CHAPTER V

=GETTING COUNTRY PATIENTS=

While the kind of publicity outlined in the preceding chapter is valuable and will make a man famous in his own city, it takes a long time to reach the people in outside territory. 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. He’s right here in town, and I can reach him at any time. I’ll drop in on him some day when I’ve got more leisure.”

A certain proportion of the physician’s town folk respond to the publicity bait, but he must have the fat fish from outside if he is really going to get large fees in great number. How is he going to reach them? Here is the plan successfully worked by one doctor who has made himself wealthy.

He made arrangements with an advertising agency to secure the insertion of “pure reading matter” ads in a number of country newspapers in towns within 500 miles of Chicago. His press agent then prepared an article reading about as follows:

=LOCOMOTOR ATAXIA CURED!=

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=Remarkable Results Obtained by a Chicago Physician=

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=Prominent Man Afflicted With This Terrible Ailment For Many Years, Restored to Sound Health After a Short Treatment.=

NEW YORK, June 10.—Among the passengers on the outgoing steamer Cedric which sailed to-day for Liverpool, was Col. H. B. Thomas, of London, who is returning to his home after being successfully treated for locomotor ataxia. He walks freely, and is apparently in the best of health. When asked if it was a fact that he had been cured of locomotor ataxia, an ailment which most physicians pronounce incurable, Col. Thomas said:

“It certainly looks like it. This is the first time I have been able to walk freely, or have been without pain in ten years. I was on crutches and suffering the torments of the damned when I came to this country to take the treatment four months ago. You can see for yourself the condition I am in now.”

“Where did you take treatment?”

“With Dr. G. H. Wilkinson in Chicago. When I first got there he had to visit me at my hotel, but after the first two weeks of treatment I was able to walk to his office at —— Michigan Ave. Improvement was reasonably rapid, remarkably so, considering the obstinate nature of the ailment. Now I can walk as well as anybody, the pains have left me, and all my bodily functions are normal.”

Newspapers in the smaller towns and cities are not so particular in the definition of the term “pure news reading matter” as their larger and more prosperous contemporaries. They need the money. Consequently all the publishers who received an order from the —— Advertising Agency printed the article.

Country people as a rule are closer readers than those in the larger cities, and within a week everybody in the territory thus reached who was afflicted with locomotor ataxia was talking about the wonderful case of Col. Thomas, and writing to Dr. Wilkinson (this is not his real name) about their own cases.

Here again the services of the doctor’s secretary, who was correspondent as well as press agent, were called into play. Every letter was answered in a kindly, sympathetic manner, somewhat as follows, the stationery used being very plain and neat, but of the best obtainable material, and modestly engraved:

G. H. WILKINSON, M.D.

SPECIALIST IN CHRONIC DISEASES

—— Michigan Avenue

CHICAGO, August 2, 1910.

_Mr. John Smith, Godfrey’s Corners, Ia._

DEAR SIR: Replying to your letter of July 31st, I regret being compelled to say that, in the absence of opportunity for a complete personal examination, it would be impossible for me to say definitely what may or may not be done for you in the way of obtaining relief. If you can arrange to come to Chicago for a few days I will give your case my earnest personal attention and will then be in position to advise with you more satisfactorily.

Judging from the description of your symptoms the case is plainly one of locomotor ataxia but the ailment, as you are doubtless aware, is of such an insidious nature that, aside from the more prominent general and unmistakable indications, there are few cases which manifest themselves exactly alike. It is as a rule more satisfactory to both patient and physician, and more productive of good results, when the treatment can be arranged under the physician’s personal supervision to meet the requirements of the individual. This may possibly require a week, at the end of which time you may return to your home and continue the treatment there under the direction of your family physician.

As regards guaranteeing a cure I must say frankly that this is something no reputable physician will do. It is a practice resorted to only by what are known in the profession as quacks. The most encouragement I can give you, in the absence of a personal examination, is that, judging from your description the case is no worse than scores of others in which entirely satisfactory results have been obtained.

Should you decide to visit me please advise me by letter or wire a short time in advance so arrangements may be made to give you prompt attention on arrival.

Yours respectfully, ————

The effect of such a letter on the recipient is to beget confidence in the writer. It is frank and straightforward; it sounds honest, especially in those parts which refer to the necessity of a personal examination, and the declination to guarantee a cure. “That’s a real man, not a bit stuck up,” is the comment frequently made on receipt of one of these letters by people who had hesitated to write to such a famous specialist.

Few country people will take up treatment with a strange physician without first consulting their family doctor. They are not always governed by what he says, but they almost invariably ask his advice. If he suggests a trial you are pretty sure to get the patient. If he advises negatively the patient is not always lost, but it will require more correspondence, and when the subject does arrive he will be suspicious and hard to handle.

When the family doctor reads a letter like the one quoted he feels flattered that an eminent specialist should be willing to entrust the administration of his treatment to his care. He looks upon the proposition differently from what he would if this sentence had been omitted. His vanity has been touched. Inclined at first to throw cold water on the proposition, when he comes to this part he generally says:

“Well, of course I don’t know anything about this treatment, but Dr. Wilkinson is a man of great reputation. His success in the Thomas case is remarkable. One thing is certain. We have exhausted every resource here without getting results, and it can’t do any harm to see him and get his opinion.”

Thus encouraged the sufferer, if able to travel, will in nine cases out of ten, arrange to visit the specialist at the latter’s office. Sometimes the family doctor, from honest desire to become acquainted with the details of a new and successful treatment, will volunteer to accompany him.

But, suppose the local physician vetoes the proposition, denounces it as a fraud, and declines to be associated with it. Is the patient’s business lost? Not at all. It merely calls for a little more diplomacy. After waiting a reasonable time, say a couple of weeks, without hearing from Mr. Smith, the latter gets another letter from Dr. Wilkinson. This time the specialist writes as follows:

G. H. WILKINSON, M.D.

SPECIALIST IN CHRONIC DISEASES

—— Michigan Avenue

CHICAGO, August 15, 1910.

_Mr. John Smith, Godfrey’s Corners, Ia._

DEAR SIR: Not having heard from you in response to my letter of August 2d, I am reluctantly forced to the conclusion that conditions are such as to make your coming to Chicago impossible. This is a matter of sincere regret to me as the case appears to be one of peculiar interest and, as a physician, I would like to have opportunity of advising myself more fully as to the exact conditions.

If you will send me the name and address of your family physician I will write him asking for the necessary information, and between us we may be able to do something for you at your home. While your letter is unusually full and complete, with the facts stated in an intelligent manner not customary with laymen, you will readily understand that there are some complications in nearly every case which are more readily described by a physician, and especially one who has been watching it faithfully for a long time.

Hoping to hear from you promptly, I am,

Very truly yours, ————

When Mr. Smith receives this letter about the first thing he does is to show it to his family doctor and, no matter how much the latter was opposed to the “new-fangled” treatment at first, his chest swells with pride at the flattering reference to his ability. He says:

“Yes, Mr. Smith, you may send my name and address to Dr. Wilkinson and when I hear from him I will write him fully about your case. He is right in saying that only a professional man can give the required information properly.”

And off marches Mr. Family Physician, head erect, and with the pompous air of a drum major. Is he not about to be consulted by the famous Dr. Wilkinson, a man known throughout the land for his wonderful successes?

When the specialist receives the local doctor’s name and address from Mr. Smith, he writes the doctor somewhat after this style:

G. H. WILKINSON, M.D.

SPECIALIST IN CHRONIC DISEASES

—— Michigan Avenue

CHICAGO, August 21, 1910.

_Thomas H. Jennings, M.D., Godfrey’s Corners, Ia._

DEAR DOCTOR: I have lately been consulted by mail by Mr. John Smith, of your city, who is, I understand, a patient of yours suffering from tabes dorsalis. The case appears to be one of unusual interest and I will be under obligation to you professionally if you will make me acquainted with the details.

As you have been in charge of the case a long time it would be presumptuous on my part to attempt to outline the facts I want. You will know what to write about a great deal better than I would, and I will leave the matter entirely in your hands. My only interest in the matter now is a professional one as I understand Mr. Smith is unable to come to Chicago.

Trusting that you will accommodate me, and hoping that I may be able to return the favor in kind, I am,

Yours fraternally, ————

This does settle Mr. Family Physician for sure. For years afterward he takes delight in letting it be known how he was “called into consultation by the eminent Dr. Wilkinson, of Chicago, who said frankly that I knew more about the case than he did.” To the credit of Mr. Family Physician be it said that this latter statement was probably correct, and it might with all truth have been extended to include the assertion that he was doing as much or more for the patient as Dr. Wilkinson could.

At any rate Dr. Wilkinson receives the information he asks for, and beyond returning a brief note of thanks to the local doctor and saying that he will give the matter thorough attention as soon as he gets a little respite from his rush of duties, that is the end of it for the time being.

But Dr. Wilkinson is not idle. He is conducting, or rather his secretary is, a similar correspondence with scores of other physicians and prospective patients. From the letters thus received a card system is arranged, all the “prospects” being grouped by localities.

One day Dr. Wilkinson finds that he has some fifty good “prospects” in the immediate vicinity of some good town, and decides to make a round up. He then writes, either to the prospective patients in that neighborhood, or the physicians, if his correspondence with the latter has been encouraging, a letter somewhat as follows:

G. H. WILKINSON, M.D.

SPECIALIST IN CHRONIC DISEASES

—— Michigan Avenue

_Thomas H. Jennings, M.D., Godfrey’s Corners, Ia._

DEAR DOCTOR JENNINGS: Since the receipt of your letter relative to the case of Mr. Smith I have been called to —— for consultation in a serious case. I will be at the —— hotel on Thursday next but will be very busy, and do not think it safe to make any engagements, aside from the consultation, for that day. If you can arrange to meet me on Friday (the following day) between 10 and 11 a.m., I will remain over. I suggest this as it will afford us an opportunity of discussing Mr. Smith’s case to better advantage than it is possible to do by mail. There will, of course, be no fee attached to this service on my part.

Kindly let me know at once whether I may expect to have the pleasure of meeting you so that I may arrange my time accordingly.

Yours fraternally, ————

Dr. Jennings is impressed by the compliment thus paid him by the eminent specialist. So are the dozen or more other physicians to whom Dr. Wilkinson writes, most of them hastening to make engagements to meet the specialist at varying hours.

If the correspondence has been entirely with the prospective patient, and no family physician has been enlisted as an intermediary, the “come on” letter is made to read differently. In cases of this kind the doctor would say:

G. H. WILKINSON, M.D.

SPECIALIST IN CHRONIC DISEASES

—— Michigan Avenue

_Mr. Thomas Ratcliffe, Eagle Mills, Ia._

DEAR SIR: Since writing you last I have been called to —— for consultation in a serious case and will be at the —— hotel on Thursday next. As I can arrange to have a little leisure I would suggest that you meet me there at 11 a.m. so that I may be able to make a satisfactory diagnosis of your case, and thus be in position to advise you intelligently as to the prospects for obtaining relief.

I feel free to make this suggestion as there will be no fee or charge of any kind for this service all my expenses being guaranteed by the parties with whom I am to consult.

Kindly let me hear from you at once as I have many demands upon my time and wish to arrange my schedule to the best advantage.

Yours very truly, ————

The fact that he has not been invited to visit ——, or any other town for consultation purposes does not bother Dr. Wilkinson. It is one of those “harmless prevarications” tolerated and even encouraged, in all professions. It would not be dignified nor ethical for a doctor to start out on the road on a hunt for patients. It is not improper, once having been “called” to another city, to take advantage of the trip to do a little professional business on the side.

Dr. Wilkinson must have an excuse for visiting ——. The most plausible excuse is that he has been invited there in consultation by some brother physician whose name is withheld.

Before the time comes for starting for —— Dr. Wilkinson has received replies to his letters. Most of these are favorable, and the doctor is enabled to make out a time card that will keep him profitably engaged while in ——. This card should read:

=Thursday, Sept. 22, 1910.=

10 a.m.—Dr. Jennings about John Smith. 11 a.m.—Thomas Ratcliffe. 12 m.—Dr. Thompson, Cross case. 1 p.m.—Mary Brown. 2 p.m.—Charles Harris. 3 p.m.—Dr. Williams, Green case. 4 p.m.—Harry Bronson.

Before leaving Chicago the doctor will have his secretary get out the correspondence with each of the “prospects” and this, each lot enclosed in its own filing packet, will be put in his suit case or hand valise.

Arriving at —— Dr. Wilkinson will arrange with the hotel clerk to notify him when anybody calls. At 10 a.m. Dr. Jennings will be announced.

“Tell him,” Dr. Wilkinson will say to the bell boy, “that I am very busy just now and must ask him to excuse me for ten minutes. I will be able to see him promptly then.”

This gives the doctor time to get out the Jennings correspondence and refresh his mind as to the particulars of the Smith case. Then he sends word to have Dr. Jennings shown up.

“Sorry to have been compelled to keep you waiting, doctor,” and a warm cordial handshake, greets the country physician who is at once impressed with the fine appearance and friendly manner of his visiting brother. There is a little preliminary talk about the trip, the country, the weather, etc., and then the Smith case is taken up and thoroughly discussed.

“If I had time,” says the specialist, “I’d like to see Smith, but that’s out of the question. Your very clear and able description of the case has impressed me strongly. One of these days when I happen to be out here again with more time on my hands, and the patient is still living, I’ll ask you to take me out to see him. I understand it’s only a short distance from here.”

“Just thirty minutes’ ride on the Lincoln branch, doctor,” replies Jennings. “Why can’t you run out with me this afternoon? No time like the present, you know.”

“The trouble is that I will be busy until 4 p.m., and then it will be too late.”

“Not at all. There’s a train at 4:30 and we can be at Smith’s home by 5. Better go. Barring his ailment you’ll find Smith a good host. He’s rich and has a fine home, and the best of everything. I know he’ll be glad to pay liberally for your opinion whether it is favorable or unfavorable.”

“Well, doctor, if you think there is no doubt of my being able to get back so as to take the 10:30 train for Chicago I guess I’ll have to go with you. Really I should not do it as I have a hard day’s work ahead of me, but you have aroused my interest in the case and I would like to see the patient. I’ll meet you at the depot at train time. Until then good bye. I can’t begin to tell you how much I appreciate your call. If conditions were different I would insist on your being my guest for the day, but, as you well know we medical men are not our own masters.”

Without appearing to hurry he gets rid of Dr. Jennings before it is time to receive the next caller and, by exercising a little tact, the various people with whom he has made engagements are kept from meeting one another. Out of the four appointments he has made with laymen the doctor will ordinarily obtain fees from at least two, if not all four of his callers. Just how he does it will be explained in another chapter.

At 4:15 Dr. Wilkinson is at the depot where he finds Dr. Jennings waiting. On the train, the specialist delicately brings up the matter of fees.

“One great trouble with a treatment of this kind is the expense. The fees must necessarily be large and it is difficult to get even wealthy men to pay them. It is a relief to be able to discuss this part of the subject candidly with a brother physician like yourself who has the brain and common sense to appreciate it.”

Once again Dr. Jennings is pleased at the confidence reposed in him, and the more so when Dr. Wilkinson continues:

“Of course in a case like this where the local physician interests himself, takes his time to visit a patient with the specialist, gives the latter the benefit of his knowledge of the case, and continues the treatment after the specialist has gone, there should be a division of the fee. The local physician cannot be expected to donate his services; that would be ridiculously unfair.”

The country doctor is more interested than ever. Should he be super-sensitive about acceptance of a fee, and inclined to question the ethics of the arrangement he is quieted with the assurance that it is in common practice all over the country. In most cases, however, there is no tendency of this kind. The local practitioner is ready, and anxious to get his share of the money. His main concern is about the amount. Frequently he asks:

“What do you think we can get doctor?”

“That depends upon the man. You know him better than I do. You say he is wealthy, so his ability to pay is not to be questioned. We’ll fix upon an amount that will be equitable under the circumstances. It should not be less than $500.”

The prospect of obtaining $250 so easily is very alluring to Dr. Jennings. He does not realize that the specialist is using him as a bait, making him stand sponsor as it were, for the merit and efficiency of the treatment. Arrived at Smith’s home Dr. Jennings is warm in his endorsement of everything Dr. Wilkinson says and does. The latter examines the patient carefully, asks him numerous questions, frequently referring to Dr. Jennings for information upon technical points, and showing deference for the opinions of the family physician. Finally the stage is reached where it is necessary to talk business.

“If you should decide to take this treatment, Mr. Smith, I will arrange with Dr. Jennings for its administration. It should be given twice a day. I will furnish all the remedies and, advised by frequent letters from Dr. Jennings as to your progress, will outline such changes from time to time as may appear necessary.”

This naturally leads Mr. Smith up to asking, “Do you think you can cure me, doctor?”

“Well, Mr. Smith, as Dr. Jennings will tell you no reputable physician countenances the word ‘cure.’ I will say, however, that I have had many cases, some of them apparently even worse than yours, in which entirely satisfactory results have been obtained. Here are a couple of letters just received which I am requested by the writers to show. They will probably interest you.”

Saying this the specialist brings out a couple of letters written by patients who have been benefited. They are bona fide letters. It would be strange if out of the large number of people treated some cases did not yield satisfactory results. The letters read about as follows:

PITTSBURGH, ——, 1910.

DEAR DOCTOR WILKINSON: Replying to your enquiry of recent date regarding my condition I am most happy to be able to say that marked improvement continues. The pains have entirely disappeared, all the functions of the body are normal, and I walk long distances every day without cane or crutch. This result obtained in a little less than ten months of treatment is most pleasing considering that I was sorely afflicted for over ten years, and that my case was pronounced incurable by the best specialists both here and abroad. Dr. Kennedy, my family physician, says the change in my condition is miraculous.

Don’t hesitate to show this letter to those who may be similarly afflicted. It is a duty which I feel that I owe humanity to make known what has been done for me.

You will probably also hear from Dr. Kennedy within a few days. With sincere thanks, I am,

Most gratefully yours, ————

Drowning men clutch at straws. Mr. Smith knows that he is afflicted with an ailment which other physicians have been unable to relieve. Here appears to be something effective. Hope dawns, and he enquires:

“What will it cost, doctor?”

“That, my dear sir, is a question I was in hopes you would not ask. Worry over the expense of treatment always tends to retard or delay complete recovery. What is money compared with health. Why should you set one against another? Can you measure the monetary value of health as you would that of a ton of coal, or a ton of hay?”

Mr. Smith begins to feel ashamed of himself, and all the more so when his family physician chimes in and endorses what the visiting specialist has said:

“I guess that’s all right, doctor,” responds Smith. “You can’t measure health against money, but I must have some idea as to the expenses. It may be beyond my means.”

“We’ll fix that all right,” says Dr. Wilkinson. “The usual fee for complete treatment is $150 a month.”

“How long will it take?”

“That’s something no man can tell. I’ve had cases in which the desired results were obtained in so short a time as four months, and others in which they were deferred for fifteen months. If there is such a thing as striking an average I should name it at ten months.”

“That would be $1,500. That’s an awful lot of money.”

“It’s nothing in comparison with good health. I have had many patients who preferred to pay a lump fee in advance in order to get the worry about money details off their minds. Under this arrangement the treatment is continued as long as may be necessary whether it is four months or fourteen. In such cases I accept $1,000. This not only pays for the entire course of treatment but it saves the patient $500 should the course be continued for ten months, which is not at all unlikely.”

The saving of $500 appeals to Mr. Smith, and he accepts the proposition. While he is signing the check Dr. Jennings has to pinch himself to see if he is really awake. The idea of getting $500 for his share of an hour’s talk is overpowering. The check delivered, Mr. Smith is assured that the remedies will be in Dr. Jennings’ possession within the week and that treatment will start at once.

Once outside Dr. Jennings is impelled to ask: “How did you come to fix the fee at $1,000, doctor? I thought you said it would be $500?”

“I said not less than $500. But I found Mr. Smith more responsive in this connection than most men, and it was just as easy to get $1,000 as it would have been $500. By the way, how are we going to divide this check?”

There is nothing to do but for Dr. Wilkinson to remain in town over night and for Dr. Jennings to identify him at the bank the next day. This is done, and the money drawn and divided. Who gets the best of the bargain? Apparently both doctors are on the same footing, but are they? Dr. Wilkinson has $500. For this he will send once a month for a few months a supply of treatment the actual cost of which will not exceed $2.50 a month—perhaps $25 for ten months. Dr. Jennings, on the other hand, must visit the patient every day, administer the treatment, keep track of his condition, note such changes as may occur, and report them to Dr. Wilkinson.

Dr. Jennings must perform his duty in person, he cannot delegate it to another. Dr. Wilkinson does most of his work, except the actual case taking, through hired help. He has a dozen, or a hundred, Dr. Jennings working for him all the time.

Many specialists are averse to working in connection with family physicians. In some instances this is because of short-sightedness on the part of the specialist. He doesn’t like the idea of dividing his fee with the country practitioner. In other words he is greedy and wants it all, losing sight of the fact that in the great majority of instances the family physician is the deciding arbiter and, without his aid, a lot of cases would be lost.

Then there are specialists who have not the knack of making friends with the country doctor. The latter is naturally opposed to the specialist; he thinks, whether justly or not, that his own method is best and looks askance on “new-fangled” ideas in practice, especially when a good fee is liable to go to the stranger. But, let this same country physician be led up in the proper manner to the division of fee proposition and he takes a different view of the situation. It seems like a lot of money to give away, but it is a good investment. The man who accepts the division stands committed to the treatment; he becomes a booster instead of a knocker. If the case does not turn out well there is little chance to find fault with the specialist. The local Dr. Jennings has been in charge and upon his shoulders rests the responsibility. Should the patient complain the local physician can, and very likely will say:

“Of course it is a disappointment Mr. Smith, but the practice of medicine is full of disappointments. There is one consolation. You have had the benefit of the latest treatment evolved by medical science. Dr. Wilkinson arranged the treatment to meet your special needs after I had given him a complete history of your case, and you must admit that I have been faithful in its administration. I’m sorry that the results were not different, but that is something every physician has to contend with.”

Left without the services of the local physician as an ally the specialist would probably be blamed for the failure, and the patient might even refer to him as a swindler. Such things have occurred with the result that the specialist’s chance of getting any more patients in that neighborhood was wiped out. But, by retaining the services of the family physician the specialist is taking out insurance against this very happening.

Dr. Jennings, of course, does not realize that he is being made a buffer of. He has had, as he thinks, the scientific features of the treatment carefully explained to him, and the theory is reasonable and in thorough accord with that of accepted authorities. As for the division of fee—why he certainly is entitled to pay for his services in treating Mr. Smith, and it is much better for the latter to have Dr. Wilkinson stand this expense than for it to fall upon Mr. Smith.

It’s all in the viewpoint, and the viewpoint can be just what the specialist makes it. If he is a clever man it will be favorable; if he lacks tact and is antagonistic in nature, it will be unfavorable. As to this latter contingency it may well be said that a tactless, antagonistic man has no business operating in this field. Tact and suavity and an impressive appearance count far more than a knowledge of medicine, and will get more money every time.

It’s worth considerable to have the good will of family physicians in the country districts, so that when occasion arises they will say: “Dr. Wilkinson is an able man, and perfectly square in his business methods. We (observe the “we”) didn’t get the desired results in the Smith case, but it must be remembered that it was an unusually serious one, and Dr. Wilkinson said so at the time. Recovery would have been little short of a miracle. Had the treatment been taken before the disease was so far advanced there is every reason to believe the results would have been different.”