CHAPTER X

=GETTING FEES IN ADVANCE=

It is one thing for patient and physician to agree upon a fee. It is another thing for the physician to get the fee in advance. Still, it can be done in most instances, but it requires diplomacy of a high order. It is frequently, one might say almost invariably, the case that, after the fee has been tacitly agreed upon, the patient will enquire:

“How is this fee to be paid, Doctor?”

“In advance,” the doctor will reply in a mild, it-doesn’t-matter manner.

“Isn’t that rather hard on the patient, Doctor?”

“It is the only way in which we can protect ourselves. If we extended credit indiscriminately many patients, when assured that they were well started on the road to recovery, would disappear, and it would require long, expensive litigation to collect from them, even if we could get service on them here, which is doubtful. The average man, Mr. ——, has a queer idea about the obligation of a doctor’s bill. It is the last thing he will pay voluntarily, even when almost miraculous benefits have been obtained.”

“Don’t you ever extend credit?”

“Oh, yes. When assured of a man’s financial responsibility and honest intention, we are glad to accommodate him in a reasonable way if it is inconvenient for him to pay cash.”

In this, as in naming the fee, the physician must create the impression in the mind of the subject that payment of the fee is about the last thing he is thinking of. There must be no anxiety, no undue haste to get the money—at least not so that the patient can notice it. Switching the conversation for a few moments back to the case itself, in order to get the patient’s mind diverted, the doctor will finally say:

“Now, in your case, Mr. ——, if it is any object to you, I can arrange for you to pay the fee monthly. If this is satisfactory you can pay $150 a month while you are under treatment.”

“How long will that be, Doctor?”

“I don’t know. Certainly six months, perhaps twelve, and possibly longer. Nobody can tell in advance how a chronic ailment like yours will respond to treatment. It is very seldom that we have two cases exactly alike in this respect. If there is such a thing as striking an average I would place it at about ten months.”

“Would I have to remain here all that time?”

“Oh, no. A month or so, should be sufficient. May be less. Just long enough to allow me to get the treatment graduated to meet the requirements of your case. Then you may return home and continue it there. It would be better, of course, if you could stay here the entire time, but there is no real necessity for it.”

“On the basis of ten months it would cost me $1,500?”

“About that. Perhaps a little less; perhaps a little more. By taking advantage of the $1,000 proposition you will save about $500. It is really immaterial to me which offer you accept save for one thing. No matter how well a patient is progressing there is sure to be more or less reaction at times. It would be marvellous if there were not. These spells of reaction are only temporary, but the patient, not understanding this, is inclined to become discouraged and, if he is paying his fee by the month, may quit just at the time when, if he had continued treatment a little longer, he would have become a well man. In such a case he not only loses the money he has paid, but also the certainty of recovering his health. On the other hand, if his fee is paid, he will argue that he might as well stick it out as it isn’t going to cost him any more.

“Naturally I want to obtain as great an amount of success professionally as possible. For this reason when a patient asks my advice on the subject I tell him to pay the fee and get it off his mind. This not only saves him money, but relieves him of financial worry so that he responds more readily to treatment and, above all, it makes sure of his continuing the treatment until his health is restored.”

While endeavoring to convince the patient that the fee occupies a minor place in your mind, do so by actions and manner, not by words. Never say outright that you don’t care when the fee is paid, or that you are not thinking about the fee, or anything of that kind. If the patient sees fit to form this impression, let him do so; it strengthens the probability of your getting the money. The average man, especially the one who has money, is not a fool. He is quick to form conclusions. If he can see where he can save $500 on a bill of $1,500 he is going to grasp the opportunity without much urging, provided he is reasonably well assured of getting value received. This assurance is entirely a matter of confidence. If the doctor has obtained the patient’s confidence by dignified, yet courteous (not servile) manner, and modest talk, he is going to get the fee then and there. If he has fallen short of securing this confidence all the arguments he can advance will not induce the patient to unbelt. In fact, the more argument he makes the weaker his case becomes.

A discount of one-third is a proposition which appeals to any man of business sense. He does not know, of course, that the physician has named a figure much higher than he is willing to accept, with this very purpose in view. One thousand dollars would be a lucrative fee if paid by the month, and the doctor can well afford to accept it in advance on the terms he names. Few people will take treatment longer than three, or at the most four, months. They either become well in that time, or grow discouraged and quit.

Another thing. There is a great deal of convincing force in the statement that payment of the fee in advance holds the patient to the treatment. At least it looks that way to the layman.

In most instances where a man has the funds in bank he will write a check without further comment. Occasionally a patient will be unable to do this, owing to a shortage of funds, and will say:

“Well, I have decided to take the treatment, Doctor, if you can give me a little time on part of the fee. I can pay you $500 now, but would like about sixty days’ time on the rest.”

“Certainly, Mr. ——. If it will be an accommodation to you I will be glad to do it. It is contrary to our usual practice, but I feel that I am safe in making an exception in your case.”

The check is written and handed to the doctor who, without apparently examining it, puts it carelessly in his pocket, and then makes an entry in his desk diary, noting the patient’s name and address, nature of his ailment, date, amount of fee, and size of payment. When all this is done the first treatment is given, and engagement made for succeeding treatments at a certain hour each day.

Taking advantage of the time when the patient is rearranging his clothes after treatment the doctor hurriedly fills out a sixty day note for $500, making it payable to the order of the patient himself. Just as the latter is ready to leave the doctor will say:

“There’s just one thing more, Mr. ——. In order to guard against any possible misunderstanding in the future I have drawn up a little memorandum of our agreement as a sort of protection to you. Now, if you will kindly place your signature there——”

As he says this the doctor rises from his chair and motions the patient into it, at the same time dipping a pen in the ink well and handing it to him.

“Yes, on that line; yes, that’s the place. Now (turning the note over so the back is uppermost), once more across the end, so. There, now we have the agreement in form so no one can take advantage of you. Be sure to come promptly at 10:30 to-morrow.”

After the first treatment most men are excited and easy to handle in this way. They do what the doctor bids in a sort of unconscious way. They don’t realize that they are signing a note. The doctor has referred to it as a memorandum of agreement, and it seems only proper that there should be a writing of this nature.

Sharp practice? Yes. Dishonest? No. The patient has agreed to pay a fee of $1,000. He has paid $500 down and promised to pay the rest in sixty days. The doctor has merely induced him to put this promise on paper. If the maker of the note is responsible (and the doctor has assured himself of this in advance) the full $1,000 is secured then and there, less an ordinary discount fee on $500, as a note of this kind is easily negotiable. The doctor has taken the precaution to protect himself instead of depending entirely upon the honesty and good intention of his patient.

The latter has barely left the office before both check and note, properly endorsed, are on the way to the bank where the note is discounted and the proceeds, with the check, deposited to the credit of the physician.

It may be said that this sounds too easy and simple to be true. Perhaps it does to those who are not acquainted with the methods of the up-to-date “case taker.” But fees, and big fees, are being obtained in exactly this manner every day in every large city in the country.

The physician who has a well-established office practice does not, as a rule, resort to this method with his regular patrons at first. He charges what seems to be a large fee, $5 to $10 each time a patient calls, extends credit indiscriminately, and loses fully one-half of the money represented by his book charges. If he is wise he learns by experience, and caters to the patronage of strangers from whom he can get his fees in advance. He gradually gets too busy to receive those who want their fees charged. He has learned his lesson and is willing to profit by the example set by other doctors who, while not recognized as models in the line of ethics, know how to make the practice of medicine pay.

“How’s business, Doc?” asked a friend of a physician who has achieved considerable fame as an office specialist.

“Bully,” was the reply. “Did over $300 to-day.”

“Get it?”

“No, but it’s good.”

And the poor fool actually thought so until he failed to get any adequate returns from the many bills he sent out, or the numerous calls made by his hired collector. Now he is making money. Why? Because every caller, whether regular patient or stranger, who wants to consult that doctor professionally, must “ante” his $10 with the polite secretary in the reception room before he can get into the doctor’s office. Result, exodus of dead beats, and others whom there was no profit in seeing.

Prominent attorneys adopt this system. Why is it not just as ethical and fair for physicians to employ it? If a patient agrees to pay the fee asked by the physician there is no reason, moral or legal, why he should not do so. And yet, unless this fee is paid in advance, or well secured, the chances are about ten to one that the doctor will never get it.

Sometimes the patient will discover that the “memorandum” he is signing is a note, and may say:

“Why this is a note, Doctor?”

“Well, it is in note form, but you will see that it is payable to your own order, Mr. ——,” the doctor will say. “I don’t think it will be of much use to anybody else. It is put in this form for your own protection.”

This is usually sufficient, unless the patient is a city banker, or an unusually smart man of business. Should this latter be the case, which is not likely as men of this class invariably pay cash in advance, an explanation is readily forthcoming to the effect that it is merely an evidence of good faith on the maker’s part, etc. Occasions of this kind are very rare, however, as most men are so thoroughly hypnotized at the moment that they readily do whatever the doctor suggests.

The smart man is as a rule the easiest to get a good fee from. His business education has been such that he is not looking for something for nothing. If a thing is really good he knows it must be paid for, and that the price must be in accordance with its merits—or supposed merits. Strong belief in actual merit is a matter of education, the doctor acting as instructor and demonstrator.

One holiday when the office was closed the writer and the physician with whom he was associated in business were sitting in the doctor’s private room discussing ways and means for getting in more patients. The main entrance door was locked. Suddenly the knob was heard to turn and it was evident somebody was trying to get in. Going to the door the writer opened it and stood face to face with one of the best known and wealthiest men in Chicago, a man noted for being extremely close in his financial deals. Affecting not to know him the writer said:

“What can I do for you, sir?”

“I’d like to see Dr. ——.”

“The office is not open for the reception of patients to-day, but the doctor happens to be here for a moment. If you will step in and take a seat I will ascertain if he can see you.”

When the caller was seated the doctor was hurriedly notified as to his identity and financial means, and word was sent out to show the gentleman in. After a consultation of twenty minutes the caller left, and the doctor had his check for $2,500. As he handed it to the writer the doctor said:

“Mr. —— did not have one of his own checks with him, and had to write this on one of our blank forms. He doesn’t want it to go through his bank in this shape and has asked me to hold it until he comes in Saturday when he will exchange it for one of his own.”

The check was put away and on Saturday when Mr. —— called the writer, who was the treasurer of the concern, was out at luncheon. As the new patient handed the second check to the doctor the latter was compelled to say:

“I’m sorry, Mr. ——, but I’m unable to give you back your first check right away, Mr. ——, our treasurer, has it locked up in the safe, and I cannot get it until he returns from luncheon.”

“Oh, that’s all right,” replied Mr. ——. “Any time will do.”

And away he went, leaving both checks, representing $5,000, and as good as gold, in our possession. The doctor had won his confidence from the start.

In this particular instance there had been no advance correspondence, and the caller was unknown to the doctor either personally or by name. The writer happened to know him by sight and thus was able to “tip” him off to the doctor. If it had not been for this it is probable that the fee would not have been more than $500, and the doctor would have congratulated himself on having done a good day’s work at that. What makes the case even more remarkable is the fact, as previously stated, that the man had the reputation of being very close in money matters. Yet here was an instance in which he not only paid the fee of $2,500 in advance without a murmur, but actually entrusted a stranger with $5,000 of his funds.

After two weeks of personal treatment this same man, acting on the advice of the doctor (who was to share in the fee) had partially arranged to pay another specialist $10,000 for the treatment of his wife, and was on the point of closing the contract when the blundering tactics of the second physician upset the whole thing. Negotiations were progressing favorably, there was no dispute as to the amount of the fee, or anything of that kind, when a single mis-step aroused his suspicions, and the deal fell through. In talking the matter over later Mr. —— said:

“I may be sorry, Doctor, that I did not accept Doctor ——’s proposition, but to tell the truth he didn’t impress me favorably. Now if it were you who were to conduct the treatment I wouldn’t hesitate a moment.”

The joke of the thing—and it was a joke—lay in the fact that of the two men the doctor he had no confidence in was by far the more able and competent of the two. But he lacked tact; he didn’t know how to inspire confidence in his patients; didn’t know how to conceal the disagreeable truth and enlarge on the non-essentials making them appear as the more important of the two. He was too brutally frank. The doctor who got the $2,500 fee and retained the entire confidence of his patient to the last, was a past master in the gentle art of what is known in slang parlance as “bull con.”

All of which tends to show that the getting of a big cash fee rests entirely on the impression created by the physician. If this impression is favorable the fee will be forthcoming; if it is not a yoke of oxen couldn’t yank it away from the patient.