=PRESCRIBING OF REMEDIES=
The time will come when the physician who has not made an arrangement
with some pharmacist for a division of the prescription fees, will be
obliged to resort to old-time methods and dispense his own remedies. He
will have to do this, or go out of business—excuse me, I meant give up
practice. It’s high treason, unethical, to speak of a doctor as being in
business, but there’s no good reason for it. Anything that a man makes a
living at is a business, and if the doctor cannot make a living, and
something more, why he’s in the wrong rut.
Barring the division arrangement referred to there are three things
opposed to the physician’s interest which the druggist must do, or give
up his store. These are:
1.—Sell patent medicines.
2.—Prescribe over the counter.
3.—Charge exorbitantly for the medicines prescribed.
There is nothing in all this that is illegal, but it is opposed to the
best interests of the profession. At first sight it appears an evidence
of imbecility to send prescriptions to be compounded by a competitor.
Yet you send them to the druggist, who is your most active competitor.
Not only is he one directly, but he is often the agent of some other
doctor or doctors whose merits he glibly contracts with your demerits,
for the edification of the patient. You tell him, time and again, not to
repeat your prescriptions, but to no purpose. In some cases you know
that he is giving commissions to one set of doctors, while his clerks
are getting commissions from practice sent to others, yet you stick to
him.
Now, there’s but one solution of the problem. Every doctor who can
should dispense his own medicines. The people like it, and the
profession will soon learn to like it. The doctor can furnish medicines
cheaply and still make a profit. The patient pays a bill for services
and medicines much more cheerfully than one for services alone.
Not the least of the good things that would result from the doctor doing
his own dispensing would be the familiarity with his working tools thus
acquired. Most men enter practice without the least knowledge of the
physical qualities of the drugs they expect to use. Many a man has
prescribed, over and over again, remedies he never saw, smelt or tasted.
The best doctor is he who is most familiar with his curative agents.
Another desirable result would be the doctor’s renunciation of
polypharmacy. He would soon learn that the number of serviceable drugs
is by no means legion. Where a number of doctors occupy an office, they
should have their own dispensary.
When neither plan suggested is feasible, the doctor should endeavor to
find a druggist who, in consideration of having practically a monopoly
of the prescriptions of that particular physician, will dispense his
prescriptions on cipher and never without an order. It is possible to
find such druggists. Self-interest is likely to induce them to treat the
doctor fairly, when all other arguments fail. There is a peculiar
advantage in this system in the fact that the doctors’ favorite formulæ
can be kept in quantities already prepared, thus saving time and
assuring uniformity in dispensing. Under such an arrangement, too, the
druggist is able to be much more reasonable in his prices. He is also
likely to keep such special preparations as the doctor may request, thus
avoiding the temptation to substitute.
One thing is certain in the relations of doctor and druggist, viz., the
time is not far distant when the doctor will either dispense his own
drugs or will boycott every druggist who counter-prescribes or sells
patent medicines. The profession will not go blindly on forever,
carrying grist to the other fellow’s mill.
Next we must contend with the proprietary medicine fakir. The doctor’s
experience often breeds a lack of confidence in his remedies, and his
materia medica narrows year by year. Yet his patients clamor for relief,
and in despair the doctor receives, with open arms, the fakir who agrees
to furnish him with speedy cures.
Behold the result. The pharmacopeia is fast drifting into the valley of
dead lumber. It is no longer necessary to know anything of materia
medica and therapeutics—the fakir attends to all that for us. We are no
longer offended by the gratuitous insult offered us by the proprietary
medicine fiend, who knocks at our door, and, with the implied
insinuation that he furnishes brains for the medical profession,
clutters our office tables up with samples, the labels on which tell us
all about diseases and the only preparations that will cure them. Pah!
How most of them smell! And what a nuisance they are.
But the fakir has done his work well. He has evolved the ready-made
doctor—man of all work, aye, slave to the fakir. How gently flows the
current of Dr. Readymade’s professional life. No more incurable cases.
No more midnight oil—for why should he be a slave of the lamp? No more
worry. No more care. No more expenditures for books, journals and
instruments. All the doctor has to do nowadays is to read the labels on
the bottles and boxes of samples the fakir brings him. Does the patient
complain of stomach disturbance? He is given “Stomachine.” Are his
kidneys working overtime? “Kidneyol” is the proper caper. Is there a
pain lurking somewhere in his economy? Give him one of these pretty
little tablets with a hieroglyph on it, which nobody knows the
composition of—so the firm that makes them claims. Oh, the practice of
medicine is so easy nowadays. Ready-made diagnosis and treatment—what
could be simpler?
The proprietary medicine fakir begins his little song by assuring the
physician that his wonderful preparation is for the use of the
profession only. He is trying to introduce it “along strictly ethical
lines.” He has given the preparation a fanciful name and marked it with
a special design “for the protection of the physician, who, of course,
wants to know that his patient gets just what is ordered.” What an
imbecile the doctor is. The chief objects of the special name and
hieroglyphic design are:
(1) To induce the physician to order the preparation frequently, the
name being catchy and easy to remember.
(2) To let the patient know what is ordered, so that he can prescribe it
for himself and friends without the aid of a doctor.
Having popularized the preparation in this manner, the proprietary
medicine man often advertises his wares directly to the public via the
secular press. If the profession protests, the wily medicine man says:
“Well, you indorsed it; the profession uses it; hence it is a good
preparation and a benefit to humanity. Go to, you are bigoted and
narrow-minded.”
Now, brethren, while the foregoing remarks are fresh in your minds, try
and recall the facts regarding “Scott’s Emulsion” and the “Midy
Capsule.”
Not all proprietary medicine men take the newspaper route—they don’t
have to. The catspaw doctor does his work too well. Witness the “little
joker” anti-pain tablet already mentioned. Probably ten times as much of
this preparation is self-prescribed as is prescribed by physicians. It
unquestionably contains drugs that should be taken only under medical
advice, and yet physicians prescribe it in a manner which leads directly
to self-prescribing by the laity. Is it possible that the Pharmacopeia
offers no agent of equal or better merit? Has the manufacturer more
wisdom than all the ages past—to say nothing of the present age of
progress? Or is this an age of medical progress, anyway?
We herewith submit the proposition that the medical catspaw is pulling
the proprietary monkey’s chestnuts out of the fire, every time he
prescribes a proprietary article “protected” by special design and under
a term that he who runs may read. The fakir laughs in his sleeve at the
profession, and small wonder. It has come to pass that he owns us, and
when his impudent agent demands a hearing at our offices we are tacitly
given to understand that our time is his by right. Perhaps it is, by
right of conquest, for the medical profession seems to be thoroughly
subjugated. The distributor of drug samples is always working in the
business interests of his firm and himself. How would it do to insist on
payment for our time from the agents of some of our irresponsible,
mushroom fake medicine factories?
There is another side to the picture. Drug manufacturers—even some of
those engaged in the manufacture of quasi-proprietary medicines—have
done much for pharmaceutic elegance and convenience. Many of our
manufacturers are conscientiously proceeding along ethical lines. We are
glad to welcome their representatives and their preparations. But,
unfortunately, such manufacturers are a small minority. The physician
should be careful how he prescribes the preparations of even reliable
firms. Preparations with special and striking names should be prescribed
under formula, where possible, and always in such a manner that the
patient cannot prescribe the preparation for himself offhand.
We have much for which to thank some of our manufacturers, in the way of
elegant and reliable preparations—honor to whom honor is due. We should
none the less, however, guard our own interests. The manufacturers
cannot always do so, and sometimes will not. There is no objection to
secret methods of preparation of medicine so long as the formula is
known. The physician should know what he is prescribing. It is an insult
to offer him any other class of preparations. When prescribing he should
prescribe under a term comprehending the formula of the drug, or under
his own cipher. Where the nature of the preparation is such that he
cannot do this, the doctor had better look elsewhere for a remedy.
Again we say, if you cannot make a satisfactory division arrangement
with a competent pharmacist who will protect your prescriptions, and
treat them as confidential, dispense your own remedies.
Never prescribe a proprietary remedy by its trade name. In so doing you
advise the patient of what he is taking and in time he will buy it
without your prescription or advice. If you are satisfied that the
preparation is a good one and really has medicinal merit—which a few of
them do—prescribe it, if you must, by formula. Don’t let the patient
know what you are giving him.
The money in the practice of medicine is in mystery. People don’t attach
much importance or value to things that they know. It is the mysterious
that commands their attention—and money. Let a man know that you are
giving him a certain proprietary preparation and he values it only at
the established market price. Give him the same ingredients in the form
of a regular prescription, each item written out in its Latin name with
the proper hieroglyphics for quantities, and he will rate you as a
wonder worker. Add “aqua, quant. suf.,” and he is knocked daffy.
It’s simply another form of that peculiar trait of human nature which
leads the average man to “kick” when his regular family physician
charges $5 for making a ten-mile call on a stormy night, when he will
travel the ten miles himself and cheerfully pay a specialist $25 for ten
minutes’ consultation in the latter’s office.
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