1. "Her conditon is serious, but I am hopeful." (It might be added that all sickness is more or less dangerous, as complications cannot be foretold.) 2. This is always possible but not probable.' 3. "Causes are so many and complex, that no single cause is likely." (Or, it might be stated truthfully, that "her assimilative functions were upset.") 4. "It depends. Wine or food is dangerous if used indiscreetly." (Reference may be made to dangerous doses of all remedies.") 5. "Yes, if the cause can be removed." (Then be prepared for the subsequent question, and confound the querist with the pathology.) 6. "Do you think I would give your child harmful medicine?" (The proper reply to such a question is such as might be given to expressed lack of confidence in any case.) 7. "No reason why she should not, if she fully recovers." 8. "Čan never tell without knowing the cause of it. Anything that will remove the cause, and that will require careful examination." 9. Same as 6. IO. "For the same reason that some Christian Science patients recover. The influence of the mind on the body. II, 12. Too trivial to deserve attention. 13, 14, 15. Social ethics determine these. 16. "John's metabolism is badly upset, and where it will finally focus cannot be foretold." If this querist wants to know what metabolism is: "That bodily function which throws out from the body the worn-out matter, which, if retained, 3. Explain or fog the pathology—as in most cases you can. 4. "I have never had any bad results from chloroform, and consider it practically safe." 5. Explain the clot and say that "if brain is not too seriously interfered with, the blood may be absorbed, with fair recovery." 6. "No; I regulate the dose according to age." 7. "In this case we look for a return of robust health." 8. "Headaches have various causes, and not until this is ascertained could we advise proper treatment." 9. "Every correct remedy is in use; but this being a serious disorder, please feel free to call a council." 10. "This illustrates shock cure; the nerve is scared." II. "Alarmingly ill; too early to predict result." 12. "Very much better and likely to make a prompt recovery." 13. Bow to all, speak only to nurse; advise less company (often). say 14. Depends on case; as before, may "Good-day all; you are doing nicely." 15. "An abdominal trouble." TO THE MEDICAL COUNCIL I answer "Battling of Questions for Young Physicians": 1. "Yes, very. May possibly get well." 2. "There is always danger of complications." 3. "Want of healthful equilibrium.” 4. "Yes, in the hands of ignorance.” 5. "Oh, yes; if he had it in time." 6. "Altogether owing to whose children." 7. "Yes, if she fully recovers." 9. "Yes. Have tried everything." Answers to Dr. Proud's questions: I. "There is no immediate danger." 2. "Certain complications sometimes occur, but I am watching for them, and ready to act as the first symptoms appear." 3. "Give diagnosis and cause." 4. The danger is so remote, when used properly, that we do not fear it." 5. "No. The patient may, however, improve, but it will be slow, and only partially regain his health." 6. "No, the medicines I give children are just what they need." 7. "Yes," or "No," according to the nature of the case and the probable results. 8. "I have several remedies I use according to the indications in each case. Shall I prescribe some for you?" 9. "I am sure I have not. I am watching every symptom carefully, and also for complications, and am prepared to meet them." 10. "Fear is Nature's anesthetic. Pain will return when the scare is over." II. "Doing as well as could be expected under conditions present." 12. "Much better." 13. Speak politely to all. Then proceed to your business. 14. "Good-day." Pass out quietly. Never apply a plaster splint to a compound fracture. Treat the lacerations and contusions antiseptically. The bandage is so applied that, while holding the bones, it does not cover the laceration. It is a good rule to unbandage a fractured limb every two to five days, particularly a compound fracture; then wash and rub the limb thoroughly. Ununited fracture comes more frequently from circulatory stasis than from movements of the fractured ends; then do not be so dreadfully afraid of possibly breaking adhesions when the splint is carefully removed. A little massage will quickly compensate for a trifle of the disturbance of the fractured ends. If pus should form, use calcium sulphide and echinacea, or ichthyol; keep bowels free and apply H2O2, ichthyol, etc., locally. Every traumatism has its medical as well as surgical aspect; that's what's the matter with the man of one idea—the surgeon. Above all, call frequently upon your fracture cases; and if they want the dressings or splints altered, try to oblige them, for that is what they pay you for.-BOYNTON, in Medical Journal. I find THE COUNCIL still one of the very best and most readable, as well as instructive medical periodicals I take. I wish you great sucess during the coming year, because THE COUNCIL, for intrinsic worth, deserves it. Sincerely, Chester Heights, Pa. C. C. CRAWFORD, M, D. I used the Physicians Pocket Account Book last year and I am very much pleased with it. Capron, Va. DR. F. E. WILLIAMS. The Business Side OF MEDICAL PRACTICE. While we as physicians desire to be scientific students and practitioners of medicine, yet we desire also, for the welfare of our dependent ones and for the sake of our standing in the community, to secure a fair compensation for the services we render to our fellow-men and to society. To this purpose The Council will occasionally conduct a brief department in which may be discussed those subjects that pertain to the financial welfare of the practitioner and the profession. Ideas are solicited for this column. A Hard Bill to Collect. Drs. G. G. White and W. A. Milleo, of Elkader, Iowa, report a peculiar medicolegal experience, in the Philadelphia Medical Journal of December 14, 1901. They presented a bill for medical services, which the defendant refused to pay on the ground that the charge was excessive, and the bill ambiguous. The doctors were prevented from proving the value of their services by stating what they had been, because the legal code of the State provides that a physician has no right to testify as to the nature of the malady of a patient, unless permitted to do so by him, which in this instance was, of course, refused, thus preventing the claimants from proving their bill to be a just one. The doctors suggest that the only remedy in a case of this kind is to collect in ad vance. This is, undoubtedly, the best remedy, but is by no means always feasible, in fact, only so in exceptional cases. It is, however, always possible to get a note for the amount from the patient, payable at sight or at such time as may be arranged for, and this may be an ordinary note or one confessing judgment, and in Pennsylvania waiving the exemption provided by the constitution of the State. Another remedy would have been, and we believe still exists, for the plaintiffs in this Iowa case to tender another bill, specifically setting forth, in as much detail as is necessary, the exact number and times of the rendering of services, together with their nature, and then again entering suit. They could then challenge the defendant to produce his bill and prove that it was ambiguous, if this should again be his defence, failing in which, they can offer a duplicate in evidence. Further than this, should they not be able to put this matter before a jury, they can get all the detailed information necessary as to the number of times this man was seen, how long a time it required in each instance, and just what was done, without necessarily exposing the nature of the ailment. If special knowledge was requisite in doing this work, this fact should also be set forth. We feel confident that these gentlemen have redress, even under the laws of Iowa, provided they go to work about it in the right way, and we think it a duty that they owe to the profession as well as to themselves, to make another attempt to collect what is due them. Doctors in Speculation. We notice many of our exchanges carrying large and flaming advertisements of Wall Street speculating houses, where the other fellow holds the information and the investing doctor is supposed to furnish the money. How such medical journals can excuse themselves for such a course we cannot imagine. They certainly know that such schemes invariably come out but one way-the too confiding doctor parts with his money and gains some experience. But what must he think of the medical editor, who, for a little pelf, Judas-like betrays him into the hands of the sharpers, who laugh at the dupes while spending their money in the riotous debauchery so common in New York City! Doctor, stay out of speculation. The chances are all one way-against you. Invest your money in some useful and permanent form, as near to you as possible, so that you can look over it without damage to your practice. We will not betray you with any bogus "financial" advertisements if we know it. The General Practitioner Also a Specialist. It has been our theme for many years that each general practitioner should also qualify himself specially in some one branch. We are glad to see the same idea so well expressed by Dr. Thomas H. Manley, of New York, in the following quotation from an article by him in the Times and Register: "The busy, overworked (?) practitioner has ample time to qualify in at least one side study, and cultivate that in order that he may ply it with success; moreover, when time has thinned and frosted his hair, when he is no longer equal to the exposure and hardship of general practice, he may ply this branch with profit and advantage." Commercialism Necessary in Medicine. No other class of men is less well rewarded for a life of devotion and selfdenial than are the medical men of the age. Out of the one hundred and twentyfive thousand doctors in the United States, how many are there who make and save money? Men following other and less arduous pursuits are enabled to retire at the close of a business career with sufficient property to enable them to live in until the end of their days; but the phycomfort and sometimes even in luxury sicians who can do this are very few. Unfortunately for the physician, the medical profession seldom sees combined in its members the two factors of ability as a practitioner and ability as a business man. This can undoubtedly be accounted for to some extent by the fact that the true doctor gives himself up to his work of healing, thinking little of the matter of recompense for his services. Commercialism does not easily develop in harmony with medical achievement. Our best physicians and surgeons must be men with a scientific bent and the very thing that makes them successful in the practice of their profession takes away from the practical business side, so necessary to the material success of the medical man. How many physicians are there who collect their fees with the same regularity that the merchant uses? Not many. Why has not the doctor the same right to his pay that the business man has to his? Some physicians say that the merchant has already bought and paid for his goods and therefore has to be reimbursed in order to carry on his business. Very well. But the physician has also bought and presumably paid for his education and his equipment, the means by which he is enabled to carry on his profession. He is entitled to reimbursement for his outlay, if the only commodity he has to offer-namely, his services-is worth receiving. The doctor who is a poor collector does not appreciate his own services at their full value and under such circumstances he must not expect a great many of his so-called "patients" to appreciate them, either. The physician, on the other hand, who has enthusiasm and strong convictions that he is fully conversant with his profession and must be paid for what he does, usually gets his fee and with it the respect of the community. Only in this Only in this way can he obtain the means for carrying on his profession. In these days of elaborate equipment for physicians and surgeons, the new devices and inventions constantly being brought into use, considerable outlay is required for a practitioner who wishes to be thoroughly modern; and there is no reason why he should not be paid proportionately for the in creased value of the services he is able to render with proper equipment. It is found that the physicians who send in their statements promptly on the first of the month or as soon as their services are no longer required-owing to the recovery (or death) of the patient-are successful men who are able to enjoy every advantage that prompt payment of their own accounts brings. The medical man who is "too easy" has to go without the money he needs for a post-graduate course or for a change of scene-and nothing is better for a physician than to get away from home and his "chronics" for two months out of the twelve if he can afford it. And in the majority of cases he cannot afford it unless he has collected the money due him from his patients. Experience has taught the physicians that it is best to respectfully demand their fees within a reasonable time for services rendered-and a reasonable time can be determined by the customary time extended to the physician himself, when he wishes to make purchases. A Why should physicians give two to five years' time and then ask for their money when other people demand their pay from the profession at 30 to 60 days? reasonable theory to go on is that if there is any patient of the class ordinarily described as a "dead beat" he won't pay at the end of any time, however generously extended, and the physician is just so much ahead by finding out early the patient's unwillingness to pay, saving himself time and a possible waste of medicine. There is a certain class of men who can and do pay small bills, but can't and won't pay large ones. Every physician has probably had patients who have owed them large bills and are then ashamed to send for them in time of illness, preferring to consult a new man. This is only one of the bad results of over-kindness on the part of the physician. Every practitioner has some charity patients; but it is much better to know in advance that the services rendered are to be set down to charity.-From Detroit Medical Journal. 18690 |