CHAPTER XIII

=PRESCRIBING OF REMEDIES=

The time will come when the physician who has not made an arrangement with some pharmacist for a division of the prescription fees, will be obliged to resort to old-time methods and dispense his own remedies. He will have to do this, or go out of business—excuse me, I meant give up practice. It’s high treason, unethical, to speak of a doctor as being in business, but there’s no good reason for it. Anything that a man makes a living at is a business, and if the doctor cannot make a living, and something more, why he’s in the wrong rut.

Barring the division arrangement referred to there are three things opposed to the physician’s interest which the druggist must do, or give up his store. These are:

1.—Sell patent medicines.

2.—Prescribe over the counter.

3.—Charge exorbitantly for the medicines prescribed.

There is nothing in all this that is illegal, but it is opposed to the best interests of the profession. At first sight it appears an evidence of imbecility to send prescriptions to be compounded by a competitor. Yet you send them to the druggist, who is your most active competitor. Not only is he one directly, but he is often the agent of some other doctor or doctors whose merits he glibly contracts with your demerits, for the edification of the patient. You tell him, time and again, not to repeat your prescriptions, but to no purpose. In some cases you know that he is giving commissions to one set of doctors, while his clerks are getting commissions from practice sent to others, yet you stick to him.

Now, there’s but one solution of the problem. Every doctor who can should dispense his own medicines. The people like it, and the profession will soon learn to like it. The doctor can furnish medicines cheaply and still make a profit. The patient pays a bill for services and medicines much more cheerfully than one for services alone.

Not the least of the good things that would result from the doctor doing his own dispensing would be the familiarity with his working tools thus acquired. Most men enter practice without the least knowledge of the physical qualities of the drugs they expect to use. Many a man has prescribed, over and over again, remedies he never saw, smelt or tasted. The best doctor is he who is most familiar with his curative agents. Another desirable result would be the doctor’s renunciation of polypharmacy. He would soon learn that the number of serviceable drugs is by no means legion. Where a number of doctors occupy an office, they should have their own dispensary.

When neither plan suggested is feasible, the doctor should endeavor to find a druggist who, in consideration of having practically a monopoly of the prescriptions of that particular physician, will dispense his prescriptions on cipher and never without an order. It is possible to find such druggists. Self-interest is likely to induce them to treat the doctor fairly, when all other arguments fail. There is a peculiar advantage in this system in the fact that the doctors’ favorite formulæ can be kept in quantities already prepared, thus saving time and assuring uniformity in dispensing. Under such an arrangement, too, the druggist is able to be much more reasonable in his prices. He is also likely to keep such special preparations as the doctor may request, thus avoiding the temptation to substitute.

One thing is certain in the relations of doctor and druggist, viz., the time is not far distant when the doctor will either dispense his own drugs or will boycott every druggist who counter-prescribes or sells patent medicines. The profession will not go blindly on forever, carrying grist to the other fellow’s mill.

Next we must contend with the proprietary medicine fakir. The doctor’s experience often breeds a lack of confidence in his remedies, and his materia medica narrows year by year. Yet his patients clamor for relief, and in despair the doctor receives, with open arms, the fakir who agrees to furnish him with speedy cures.

Behold the result. The pharmacopeia is fast drifting into the valley of dead lumber. It is no longer necessary to know anything of materia medica and therapeutics—the fakir attends to all that for us. We are no longer offended by the gratuitous insult offered us by the proprietary medicine fiend, who knocks at our door, and, with the implied insinuation that he furnishes brains for the medical profession, clutters our office tables up with samples, the labels on which tell us all about diseases and the only preparations that will cure them. Pah! How most of them smell! And what a nuisance they are.

But the fakir has done his work well. He has evolved the ready-made doctor—man of all work, aye, slave to the fakir. How gently flows the current of Dr. Readymade’s professional life. No more incurable cases. No more midnight oil—for why should he be a slave of the lamp? No more worry. No more care. No more expenditures for books, journals and instruments. All the doctor has to do nowadays is to read the labels on the bottles and boxes of samples the fakir brings him. Does the patient complain of stomach disturbance? He is given “Stomachine.” Are his kidneys working overtime? “Kidneyol” is the proper caper. Is there a pain lurking somewhere in his economy? Give him one of these pretty little tablets with a hieroglyph on it, which nobody knows the composition of—so the firm that makes them claims. Oh, the practice of medicine is so easy nowadays. Ready-made diagnosis and treatment—what could be simpler?

The proprietary medicine fakir begins his little song by assuring the physician that his wonderful preparation is for the use of the profession only. He is trying to introduce it “along strictly ethical lines.” He has given the preparation a fanciful name and marked it with a special design “for the protection of the physician, who, of course, wants to know that his patient gets just what is ordered.” What an imbecile the doctor is. The chief objects of the special name and hieroglyphic design are:

(1) To induce the physician to order the preparation frequently, the name being catchy and easy to remember.

(2) To let the patient know what is ordered, so that he can prescribe it for himself and friends without the aid of a doctor.

Having popularized the preparation in this manner, the proprietary medicine man often advertises his wares directly to the public via the secular press. If the profession protests, the wily medicine man says: “Well, you indorsed it; the profession uses it; hence it is a good preparation and a benefit to humanity. Go to, you are bigoted and narrow-minded.”

Now, brethren, while the foregoing remarks are fresh in your minds, try and recall the facts regarding “Scott’s Emulsion” and the “Midy Capsule.”

Not all proprietary medicine men take the newspaper route—they don’t have to. The catspaw doctor does his work too well. Witness the “little joker” anti-pain tablet already mentioned. Probably ten times as much of this preparation is self-prescribed as is prescribed by physicians. It unquestionably contains drugs that should be taken only under medical advice, and yet physicians prescribe it in a manner which leads directly to self-prescribing by the laity. Is it possible that the Pharmacopeia offers no agent of equal or better merit? Has the manufacturer more wisdom than all the ages past—to say nothing of the present age of progress? Or is this an age of medical progress, anyway?

We herewith submit the proposition that the medical catspaw is pulling the proprietary monkey’s chestnuts out of the fire, every time he prescribes a proprietary article “protected” by special design and under a term that he who runs may read. The fakir laughs in his sleeve at the profession, and small wonder. It has come to pass that he owns us, and when his impudent agent demands a hearing at our offices we are tacitly given to understand that our time is his by right. 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. We are glad to welcome their representatives and their preparations. But, unfortunately, such manufacturers are a small minority. The physician should be careful how he prescribes the preparations of even reliable firms. Preparations with special and striking names should be prescribed under formula, where possible, and always in such a manner that the patient cannot prescribe the preparation for himself offhand.

We have much for which to thank some of our manufacturers, in the way of elegant and reliable preparations—honor to whom honor is due. We should none the less, however, guard our own interests. The manufacturers cannot always do so, and sometimes will not. There is no objection to secret methods of preparation of medicine so long as the formula is known. 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.

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. Let a man know that you are giving him a certain proprietary preparation and he values it only at the established market price. Give him the same ingredients in the form of a regular prescription, each item written out in its Latin name with the proper hieroglyphics for quantities, and he will rate you as a wonder worker. Add “aqua, quant. suf.,” and he is knocked daffy.

It’s simply another form of that peculiar trait of human nature which leads the average man to “kick” when his regular family physician charges $5 for making a ten-mile call on a stormy night, when he will travel the ten miles himself and cheerfully pay a specialist $25 for ten minutes’ consultation in the latter’s office.