=THE PHYSICIAN WHO SUCCEEDS=
To a great extent Nature has a commanding influence in the equipment of
the successful practicing physician,—the man who actually secures the
desired results in his treatment of patients, builds up and retains a
good practice, and obtains a financial income of respectable
proportions.
Any man of ability, with the necessary education and training, may
obtain a certain amount of success as a physician and make a modest
income—or drag out a miserable existence; this latter is the most
probable. It is a well-established fact that the great majority of
physicians are not what the world would call prosperous. This is not
because they do not earn enough to secure a competence, but because they
do not get it.
The doctor’s bill is almost invariably the last one paid. His practice
is generally among the middle classes, people whose intentions are good,
but whose incomes are limited. If there is anything left after the rent,
and grocery and butcher and other bills are paid the doctor will,
perhaps, get something on account, but as a rule he doesn’t.
This is mainly owing to the fact that the average physician is a poor
business man; he does not place an adequate value on his services, and
is slack in looking after collections. If pressed by his wife, or some
friend, to be more particular in this respect, his almost invariable
reply will be:
“It would not look well for me to put myself on the same plane with
merchants. Mine is a profession, not a trade. Besides, I’m in duty bound
to do a certain amount of charity work.”
Now charity work is all right in its place. An honest, upright
practitioner will never refuse to respond to a call for his services in
deserving cases because the payment of his fee is uncertain, but this
does not obtain to the extent of virtually making paupers of people who
are actually able to pay. And yet this is really what happens when a
physician conducts his business affairs in a slipshod manner, and this
is what most of them do. There is no excuse or reason for it.
But we started in to tell of Nature’s part in the equipment of the
successful physician. What is the equipment? The possession of a robust,
healthy physique, a sunny, cheerful disposition, and a fair knowledge of
medicine, and ordinary business ability. All are essential if real
success is to be attained, either in a medical sense, or in the
accumulation of a respectable income.
Let us take two instances for the purpose of comparison. In one case we
have a practitioner with just a fair knowledge of medicine, but in the
possession of all the characteristics mentioned. His very presence in
the sick chamber acts as a tonic to the patient.
Then we have a thin, undersized, nervous, dyspeptic physician;
dissatisfied with himself and the world generally. He is a thorough
master in medicine, and his treatment is more scientific than that of
his less learned brother. His presence in the sick chamber, however, has
anything but a soothing effect on the patient. On the contrary it
irritates him, and the effect of the scientific treatment is nullified.
This is not an exaggerated case. There are thousands of just such men in
practice.
Which practitioner is going to have the greatest meed of success? The
answer is easy—the one who cheers and encourages his patient by the
magnetism of his presence.
Talk as we may, suggestion is a powerful factor in the practice of
medicine. I do not mean by this that suggestion alone will cure illness
(this statement is made without intention of affronting those who
believe in Christian Science). But there is ample evidence to the effect
that suggestion goes a long ways in making medical treatment effective.
It is only the physician whom Nature has equipped in the manner
indicated who can offer the right kind of suggestion and he does it
unconsciously.
A physician of this kind is bound to become popular, and popularity
begets a large practice and commensurate fees, provided the practitioner
is in the right location, and has the business acumen to place the
proper value on his services.
From time immemorial physicians have been imbued with the idea that they
must adhere to a set scale of fees. I am speaking now of the average
doctor, the man with a general practice. All patients, the laborer and
the banker, the wage earner and the millionaire, are charged the same.
In the country districts, the small towns and cities, this charge is
usually one dollar a visit. In the larger places it is generally two
dollars.
Why should this be so? The architect, the attorney, the civil engineer
are all professional men in the same way that the physician is. Whoever
heard of any of them adhering to a set scale of fees in the same way
that doctors do? Invariably they regulate the charge for their services
according to the money value involved, and the nature of the services
required. The man who employs an attorney in litigation where a large
money value is at stake naturally expects to pay a much larger fee than
the man who employs the same attorney in a minor case. The man who wants
plans for a million dollar building pays the architect greatly in excess
of the one who builds a one thousand dollar house. The principle is
sound and all parties concerned are satisfied.
In the eyes of the Almighty all human lives are of the same value, and
it would be cruelly unjust to attempt to appraise them on a commercial
basis. But this should not prevent a physician from grading his fees in
proportion to the ability of his patients to pay them. What might seem
like a large amount to a wage earner, would be a mere trifle to one in
more affluent circumstances. The lives of both are equally dear to them,
and both are willing to pay the doctor according to their respective
ability.
Custom, the mother of much folly, is the only excuse for adhering to the
old, antiquated system. A physician who is called out of bed on a stormy
night to answer an emergency call from the home of a coal heaver would
not be justified in asking more than the minimum fee. But why should he
perform exactly the same service at exactly the same charge for one who
is able and willing to pay ten times as much, or even more? It is not
sensible, it is not fair.
“But it would be a violation of the code of ethics,” some one may say.
Bah! The code of ethics be —— but that’s another story which will be
told later on in this volume. The plan suggested, however, is not a
violation of the code of ethics. There is nothing unethical in a
physician regulating his fees to please himself, provided no injustice
is done, and none of his patients is oppressed in this respect. There
are certain physicians in the large cities who will not respond to a
call for less than $25. There are others who perform the same services
for $2. Yet both kinds are strictly ethical and are recognized by the
medical authorities as such.
The reason for this wide difference is that the $25 men have used
business tact in the practice of their profession, and elevated
themselves to a position where, by reason of their prominence, they are
justified in naming whatever fees they think they can get. And these
fees are almost invariably cash.
On the other hand the $2 men are timid in a business way; they hide
their light under a bushel as it were, and consequently lack widespread
reputation. Their fees remain at $2 because they don’t ask any more, and
their ledgers are laden with unpaid accounts.
There is no reason why a physician should not collect his bills with
just as much promptness as a merchant. It is usually his own fault that
they go unpaid. Statements should be sent out regularly on the first of
each month, and if there is no remittance by the 15th, it can be found
inconvenient to make any further calls. This, of course, is allowing
that the patients are able to pay. Where real inability to meet the bill
exists it becomes a matter for the physician to settle with his own
conscience.
Our medical schools are full of young men who are wasting their time and
doing the world at large an absolute injustice by studying medicine.
They are doomed to failure before they are well started because Nature
has not endowed them with necessary qualifications for successful
practitioners. Their instructors realize it, but the tuition fees are
needed for the support of the schools, and year after year big crops of
alleged “doctors” are turned out. It might be unfair to refer to them as
incompetent, and yet this is what many of them really are. Most of them
know medicine theoretically and know it well, but lack the vital
essentials of success.
It would be a simple matter of justice to these young men if some plan
could be devised for weeding out those who are manifestly unfitted for
the practice of medicine before they have wasted their time and money on
medical instruction. So long as such a plan is lacking it becomes the
duty of the individual to assume this responsibility himself. The mere
desire to become a physician should not satisfy the aspirant for medical
lore. He should question himself closely as to his fitness. His
character may be the best, his ability to acquire the necessary
knowledge unlimited, but unless Nature has equipped him as previously
outlined, the most he can hope to attain in the medical profession is
mediocrity so far as actually helping the sick, and obtaining prestige
and wealth are concerned.
There are men, it is true, of high standing in the profession, who do
not possess these qualifications, but they are few in number and, as a
rule, are consulting, rather than practicing physicians. Other doctors
call upon them for advice because of their recognized skill and
learning. They give this advice wisely and well, but in the sick room
would fall far short of obtaining the same results which other men, more
favored by Nature, obtain by acting upon the advice they give.
Time was when the word “physician,” conveyed the idea of a man with a
beard. The two were intimately connected in the public mind. In many
parts of the country, especially in remote districts where modern ideas
and knowledge of the germ theory have not penetrated, this relationship
still exists. In such places a full beard is an efficient badge of the
doctor’s calling, and is essential in establishing his professional
identity among the people.
Despite the widespread knowledge of the fact that beards are nothing
more nor less than nests and hatching beds in which millions of disease
germs find shelter, there are to-day numerous localities in which
doctors as well as the laymen cling stubbornly to the belief that a
physician without a beard is “no good.”
“Go on, neighbor, don’t try to fool me. That man’s no doctor. How do I
know? Why, he ain’t got no beard.”
This is no uncommon statement to encounter in rural regions, and even in
some fair-sized towns. Even the doctors themselves do not appear to
recognize the fact that it is possible to separate their beards from
their profession, and that it would be to the benefit of their patients
and the advancement of their own reputations in the end to do so.
Modern, well-educated physicians know that many, in fact nearly all the
ordinary ailments, are of germ origin. They also know, for instance,
that a patient suffering from typhoid, or typhus, or some like disease,
is continually reproducing these germs in immense numbers. For a
physician with a full beard to lean over the bedside of such a patient
is to invite millions of these germs to invade his beard, and wherever
he goes he carries these germs with him and spreads the disease.
It is bad enough when decent precaution is taken as the hair of the
head, the mustache, and even the clothing itself will harbor too many of
the bacilli. But to wear a beard is to greatly increase the
accommodations for these undesirable lodgers. In this way the health and
lives of thousands of people are daily jeopardized.
This is why beards should have no place on the faces of physicians, and
the more highly educated and more progressive the physicians are the
fewer will be the beards found among them.
Another thing is a prime requisite in successful practice and this is
the most scrupulous cleanliness. This refers not only to the person and
apparel of the physician, but to the instruments which he handles.
Some years ago an Iowa cattleman suffering from a chronic trouble, came
to Chicago for treatment which was administered hypodermatically. He
made fair progress toward recovery, and finally was in condition to
return home where the treatment was continued by his family physician.
For a time the reports made by the Iowa doctor were of a glowing nature.
Mr. —— was getting along nicely, and the improvement in his condition
was nothing short of miraculous. Suddenly word came that there was a
change for the worse, and the Chicago specialist was requested to go to
Iowa and make an investigation. He did so. On arriving in the town
nearest the patient’s home he first called upon the local physician and
together they drove out to see Mr. ——. The latter was evidently fast
approaching a collapse and the specialist was at a loss to account for
the remarkable change. He was assured that his instructions had been
closely adhered to, both the patient and the local doctor agreeing upon
this point. Finally the specialist said:
“Doctor, let me see you administer the hypodermatic part of the
treatment.”
The local physician took from his overcoat pocket a hypodermic syringe
without case or other protection. This he stuck into the bottle of fluid
which constituted the treatment, and was about to make the injection
when the specialist shouted:
“Great heavens, doctor, don’t do that! Let me see that syringe a
moment.”
Holding the syringe up to the light the specialist found it extremely
dirty on the inside of the glass barrel, and the needle point covered
with lint. Calling the local physician into an adjoining room he said:
“My God, Doctor, it’s a wonder your patient is not dead. You are
poisoning him to death. How long is it since you sterilized this
syringe?”
“Why, it was sterilized when I got it, wasn’t it?” replied the local
M.D. innocently.
“Yes,” answered the specialist, “and my instructions were that it should
be cleansed with alcohol before and after every injection, and
sterilized in boiling water at least once a week. This has not been
done.”
Then and there the visiting physician opened the eyes of his country
brother as to the grave importance of utter and absolute cleanliness in
all branches of practice, and especially in the administration of
hypodermatic treatments.
For nearly ten weeks this doctor had not cleansed the syringe. During
all this time he had unconsciously been injecting into the system of his
patient the most virulent of poison in the form of the decomposed lymph
which remained in the syringe barrel, as well as such foreign substances
as accumulated on the unprotected needle of the syringe.
And yet this “doctor” was popular and successful in a way, (in mild
cases), despite his failure to keep up with the progress of modern
thought. He was one of the old-fashioned full-bearded type, ignorant of
germs and germ-theory, and too self-opinionated and set in his way to
keep himself posted as to what is going on in the world of medicine.
I wish I were able to state honestly that, in the instance here referred
to, the patient recovered, but he did not. The damage had been done, and
it was too late, when the specialist was called in, to overcome it.
This is a truthful narrative. It is being duplicated in many instances
owing to the ignorance and incapacity of men who, while possessing
diplomas, are really unfitted for the practice of medicine. It
illustrates in a sad, but forceful way, the necessity of being “up to
date,” and mixing common sense with the medical lore acquired in the
schools.
“Costly thy habit as thy purse can buy,” should be the rule. A physician
should never dress flashily, but he should be garbed well. It creates a
good impression. The time and money expended on improving the personal
appearance is well invested. Patronize a competent tailor. A portly,
well-conditioned man, well clothed, and of sunny, cheerful ways, will
work wonders in the practice of medicine. Impressions are created
largely by appearances. The man who looks affluent, who conducts himself
in a good-natured, dignified manner, will succeed even though he be
lacking in a thorough knowledge of his profession. The man who is
slouchy and ill-kempt, and who takes no pains to be pleasant and
obliging, will fail, no matter how well grounded he may be in the
science of medicine. Why? Because he will repel people instead of
attracting them. This same rule holds good in all lines of business, but
it is specially applicable to the practice of medicine.
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