He shook hands with the mother, told her how pleased he was to see any patient of his former student, glanced at the baby in her arms and then read the card-half aloud: “Ah! Six months-inability to retain food-vomiting-gastric insufficiency-um-ah-I see”.
(Turning to the nurse): “Miss R, please bring Mrs. M formula number six from file number one”.
Turning to the mother, he glibly instructed her to prepare the babys food exactly according to the printed formula; to hold the baby in her lap at an angle of forty-five degrees while feeding; to keep the baby at about the same angle when it was in bed and not to “jiggle it” when laying it down or taking it up, “so that the food would stay down”.
“Then it will be all right,” he assured her as he shook hands with her again, instructed her to call in a week and bowed her out.
The nurse escorted her to the cashier, who collected the fee of fifteen dollars (first consultation0 for a three-minute interview (five dollars per minute), without examination, question or even inspection, and without permitting the mother-a highly intelligent and cultured woman-to tell him anything of the history or symptoms of the case.
The mother followed instructions scrupulously and returned at the appointed time-to find about the same number of patients waiting; to go through the same routine; to report that there had not been the slightest improvement-that in fact the baby was worse-and to receive another three-minutes interview and printed formula without further examination. She was charged the regular office fee of ten dollars.
At the end of the second week, the baby having steadily grown worse, the lady decided that she would disregard the instruction to “come again” and call a physician known to take sufficient time and pains to properly examine and prescribe for his patients and to give “value received” for the liberal fees which he charges and is ungrudgingly paid.
Here is a man who is seeing a patient every three minutes and collecting on an average, over two hundred dollars per hour for -what? Will anyone say that such service is worth two hundred flock to him. His office is always crowded. He is said to be about to retire from practice-in the prime of life?.
How does he “get away with it”? How, if not by trading upon a reputation gained in his early, better years; by ostentatious display and assumption of a superior air; by flattery and unctuous reassurance; by the subtle suggestion of professional eminence conveyed by the fashionable location, elaborate equipment and personnel of his establishment; by his large fees; by the publicity given him by those who knew him in the days when he was building a reputation by really good work, but who do not know that he has yielded to cupidity and the lure of money and degenerated into a mere faker.
The man has ability and there was a time when he deserved confidence, but that time has passed, never to return. The lire of money too great.
The similarity of the two cases is evident. Both men are well along in years. Both have native and acquired ability. Both are deceiving themselves and their patients and rendering service which is worthless. Both are trading upon reputation gained in the earlier years of their practice. Both are “bluffing”.
Their followings remain large for the time being, partly because of the momentum gained in their gulled-for a while. People “follow the crowd” to a popular doctor much as they do to a circus, but when they get into the big tent and find that the program consists principally of handing out peanuts and pink lemonade many of them will not go again. Eventually these “canny” ones become a crowd. When they do, then look out!.
The bearing and influence of a physicians schedule of fees upon the character of the service he renders to his patients is commonly overlooked.
Beyond adopting without question the rates that prevail among the physicians in his vicinity; or perhaps deciding that he will charge less or more than the customary rates, according to his notion of how best to get and keep a lucrative practice for himself, the physician usually gives the subject of fees little or no thought. He usually looks at it merely from the monetary side.
He does not realize that the rate of compensation he establishes and the principles which determine it will have a powerful psychological influence for good or evil upon him and his patients, affecting both the character of his work and its results. It may be well to briefly consider the subject in some of its broader aspects in the hope of leading to the adoption by physicians of a broader and more enlightened financial policy.
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, it becomes the business of the executive to see that every department is co-ordinated and in working order, and that standards are maintained.
Modern business men are also agreed that service is the only basis of 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 them 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 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 theses derelictions are found among the men who have the largest followings, who are the most popular with the laity and whose 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 far 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 for 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 and will strive to get the equivalent for it in money, goods or privileges.
No honorable man will demand or take money he has no 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 devoted to each patient until he feels that it is commensurate with the fixed fee he has elected to receive.
Dr. Close was born November 24, 1860 and came to study homeopathy after the death of his father in 1879. His mother remarried a homoeopathic physician who turned Close's interests from law to medicine.
His stepfather helped him study the Organon and he attended medical school in California for two years. Finishing his studies at New York Homeopathic College he graduated in 1885. Completing his homeopathic education. Close preceptored with B. Fincke and P. P. Wells.
Setting up practice in Brooklyn, Dr. Close went on to found the Brooklyn Homoeopathic Union in 1897. This group devoted itself to the study of pure Hahnemannian homeopathy.
In 1905 Dr. Close was elected president of the International Hahnemannian Association. He was also the editor of the Department of Homeopathic Philosophy for the Homeopathic Recorder. Dr. Close taught homeopathic philosophy at New York Homeopathic Medical College from 1909-1913.
Dr. Close's lectures at New York Homeopathic were first published in the Homeopathic Recorder and later formed the basis for his masterpiece on homeopathic philosophy, The Genius of Homeopathy.
Dr. Close passed away on June 26, 1929 after a full and productive career in homeopathy.