Albert V. Harmon

“ If the profession is to be judged according to its own standards the low estimate of the value of medical services held by the public at large is not to be wondered at. If the physician does not place the value of his skill and ability at a high figure, how can he blame the public for taking advantage of the low rates he names. Surely the people are not going to volunteer to pay more for an article than the owner asks for it. ”

“ He wishes the patient to think that the doctor and his family dine with the chameleons, or are fed by ravens. Yet the medical Elijah waiteth in vain for the manna-bearing birds—they know him for what he is, a counterfeit prophet who vainly yearns for the flesh-pots of Egypt—who has a ponderous and all-consuming desire for pabulum, and a microcephalic capacity for finance.
Doctors are supposed to be keen judges of human nature. I often think this is absolutely without foundation. Defective knowledge in this direction is a very expensive luxury to the medical profession. ”

“ It is rather a delicate matter, perhaps, for a college professor to touch on the evils of medical colleges in their relation to the business aspect of medicine, but I shall nevertheless speak plainly and to the point. While theoretically the better class of medical colleges were founded solely for the advancement of science, it is none the less true that self-aggrandizement has been the pedestal on which most of our disinterested giants in the teaching arena have stood and are standing. ”

“ 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. ”

“ As a broad, general proposition the reputable profession as a whole has about as much sense as the dodo, and, unless signs fail, will, sooner or later, meet the fate of that remarkable bird. How the profession can expect the respect and appreciation of the public when it has no respect or appreciation for itself is difficult to conjecture. The public cannot be expected to keep clean the nest of the medical dodo. Furthermore, the public quite rationally values the stupid thing according to its self-appraisement. ”

“ We have done the best we could to breed competition by manufacturing doctors, and we are doing all we can to make that competition first class—a queer business proposition in force of the oversupply of doctors. We are unjust, too, to the men we educate, by offering them inducements to enter an already overcrowded profession—but so long as human nature is as it is I see no way out of the dilemma. ”

“ Shall we say that the professional man is distinguished by eminent character and ability, while the business man is not? Hardly. We know that while the business principle is pagan and not Christian to-day, still the average business man is quite as good as the average professional man, no matter what the profession may be.
“Who deserves more honor—the farmer who provides us with our daily bread, or the dentist who keeps our teeth so that we can eat it, or the physician our stomach so that we can digest it? ”

“ There is plenty of work to be done, and there would be considerable income derived therefrom, but the corporation surgeon gets it all, and receives a mere pittance therefor. The corporation claims to employ a surgeon for humanity’s sake. This is pure hypocrisy—the doctor is employed for its own protection. Every doctor knows of cases in which, by the co-operation of the claim agent and the surgeon, an injured employee has been induced to sign away his manifest rights. He is usually denied the right to select his own surgeon. ”

“ 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. ”

“ The profession at large will boycott every man who runs a college clinic, and every hospital and dispensary man. It will fight colleges and hospitals to the bitter end.
The day is perhaps not far distant when doctors outside of colleges and hospitals will run their private practices on the co-operative plan, thus dealing a death blow to the free clinic and dispensary. Every man of prominence will have his own private clinic and advertise it among his patients. What is fair for twenty or thirty men is fair and ethical for one. Each man can have his own hours for the poor ”

“ By this time the real sufferer is deeply impressed. Here is a prosperous stranger, once a fellow sufferer, dangling before his eyes the hope, nay, the certainty, of cure, with no other object than that of sympathy. It is the one chance for which he has been so long and fruitlessly seeking.
Pressed to tell where this wonderful treatment may be had, the “steerer,” if he is one of the sharp ones, will be apt to say:
“I believe the address is No. —— Michigan Avenue. Let’s see, I think I have the doctor’s card in my pocket somewhere.” ”

“ 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. ”

“ Our system of ethics has not only been hypocritic, but somewhat confusing. The young man on the threshold of medicine doesn’t know “where he is at.” He is confronted by the unwritten law that only celebrated men and quacks may advertise. Small fry, who haven’t the ear of the newspapers nor a chance for a college position, are tacitly ordered to keep their hands off. And the young fellow watches the career of the big man, who hides every other man’s light under his own bushel, and marvels much. ”

“ When a doctor is needed he is generally needed badly. It may not always be an emergency case, but almost invariably when the services of a physician are required, even in chronic ailments, delay only aggravates the patient’s condition.
If a medical man has, by special study, equipped himself to handle a certain class of diseases more intelligently and satisfactorily than the general practitioner it becomes his duty to let the public know about it. ”

“ Quoth the experienced and distinguished low-priced man, “What would the poor people do if I made myself less accessible?” They would go around the corner to that young doctor whose shingle you see swinging to the breeze, and pay more money for better service than you or any living man can give for the fees you charge. In general, the public gets just about what it pays for, save where the matter is one of absolute charity or dead-beatism. ”

“ 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. ”

“ 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. ”

“ Paying clandestinely for newspaper write-ups is despicable, yet some of the very men who protest that they “really don’t see how that could have gotten into the papers,” have paid for the advertising in good “coin of the realm.” It is queer that the newspapers should write up the most minute details of the wonderful exploits of some poor fellows, together with their family histories, and publish their photographs, without their knowledge or consent—especially queer when we read in conclusion that “Professor John Doe is the greatest surgeon that ever lived.” ”

“ It has become a matter of convenience to the public to know where to find a competent lawyer, or architect, or civil engineer. Hence the appearance of their business cards in newspapers. On the same grounds publicity by physicians is justifiable. It is more than justifiable. Mankind can, in a pinch, get along without attorneys or architects or engineers. ”

“ No power on earth can prevent that man from having that treatment regardless of the expense. He has by this time an enlarged idea as to the doctor’s ability. He is pleased with the results of the treatment administered for the original ailment. He is impressed by the evident professional skill of the doctor in “discovering” a sexual condition which he fancied was known only to himself. He does not know that the physician has simply made a shrewd guess; one that he is in the habit of making several times a week, and generally with the same result. ”

“ So far as the strictly financial aspect of legitimate practice is concerned, the sooner we impress the public with the idea that we appreciate our own market value and insist on its appreciation by the public, the better it will be for the profession. Once let it be understood that ours is a business-like and financially sound profession, and the hoi polloi will give us the respect that is our due. The public should have frequent and pointed reminders that there is more than a philanthropic side to our labors. The doctor’s wife and children deserve quite as much consideration as the layman’s. ”

“ 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. ”

“ 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? ”

“ It is a peculiar fact that in medicine, as well as in other things, “distance lends enchantment.” The person afflicted with a chronic ailment who lives in the same town with a physician who has become famous for his successes in that line, is more apt to postpone his call for relief than one who lives at a distance.
The local patient argues to himself: “There’s no immediate hurry. I’ve been afflicted in this way ten years and I’m too busy just now to take the time to see the doctor. ”