ing suflicient organization to enable them
to know at least the professionals.
If he knew the fellow was bad pay, then
it was his poor business principle, and he
deserves what follows. Very often it is the
case that we know the fellow to be, if not
bad pay, at best very poor pay, and yet he
persuades us to take the case. This is very
poor policy, for while some are good col-
lectors and some are bad the general rule is,
the man who beats one doctor will beat an-
other.
Now, by organization I do not mean ihat
we should organize to point out the dead-
beats only, but we should set about to find
a plan to compel such patients to pay their
bills. There is no more reason why each
doctor in a town should be beaten by the
same man than there is that each doctor
should take a large dose of strychnia to see
if it really does produce convulsions. And
in order to compel the payment of bills, it
is essential that we unitedly refuse to con-
tinue to practice for dead-beats. Of course
there are cases that depend upon charity,
but no one of us would refuse a worthy
case of charity. Charity of itself is not
burdensome, but to do a practice expecting
your fees, and after much trouble and wor-
ry in trying to collect, arrive at the con-
clusion that though your patient is perfectly
able to pay, he has no intention of doing
so, is irksome.
These facts being so, why is it that the
profession goes on year after year in this
unsettled state making no effort to com-
bine.?
Are we all so industrious that we enjoy
taking the burden and responsibility of the
sick with no hope of reward.? No, I think
not. There are several factors which pre-
vent this union being brought about.
In the first place, the Quack is to a large
extent responsible for this non-union in the
profession. The Quack, as you all know,
is a fellow who is always blowing his own
horn loudly and in the most brazen manner,
lauding his ability and success to the sky,
while with equal zeal and untiring energy,
he grossly slanders the honest physicians of
the neighborhood and the profession in gen-
342
THE CHARLOTTE MEDICAL JOURNAL.
eral as being behind the times, incompe-
tant, and ignorant.
The under-graduate and the unlicensed
have much the same method of procedure,
that is they do not rest their reputation up-
on their merits or their successes, but by
slandering the profession and praising
themselves, try to put themselves upon the
same plain with the regular physician.
But, you say, "What has this to do with
our union or organization?" Of itself it
has nothing. But indirectly it has a great
deal, for in our eflfort to resent such slander
we do not always confine ourselves to the
parties in question, or perhaps I should say,
we have learned the lesson so thoroughly,
and know its effects so well that when we
have a grudge against any of our profes-
sional brethren, we are apt to attack them
in this way, and I might add that there are
so many of us, have so many grudges,
against so many of our brethren that the
habit has become quite general.
The individual confidence in self is an-
other factor. Each man feels his ability
to deal with problems and conditions, and
unless he bridles his tongue, he is apt to say
things which though meant in good faith,
are apt to injure the attending physician,
and are always taken by him as direct ef-
forts at slander.
Then too, self-confidence coupled with a
species of quackery, "bragging," makes us
represent our abilities as far above their
true worth, and strange to say the whole
profession has acquired this habit until each
one seems bent on out bragging the rest.
This state of affairs between doctors has
given rise to an unnatural rivalry which is
constantly increased by the very factors
which brought it about. Consequently
when they disagree (as they usually do) up-
on any case, each one considers the other
deficient to the exact extent of the differ-
ence.
This unnatural rivalry has reached such
dimensions that the profession is unwilling
to agree upon matters of vital interest to
all. It even refuses to agree upon a plan
by which it might force its dead-beats to
pay their bills.
The patient soon discovers this weak
point of the doctor, and especially that pa-
tient who is trying harder to avoid his bill
than to pay it.
The patient knows that wherever there
is much rivalry, flattery and slander will
play a good part, and so he sets about to
beat the doctor.
This he usually does by flattering him to
death and slandering his rivals. He tells
the doctor he is amazed at his wonderful
skill and ability, that it is generally con-
ceded that he is the best doctor in all the
country, and hints mildly or even comes
out boldly and says, that the other doctors
are jealous of him, and that it is only a
question of time until he will have the
whole practice, run his rivals out of busi-
ness, and "live happily ever afterwards."
Strange to say this scheme fails in fewer cases
than one would imagine, and if you will
follow it up you will find that the doctor
on whom it fails has very few patients who
do not pay promptly. Some how they
know or find out that its no use to send for
him unless they are going to pay. You
will also find that this doctor has a good
practice because no one appreciates their
physician more than those who pay up
promptly, and also because they know they
can find him when they want him. There
is no class of people so bitter towards a
physcian, or none who denounce him more
than those who never pa}^ him.
Those who never pay stick to one physi-
cian as long as he will work for nothing, as
long as he will credit them, but when he
begins to push for a settlement they try a
new physician and find fault with the old
one, not that he has not served them well
but because they want the world to think
they have paid him.
In other words those people who never
pay have found out that if one physician
will not treat them another will, regardless
of pay, and therefore they never worry
themselves to pay any one knowing that
they can get a new physician next time if
the old one refuses to go.
Thus it is that in the course of a few
years or even months one family will owe a
bill to six or eight different physicians each
one of whom may be ignorant of the fact
that any other physician has been in attend-
ance.
These men are all victims of our poor or-
ganization, and so long as the profession
remains in this unorganized state we may
expect to do much of our work for nothing.
I have no plan to offer but could we or-
ganize, a plan would not be wanting.
DISCUSSION.
Dr. James Shwyer. — I can only get up
and go over what we have just heard. It
is certainly a most excellent paper and hits
the nail on the head. I suppose we young
fellows feel this matter of organization and
co-operation more than the older ones, be-
cause the older ones have been at it long
enough to get a little surplus, but our sur-
plus is on the wrong side, and it keeps us
hustling to make ends meet. I had no idea
what sort of paper the doctor was going to
read, but I would be glad if some of the old-
THE CHARLOTTE MEDICAL JOURNAL.
343
er men would get together and organize
some plan. I can only say that the paper
is too true, from my own bit of experience
They talk sweet, pay two or three times
then run up a great big bill and that ends
it.
Dr. C. p. Ambler. — Our essayist began
his paper with an apology, but I do not be-
lieve he needed to make any apology for it.
The paper was timely, and certainly we all
need to profit by it here in Asheville, I did
not take it, however, that the doctor was
aiming so much at an organization which
would have a standard of fees as he was at
something in the way of an organization
which would help us in collecting those fees
we had already established for ourselves.
I know of no reason why a physician should
not collect. I believe he should, aud I fur-
ther believe the reason doctors lose so many
bills is that they do not make enough effort
toward collecting. We have educated the
people to believe that the doctor can be put
off to the last one. The doctor allows that
probably because he is afraid of offending
his patient. I take it that if any doctor's
services in a certain family are looked upon
in such a light that his trying to collect a
bill is going to offend that family, they
would be better off" in somebody else's
hands. They certainly do not appreciate
his services, and they are getting to the
point where they are going to somebody
else anyhow. I make it a point to send
every patient I have a bill once a month.
On the first of every month every patient I
have, whether he is able to pay or not, is
presented with a statement of his account
to date, and he is expected to pay. Many
do not, yet many of them pay in the end.
If I have a poor case that is all right, his
rate is made according to his ability to pay.
I have many I do not charge, as most doc-
tors have, but if a man can pay, that state-
ment coming on the first of the moth is sim-
ply a reminder, and shows him how his ac-
count is growing. In that way the patient
does not run up a big account which he is
not able to pay. If you present your b'll
but once a year it will be an account which
staggers the patient, while if you had been
presenting your statement as time went a-
long it is only growing as he knows it, and
if he is not going to be able to take care of
it he will tell you, or something will happen.
I believe every man should have a bill-head
and on that should be stated plainly that all
accounts will be rendered on the first of
each month. That statement will go to
many persons who, when they see that, will
make some effort to settle. You may have
some patients you have had for years. If
you know they are good pay and don't care
to send them a statement on the first, don't
send it, but if you have some who are luke-
warm, or just running up a bill, that state-
ment is going to be a good reminder. If he
ignores'it, the next time he comes in tell
him you believe he has received your state-
ment, and your rule is to have some under-
standing at the first of each month. I ap-
preciate that it is difficult in general practice,
but I do believe if the doctor in general
practice would send his statements regular-
ly he is not going to offend the better class
of his patients, and he will keep in touch
with them in his accounts and get his mon-
ey better. I think occasionally that a doc-
tor, as any other business man, should sue.
I know it is not the custom, but where a
person is able to pay and simply does'nt pay,
I believe the doctor is justified, and more-
over he should have the courage to sue, es-
pecially here in Asheville where we have
patients who come from a distance, run up
quite a bill, and suddenly leave town with
their account unpaid. I think it is the duty
of every physician here to see that the peo-
ple, especially those from a distance, pay
their bills before they leave town. My ex-
perience has been that those who leave
town without paying don't pay, and if I
have a patient with whom I run an account
I always make a sattlement before he leaves.
I either make him give me a draft on his
bank at home, or a due bill, and if he gives
a draft he does'nt like his bank to know he
isn't going to honor it, I have been guilty
of levying on baggage and of attaching
a horse and buggy in Asheville. The man
was amply able to pay, and had represented
that he was a man of no means, and I founa
out he was perfectly able to pay, and ascer-
taining that he was going away I simply
attachen, as he ignored all my statements.
I think that is a doctor's privilege, the same
as that of any other business man. As the
essayist has said, our capital is the knowl-
edge or advice we give our patients. If
you are not going to protect that capital it
will become cheap capital among the people
with whom you do business.
Dr. Fletcher, — I have practiced medi-
cine here for ten years, and I thought I had
gotten through with all the dead-beats in
town. When I came here every doctor un-
loaded what he had on me, and it was a
burden to me for years, but I am still at it.
Every once in a while I have a new one.
We once thought a fee bill was the correct
thing. I was a little more candid and out-
spoken than some, and I furnished a dead-
beat list. A few of the others furnished
one. The rest of them got the benefit of our
experience, and I never heard any more of
it. I see it every day and I^have watched it
344
THE-TCHARLOTTE MEDICAL JOURNAL.
for years, a man will work one doctor for
awhile, and wait for a new one to come a-
round. Here is the trouble about the dead-
beat. There are plenty of doctors in every
town who cannot refuse a fee. For in-
stance, a dead-beat comes to you and says-
"I have the money to pay you." They get
you there and get you interested in the case,
and you cannot very well refuse to throw it
up then. They know how to work you.
They pay you for one visit and get you to
work and you do 50.00 worth of work. It
is a difficult question. We have a great
many floating dead-beats here, people who
come from the out-side. As Dr. Weaver
says, the fault of course lies with the doctor,
but what the remedy is I am not prepared
to say. I wish we had some way of collect-
ing our fees. I never have seen that a doc-
tor did wrong in suing the patient, because
every man is entitled to his pay.
Dr. Watson. — I did not hear the paper,
but I have maintained for a long time that
we need a fee bill as a standard for collect-
ing bills, if nothing else. I have never sued
a man, but if 1 should sue one and go before
the courts I would like to have something
on which to show I would base my fees,
and if it served no other purpose it would
at least give us a standard of charges which
we all recognize if we do not adhere to it in
our practice. Many of us would adhere to
it as near as we could. I would not want
to be bound by any fee bill, but I think
that answering that one purpose of having
a standard of charges that we might go into
court which would be an advantage. I did
not hear the paper, consequently I am not
prepared to discuss it.
Dr. Brownson. — I neverunderstood why
our blacklist was discontinued. We decid-
ed three or four years ago to have one I be-
lieve, and this list was sent out monthly I
believe, and then it dropped, but I never
understood why, I was given to under-
stand that some man on the black-list threat-
ened to sue for blackmail, and that it was
discontinued on that account, but I doubt
very much whether a dead-beat who never
pays his bill could threaten any doctor by
saying he could sue him for giving the in-
formation broadcast that he does not pay
his bills, and while a fee bill is desirable I
think it more desirable still to have a black
list, so that all physicians will know who
will not pay.
Dr. Paqjjin. — It occurs to me that this
discussion is very timely indeed, and also
that the blacklist is very necessary. The
method of applying may seem to be danger-
ous. The very paper that has been read
this evening passed through my head last
night. The application came to me because
of an occurrence in the past week, which
has not been a new one. It occurred to me
then that if this Society had a by-law or
constitution which would put it into execu- •
tive session whenever it met, and that each
man would report his names and let the
others take it down then and there, that it
would serve a good purpose. There are
men in this town who make it a business to
go from doctor to doctor. They pay a little
fee for the first time and never pay any
more. You have all seen them, and I think
this would be one way of getting at it, not
only be voluntary, but compelling members
who have had such experience to give the
names in, and let every man put it down,
and when such men come to your office if
you'd not want to practice without fee re-
fuse them. There is no reason why the
doctor should spend his time and knowledge
night and day sometime, and get nothing
but abuse for it. I am very glad the paper
was brought out. I had made up my mind
to take it up myself, but it was brought out
so beautifully that I am glad the doctor se-
lected that subject.
Dr. Ambler. — Hasn't it been the ex-
perience of every member that those who
have talked and lied about him have been
the patients he has sometime allowed to
carry accounts on his books, and which he
has never made any very great effort to col-
lect.
Dr. Fletcher. — It costs about two dol-
lars to take a judgment, and that is just two
dollars of good money thrown after bad.
Dr. Ambler. — My idea is that if you
keep after him from month to month he is
going to drop from you and go to some one
else, and in that way you are going to weed
out that class of patients who are never go-
ing to do you any good.
Dr. Reynolds. — My experience has been
from beginning to end just the same. They
call me out at one or two o'clock at night,
carry me anywhere and say they will pay
me, but when you send the bill they will
not do it. Send a collector around and pay
him for his time, and if you don't pay him
he won't collect. I can't collect any bills.
Of course some patients pay without pre-
senting a bill, and others pay as soon as you
present, but the majority of patients you
have to ding dong to get the money, and I
would rather lose my money than attempt
to collect it because you can send half a mile
and they will pay you fifty cents or a dollar,
and you can send them fifty times again and
not get a copper, but if we had a black list
and every doctor stuck to it we could col-
lect our bills, and if we want to do any
charity work we can do it.
Dr. McBrayer. — In my earlier days I
THE CHARLOTTE MEDICAL JOURNAL.
345
thought I was splitting the wind and I was
going anywhere. I got a little tired some-
times, and one week I began to take notes.
Sunday night I was called out during the
night and went. Monday night some boys
got into a fight and I was called and went.
The boys said they had the money. I went
down and fixed up the fellow's head and
charged him $5.00 and got 50 cents. Every
night that week I was called out, and I was
hustling, and at the end of the week I still
had 50 cents for my night work, and some
of my colored friends came after me on
Saturday night, and I said, "Now I will
charge you $3.00; you understand that.
Have you got the money .^" They said, "It
is right there in the house." I said, "I am
not going without it", and they said it was
all there and I could get it. I went. When
I got there among othere symptoms I asked
about was the cash. He said, "I thought
you were one of these hospital doctors.
They work for nothing." I said, "You
were mistaken this time. If you can afford
to send me a lie to get me to come to you I
can afford to go back without doing any-
thing for you" and I picked up my hat and
left.
Dr. Glenn. — I did not get to hear the
paper, but I can tell a story like I heard
some of the others. About two and a half
years ago I was not feeling well one even-
ing, and a fellow came in for me to attend
to his wife. I asked him if he had the mon-
ey and he said yes, he had it where he could
get it next morning, and I told him what
my bill would be, and he said that he would
come back with me to town to see that I got
it. After the delivery I asked for my fee.
He was standing in front of the fire-place.
and he said — "I don't owe you anything."
I said — "Why don't you; isn't that your
wife? "Yes." "Is that your baby.'"'
"Yes." "Didn't I come and wait on her
last night?" "Yes, but I expect my moth-
er-in-law to pay that bill." And I haven't
seen them since. I went to see another case
one snowy night. The fellow telephoned
me that he would pay me corn. I told him
that would be all right if he would haul it
in, and I went down and went to the barn
with him to put up my horse, and I said —
"Where is your corn?" He said he had a-
bout 3^ bushels at the house, and that was
all be had. I said — "I thought you said
you were going to pay me corn." He said,
"I did, but I didn't say how much."
Dr. Weaver. — I find that in my part
of the country the trouble is not so much
with the fee — if some fellow wants to go
for fifty cents where he ought to charge
two dollars he can have it — but the trouble
is that they will agree to pay you and per-
haps pay you for one trip and get you
started, and never pay you any more. You
may hound them and hound them and they
will just lie to you as long as you get after
them. They will say they will sell one of
their mules, and if that isn't enough he will
sell his wagons, and that is all you get.
Once I was called to see an old lady 60 or
70 years of age, stingy as she could be, a
widow who had a two or three thousand
dollar farm and well fixed. She sent for
me, and I had been there several times and
never had been able to collect anything.
She would always tell me: "I can't pay
you money, but I will bring you oats or fod-
der or hay." Well she got sick and sent
forme, and I told the boy: "If you can
secure me I will go," and he said : "I will
give you a mortgage on a mule if you will
go on," and I said "Alright, I will fix it
up here; I know what my bill will be."
He said he could not do that, but he would
as soon as I got there. I said all right. He
went on ahead of me, as I was not ready
to go then, and whan I got there the mule
was there but the boy was gone. I waited
on the old lady, and said, "Where is Jim."
She said, "He has stepped off, and you go
ahead and dose out your medicine and he
will be back." I said, "Mv medicine is
all in tablets and I can dose it out in a min-
ute." I waited there and finally I said I
had to go home, and if Jim didn't come I
would go home. She said, "You won't
leave me here to die." I said, "No, but I
know what is the matter with you, and I
will send you the medicine. Well I started
off and met Jim on the way, and he said
"Have you given her the medicine?" And
I said no, and he said, "Well come back
and I will give you the paper." Well he
gave it to me and I had it registered. About
the time it came due he came in to see me
and said, the crops had been bad, and
wanted to know if I would take 75 cents on
the dollar and call it square, and I said,
"No, I am going to collect that mortgage"
and I sent for the mule and the mortgage
was paid. There is one section in Madi-
son in which I never have any trouble.
There is another section, where I practice
most, where they never pay me. I suppose
I have made a hundred trips to place called
Bear Creek, the first summer I started prac-
ticing, and I never got a cent for any of
them. These fellows will circle round.
They go from me to the other physicians
there, and in the course of twelve months
they come back to me and say they have
tried these doctors and I am the man they
want, and they have got the money, or
some wheat or fodder they are going to
sell and pay me. That fellow has got to
346
THE CHARLOTTE MEDICAK JOURNAL.
have a doctor, and if we combine and set
down on this dead-beat business they will
manage to pay. They are obliged to have
your services, just as much as a man is
obliged to have bread and meat, and if we
make this rule and stick to it we will break
this up. When I began to practice there
was an oid physician in consultation with
me at a case of labor and he had to use the
forceps. The fellow had told me he had
the money then, and when we finished up
and started I said something about the bill,
and he said, "Gentlemen, I knowed I would
have to tell you a lie to get you here. 1
haven't a cent to save my life." I lit in to
cursing. The old doctor is a preacher and
he backed off. That fellow is a dead-beat.
He was not worth over his homestead. He
was able to pay a small bill though. We
educate them to this. It is no use for one
physician to try to make that man pay him.
The tiling must be done through a union.
In my country there are a lot of fellows
who are not graduates and actually have
the cheek of a government mule. They
introduced a bill before the last legislature
to grant a man a license who never had
seen the inside of a medical college, and it
took considerable work to defeat the bill.
The thing must be done through a society.
You cannot run those fellows out of prac-
tice. If I were to indict them they would
run me out of the country. They would