CHAPTER IX

=DECIDING UPON THE FEE=

Having ascertained the financial status of the caller, and developed the fact that he wants to take the treatment, the next move is to fix upon an acceptable fee. Here, again, tact must be used. Ability to pay is not everything. You must know your man. Take two men of equal financial rating. To one a fee of $1,000 would be an extortion; the naming of that amount would give him a violent attack of heart disease, and yet he could well afford to pay what was asked. The second man, with no greater financial resources, would write out his check for $1,000 without a murmur, and think himself lucky to get off so cheaply.

It’s all a matter of psychological impression. If you know your man thoroughly, and approach him at the right moment, you can get any fee that is within his ability to pay. And this “knowing your man,” rests largely upon the manner in which you receive him, and the impression you make upon him. It is a reciprocal affair. If you get his confidence to the extent that he unbosoms himself to you freely, you “know” him; if you don’t you are going to have hard sleddin’.

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.

A young Western physician, with the right kind of get-there spirit, settled in New York, where he was called upon to care for a young woman, the daughter of a multi-millionaire, who was suffering from typhoid fever. He saved her life, after a struggle of six months, and sent in a bill for $5,000, hoping that he might get half of it. Back came a check for $5,000, with a letter of thanks, and a “bonus” check for $50,000 more. This may seem improbable, but it is a fact.

This instance is cited for a two-fold purpose: First, to show that it does not pay to undervalue your services; and, second, that Eastern people are, as a rule, financial resources being equal, more accustomed, and more inclined, to pay liberally than those of the West. In discussing this incident a Chicago physician, a well-known man, said:

“A Chicago millionaire would have ‘kicked’ on the $5,000 bill, insisted on its being cut to $2,500, or less, and, this being done, would have stood suit rather than settle at his own figure.” In this connection Dr. Lydston quotes the following case:

One of our greatest “merchant princes” was under the care of a specialist and, as his time was very valuable, insisted that the doctor let him in at his private door ahead of all other patients, regardless of the order of arrival. His bill at $10 a visit amounted to something over $300. The “kick” registered by our “prince” might have been heard in Alaska. Result, the bill was cut in two and the doctor has another enemy on his list.

Another merchant prince, who is well known on State street—we will call him Mr. Bird, because that’s almost his name, and he is one—came to see me one day in this wise: He had heard that I had recently operated on a friend of his and removed a renal calculus. Would I show him the specimen? He then gradually developed the interesting fact that he had gall stones and had been advised to submit to an operation. What did I think of his case, and what about his operative prospects? Three-quarters of an hour slipped away, and my opinion in general had been obtained, when I suggested a physical examination.

“Oh, well,” he said, “you see, it has grown so late that I will not have time to-day. I’ll see you day after to-morrow,” etc.

That same evening, while riding to a case in consultation with one of my surgeon friends, that gentleman said, “Oh, by the way, ——, I’m going to operate on Bird to-morrow for gall stones.” And so it proved. I sent Mr. Bird a bill for consultation and he replied that he owed me “nothing,” had “just made a friendly call,” etc. I finally threatened suit and he paid the bill grudgingly, and as insolently as he dared at long range. Let me assure the reader that that $25 was a sweeter morsel than ten times the amount from any other source. Oh, how it must have hurt my friend Bird! I trust he will be a mine of wealth to my surgical confrère—he has “gall” enough to run a stone quarry in his hepatic apparatus for a hundred years to come.

Medical fees have not yet shaken off the incubus put on them by the dollar fee of the medical “daddies.” When the country was yet new, the fee question was practically settled by some of our medical pioneers, whose influence has never been dispelled. The one-dollar consultants were over-modest. We have always been ready to concede that such fees are an undervaluation of the consultant’s skill. The profession has ever refused to take some men at their own valuation—but it has suffered from the incubus just the same. Philanthropy has been advanced as an explanation of cheap fees. 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.

What does a man study law for? In order that he may be able to practice successfully and make money.

What does he study architecture or civil engineering, or any of the other professions for? Always with the one purpose of making money out of them.

No, not always. Medicine is an exception. Judging by the ordinary standard of fees men study medicine in order that they may make an unappreciative public a present of their time and skill—at least most of them do.

No fee within the range of the patient’s ability to pay is ever too great for medical services. The doctor is never in danger of being overpaid. He should “temper the wind to the shorn lamb,” but appearances are deceitful, and the doctor had best be in at the shearing, else there will be no wool for him. “Virtue is its own reward” may sound very pretty, but it is not consoling in view of the fact that it gets no other in this life and its reward in the world to come is rather problematic.

While always seeking to get the largest fee that is within the patient’s ability and willingness to pay the clever doctor will never let the patient know but what the matter of a fee is a secondary consideration. His earnest talk will be on the prospect of obtaining the desired results. So far as the patient can judge from the doctor’s attitude and conversation the professional features of the case have a much stronger hold upon his mind than the financial.

It is always best, of course, in the matter of fixing the fee to “strike while the iron is hot.” Do it at the first consultation, if possible, and have it out of the way. But the iron is not always hot at this first meeting. Unless assured that you have won the entire confidence of the patient, and that you can safely go the limit with him, don’t attempt to name the fee right away. If you do it is a certainty that you will get far less than could readily be had under more favorable circumstances. In a case of this kind, should the patient press to have a fee named, say:

“The fee is a secondary consideration with me, Mr. ——. What I am most interested in is knowing whether I can benefit you. If I can it will be an easy matter to agree upon the fee. If I cannot, it would be a waste of time to take the treatment, and I don’t want your money.”

This is pure “bunk.” The doctor doesn’t mean a word of it. He is merely sparring for time until he can get the patient in a more receptive condition, but it makes a ten strike. Whatever of doubt or hesitancy may have remained in the patient’s mind is removed.

With the powerful remedies now at a doctor’s command it is a most unusual case in which a decided change for the better does not follow the first two or three days of a new treatment. When this stage is reached the time is ripe for naming the fee.

A gentleman suffering from locomotor ataxia came into the office of a certain physician. He was frank in his statements. He admitted that he was fairly well fixed financially and had travelled all over Europe in a vain effort to find relief. He was willing to take the treatment as a sort of forlorn hope and wanted the fee fixed, but the doctor could see that he was still a little skeptical, and put him off in the manner outlined. On the third day of treatment the patient said:

“Doctor, I want to get this fee matter out of the way. I know I’m going to get well. For the last two nights I’ve slept like a baby, something I haven’t done before in years, and I feel better in every way.”

This was the doctor’s opportunity and he took advantage of it, saying:

“Well, Mr. ——, since you insist upon knowing the cost of treatment I’ll name a fee of $1,000 in your case.”

The man’s check book was out and a check written and signed in less than five minutes. It was the proper psychological moment. As the patient said later:

“I was surprised, Doctor, at the moderate fee. If you had said $5,000 I would have paid it just as quickly as I did the $1,000.”

This man got well. The state of his mind had a great deal to do with his recovery. The treatment was beneficial, but he had made up his mind that he was going to recover, and that was a great factor.

Allowing that the psychological moment is reached at the first meeting, the caller being in a receptive mood and asking for the terms of treatment, which is often the case. Don’t be modest. It is easier to lower the terms than to raise them. If the figure you name is objected to as being beyond the means of the caller there is always a way out. Then is the time to say:

“The figure I have named, $1,000, is the regular fee, Mr. ——, but I can readily understand that to pay this amount might work a hardship in your case. We are not doing a charity practice. We can’t afford to. And if we were I am positive you are not the kind of a man who would take advantage of it. You want to pay for what you get, provided it is within your means.

“In many respects your case is a most peculiar one, and I would like to undertake it as there is every reason to look for wonderful results. Now I am going to make you a proposition in strict confidence, and with the distinct understanding that it remains a secret between the two of us. I will make the fee $500, and, when you are restored to health, you are to write me a letter which I may show privately to other people who are suffering in the same way. But, under no conditions are you to tell anybody what fee I charged.”

Jump at the proposition? Does a hungry fish take the bait? He thinks that he is getting something for nothing; that a special exception has been made in the matter of a fee because the doctor is confident of restoring him to health and wants the credit and reputation that would attach to such a cure.

During all this conversation the doctor has cleverly refrained from alluding to such a thing as a cure in direct words. In no manner has he committed himself in this respect, and yet the bait has been so skilfully dangled that the caller can get no other impression than that a cure is sure to be obtained.

Then there is another class of men who will object to any fee that may be named in the hope of getting a reduction. In most instances men of this class are abundantly able to pay, but are “close.” If gold dollars were offered to them at 90 cents apiece they would want the price lowered so as to save something. When a man of this kind is encountered, and the doctor is bent on getting the fee he has named, the best thing to do is to make him ashamed. This may be done without offending them. One notably successful case taker, famous the world over for his ability to get large fees, made it a practice to say:

“I agree with you, Mr. ——, that $1,000 seems like a large fee if we leave the matter of perfect health out of the question. You surely don’t expect to buy health on the same basis that you would coal or grain, or some other merchantable commodity. You are too sensible a man for that. When you stop to consider that this ailment is chronic—let’s see, I think you said you had been afflicted about eight years—and that it is going to take earnest attention on my part for a long time to restore you to a normal condition, I think you will agree with me that, even if we adopt a cold commercial basis of valuation, the fee is not an extravagant one.”

“Perhaps you’re right, Doctor, and if I could have any assurance that—”

“Assurance. What can you have beyond what I have given you? My professional reputation is at stake, and you have been advised as to what has been accomplished in other cases. Surely you could have no stronger assurance, especially that contained in the letters from patients which I have shown you.”

All this is said in a low, well-modulated tone, without show of special desire to close the case, and it generally wins. If it does not there is always the alternative of making a special reduction in this particular case on the understanding that the terms are confidential, etc. But it is seldom that this has to be resorted to.

When patients go for treatment to a physician of fame, one whom the newspapers are forever referring to as “the eminent,” or “the famous Dr. McSwat,” they expect to pay large fees. If they could get treatment on ordinary terms it would not be so highly esteemed. Fame is the open sesame to big fee getting.

If, after the talk outlined, a caller remains obdurate a star play may often be made by the physician arising, pushing his chair back a little, and saying:

“I don’t wish to be discourteous, Mr. ——, but I am compelled to ask you to excuse me. I am a very busy man, and I am afraid that some of the people who are waiting to see me will be getting impatient. I am glad you called, and have really enjoyed my talk with you. Drop in any time at your convenience. I shall always be glad to see you.”

If the caller has any real intention of taking treatment this will generally bring him to time. In the first place it is equivalent to the doctor saying “I am too busy to waste my time on triflers,” and this touches his pride. In the second place he is afraid that if he does not take advantage of the present opportunity something may arise to change conditions before he can see the doctor again.