish a schedule rate per hour, to be used in estimating his fees for all cases requiring more than the average time (covered by the customary “fixed fee” charged by physicians in his vicinity) as in first examinations, long distance visits or detentions.
“Let him formulate a policy in respect to his mode of doing business-his attitude and demeanor toward his patients, his social relations, his style of living, his personal habits, including dress and manners, his office organization, equipment and technic–everything which goes to make up its “atmosphere”- -his manner of receiving and dealing with his patients, his methods of conducting his financial affairs (charging, billing, collecting) and do all this with due regard for the principles of efficiency, equity, justice, reciprocity, modesty, honesty and courtesy which, in the aggregate, constitute true service.
“In ordinary work the customary fixed fees of his local colleagues of equal standing will be found to nearly correspond to the rate suggested, but a schedule rate per hour is flexible and will enable him to adjust his fee in special cases to the amount of time necessarily spent on them.
“There will be cases, involving extraordinary care, responsibility or skill, in which an “honorarium” may properly be added to the regular fee based upon the time schedule.
“At the end of the first five years, if the young man has conscientiously carried out this program, he would be justified in doubling the capitalization and rate of charges for the ensuing five years. At the end of ten years he may again proportionately increase his capitalization and raise his rates to correspond; and so on, as the years pass and he gains knowledge, experience, skill and reputation.
“The progressively larger fees will act as a check upon an excess in the number of patients and permit the physician to give to each patient his just dues in time, care and thought and himself the comfortable assurance of proper compensation. This will tend to prevent him from falling into the temptations which lead to moral and professional degeneration.
“No physician should accept more cases than he can serve properly, nor demand less or more than adequate compensation.
“Eventually it may be to the advantage of all concerned for the physician to adopt the system of seeing patients by appointment only. This enables him to allot adequate time for each case, prevents waste of patients time in waiting for others and leaves the physician more at liberty.
“To those who value the psychological effect of having all the chairs in the waiting room filled, it may be suggested that a special appointment for each patient is of equal if not superior “suggestive” value, and that it savors less of quackery.
“The suggestions here made appear to be consistent with professional dignity, good business principles and policies and that unwritten law which requires every member to maintain, unsullied, the honor and ideals of the profession”.