The 
Successful Thysician 
By 
Verlin C. Thomas, M. D. 
la- 
vishing Physician to Franklin Hospital, San Francisco 
Philadelphia 'anoLondon 
W. B. Saunders Company 
1923 Copyright, 1923, by W. B. Saunders Company 
MADE IN U. S. A. 
PRESS OF 
W. B. SAUNDERS COMPANY 
PHILADELPHIA PREFACE 
Life is a road and Success is the destination. 
There are good roads and bad roads, highways and 
rough wagon paths. 
He who keeps on the highway and follows the road 
signs, reaches the end of the journey quickly and easily. 
He avoids the bumps and the detours, he saves expense 
and worry and, when the trip is over, he is happy and 
contented. 
The wise traveler uses a guide book and takes advan- 
tage of all the shortcuts. He follows the advice of those 
who have traveled the road before him and who had to 
feel their way through uncharted thoroughfares. 
A book, such as this, is like a guide book. It points 
out the way and shows the straightest and best paved road 
to the goal. 
But before the automobilist can use a guide book, he 
must learn to drive his machine and should know its 
mechanism. The young medical man, who is about to 
enter upon his career as a physician, should first be 
thoroughly familiar with all the theoretic requirements 
of his calling. 
So much has been assumed in the preparation of this 
book—that the young practitioner is properly prepared 
to practice medicine; that he is mentally and morally 
qualified to follow the profession; that he is physically 
strong enough to meet the exacting conditions and that 
he is willing to make those sacrifices which make him 
5 6 
PREFACE 
worthy of those who are his contemporaries and who 
have gone before him. 
The young doctor should realize one thing above all 
others, that the conditions confronting him in real life 
are entirely different from those in college and in the 
hospital. The student finds everything idealized. All 
his requirements are met and he lives in a Utopia. He 
asks and he is given, he seeks and he finds. The character 
of the people whom he will have to meet; the business 
side of the profession; the sordid matter of finance and 
bookkeeping; the stern law applying to physicians and 
all the other annoying details that are bound to crop up 
later in life are utterly neglected during the student 
years. Often, therefore, the young doctor is puzzled and 
vexed and disappointed, blaming his teachers and feeling 
that he has been cheated. 
The knowledge of medicine is the first essential, of 
course, in the practice of the medical profession. But it 
is not all, by any means, and to fill the gap between 
theory and practice, this book has been written. 
It is intended as a guide-book—showing the way and 
helping the traveler to keep on the right road. It cannot 
make the blunderer efficient; it cannot make the misfit fit. 
But this book can, and will, if read carefully and followed 
wisely, help to avoid the errors that others have made. 
It is based upon experience, and supplies the information 
which college text-books lack. 
The medical man must be practical and efficient. 
He must know how to meet the public and how to handle 
it. He must be familiar with accepted professional 
methods of practice and follow certain rules of modern 
life which apply to all activities of society. 
To meet these needs this volume has been conceived PREFACE 
7 
and it is dedicated to the doctor who wants to be a better 
citizen and valuable member of his community. 
I wish to express my sincere appreciation for the 
valued assistance given by the Superintendents of Nurses 
of St. Luke’s, Franklin, Lane and City Hospitals for 
the ideas on “The Doctor and the Nurse;” Mr. Clare 
Walker Banta, Vice President; J. A. Sieberlich, Manager 
of Service Department and Miss Marian S. Stayner of The 
Wells Fargo Nevada National Bank, San Francisco, for 
assistance on “The Doctor and His Investments” and 
“ Statistics of States;” Mr. J. B. Duryea, Manager of San 
Francisco office, Penn Mutual Life Insurance Co., for 
the article on “Life Insurance;” Mr. James P. Murphy, 
Counsel for The Medical Protective Co., Fort Wayne, 
Ind., for “ Malpractice Insurance,” and The Rebman Co. 
of New York for permission to use excerpts from Mr. J. 
Valentine Mitchell’s “The Doctor in Court;” Dr. N. P. 
Colwell of American Medical Association for Statistics 
on Doctors, and Mr. S. 0. Banks of The McCaskey 
Co., Alliance, Ohio, for “ Office Systems of Accounts and 
Collections.” 
I am especially indebted to Mr. Erich Brandeis for 
his valuable assistance in arranging, editing and revising 
this work. 
V. C. Thomas, M. D. 
San Francisco, California, 
January, 1923. CONTENTS 
CHAPTER I page 
Personality 11 
CHAPTER II 
How to Attract and Hold Patients 41 
CHAPTER III 
Choice of Location 65 
CHAPTER IV 
How to Recome Favorably Known in a Large City, Small City, 
or a Country Town 89 
CHAPTER V 
Changing Ability into Income 98 
CHAPTER VI 
The Various Forms of Practice 115 
CHAPTER VII 
Office Equipment and Management 138 
CHAPTER VIII 
Office Systems and Accounts 156 
CHAPTER IX 
The Doctor and His Investments 169 
CHAPTER X 
The Physician and the Pharmacist—The Physician and the Hos- 
pital—The Physician and the Special Nurse 183 
CHAPTER XI 
The Physician and the Law 210 
9 10 
CONTENTS 
CHAPTER XII 
Ethics 232 
CHAPTER XIII 
Demeanor in Critical Cases. Stating the Prognosis 261 
CHAPTER XIV 
Insurance 277 
CHAPTER XV 
Vacations and Hobbies 283 
CHAPTER XVI 
Grist prom the Mill of Experience 288 
Index 299 The Successful Physician 
CHAPTER I 
PERSONALITY 
What is personality ? 
Webster defines it as “that which constitutes or per- 
tains to a person,” and with that sweeping definition says 
that you, yourself, are your personality. 
Personality is absolutely essential to success. 
Upon your personality depends the impression that 
you will make on those you meet, an impression that will 
influence their desire to have professional or business 
dealings with you. 
It is personality that closes the salesman’s contract; it 
makes a man a good or a bad actor ; it sways juries and 
even inspires love. 
Bradstreet, the commercial authority, states that busi- 
ness success or failure is largely a personal matter. 
Incompetence, inexperience and insufficient capital are 
responsible for a large percentage of failures, but a lack 
of personality is one of the most noticeable elements. 
Medicine, after all, is a business, for while, true 
enough, it is also a profession, dollars and cents are as 
necessary to its pursuit as they are to the operation of a 
five-and-ten-cent store. 
In every business salesmanship is required. In the 
practice of medicine one cannot advertise nor shout his 
wares. Personality is one of the doctor’s chief assets and 
11 12 
THE SUCCESSFUL PHYSICIAN 
therefore the perusal of the following pages is of vital 
importance to the physician who wishes to be successful. 
What Is Personality and How Can It Be 
Developed ? 
Personality is not a fixed thing, born with you and 
beyond the reach of your control. It is the reflection of 
your character and grows as you grow, develops as you 
develop. 
“Your personality is composed of your body and all 
the ideas you have in your mind. Three great factors 
influence your personality—your knowledge of, your 
interest in, and your attitude toward the world.”* 
Everything that you have experienced since your birth 
has made some impression on your mind and every change 
brought about by experience has altered your trend of 
thought. As this thought develops, your personality 
develops with you, and hence a strong mind develops 
a strong personality. “As a man thinketh so is he,” 
and as he is, so is his personality. 
You cannot hide your real self from the world. Your 
personality is the mirror which reflects with cruel faithful- 
ness your true character. You may try to disguise your- 
self but you cannot. By your personality you will 
attract or repel. 
You should not confound temperament with person- 
ality. Temperament is more or less of a permanent 
nature. You are born with it; it is a heritage. But the 
development of your personality rests with you, and 
by constant watching and thought you may make it a 
valuable asset to yourself. 
* Hugo Miinsterberg: Psychology and Industrial Efficiency. Houghton 
Mifflin Company, 1913. PERSONALITY 
13 
While personality is an intangible element, an abstract 
thing, and cannot be seen under the microscope nor 
dissected by the operating knife, certain positive elements 
are a definite part of it and these elements can be analyzed 
and studied. 
Sincerity 
Let us suppose that an aspirant for political honors 
could convince the people of his absolute sincerity. What 
a hold he would have upon them—to what heights he 
could climb! Much of Theodore Roosevelt’s political 
success was due undoubtedly to the fact that he had the 
general confidence of his constituents, that his personality 
impressed the observer as being entirely frank and sincere. 
Your knowledge of medicine may be extensive. You 
may have devoted many years of hard and conscientious 
study to the mastery of your profession. You may have 
all the technical requirements for a successful physician, 
but if the people of the community in which you intend to 
practise do not trust you,—if your personality does not 
inspire confidence and faith in you,—all your wisdom 
will be useless and you must struggle along, doomed to 
failure. 
The history of every successful man shows that sincer- 
ity is one of his outstanding characteristics. Before you 
can approach others with sincerity you must be sincere 
with yourself. You must believe in your profession, in 
the decency of people, in the world in general. Your 
outlook on life must be optimistic and you must search 
for the good even in those whom you consider bad. 
Carlyle says—“I should say sincerity, a deep, genuine 
sincerity, is the first characteristic of all men in any way 
heroic.” 14 
THE SUCCESSFUL PHYSICIAN 
Tillotson writes—“He who is sincere has the easiest 
task in the world, for, truth being always consistent with 
itself, he is put to no trouble about his words or actions. 
It is like traveling in a plain road which is sure to bring 
you to your journey’s end, better than by-ways in which 
many lose themselves.” 
If you dedicate your whole being to the cultivation of 
the virtue of sincerity, no obstacle will keep you from 
attracting the attention and gaining the devotion of men. 
The insincere man lives a life of lies and no lie can long 
remain undetected. The most notorious criminals live 
dual lives. They depend for their success upon some form 
of honest endeavor. Their life is a sham, and they are 
most frequently caught because in some unguarded 
moment this sham is disclosed. It is for this moment 
that the hunters of men look. 
You may be able to get along quite well for a time by 
living a life of lies, but eventually you will be discovered 
and all that you will have acquired is the contempt of 
your community. The force of all the elements is against 
the liar. In the end you will be known for what you really 
are. Your impure mind, your dissolute habits, the dis- 
honesty of your purpose and your false claims of superior 
ability will become known some time, and you will be 
exposed in your real mental and moral nakedness. 
If you are inclined to be insincere—and you know it 
if you are—the remedy lies within yourself. Pitiless 
self-analysis, absolute discipline of mind and body, com- 
plete control of all your mental faculties—that is the treat- 
ment which you must prescribe for yourself and adhere 
to. 
Although this may sound simple and appear easy, but 
you will find that you have set your self a hard task. PERSONALITY 
15 
Character is not developed at once. It is not born with 
you, but must be cultivated and cared for like a rare 
plant. 
We live in a world of sham and make-believe. It is 
every man’s ambition to become rich or famous, or both, 
and he who has not reached his goal wants to appear in the 
best light. Herein lies the principal danger. Forget 
appearances: be your real self. 
Integrity 
To acquire the virtue of sincerity you must be honest. 
The dishonest person is forced to he in order to cover his 
shortcomings. The man of integrity lives in the open; 
his acts bear the piercing searchlight of closest scrutiny. 
In many ways the practice of medicine is a paradox. 
It has numerous features that are peculiar, and methods 
which would be considered advisable in business are 
entirely impossible in this profession. 
In most lines of commercial activity the success of 
salesmen is determined by the volume of business pro- 
cured. An expert in commercial lines is expected to sell 
to a customer more than he intended to buy. Commercial 
firms aim to develop every new opening for their output, 
and use every known device to create a demand for 
their products. The most extensive campaigns of adver- 
tising and promotion are carried on for this purpose, and 
widespread publicity is considered a valuable aid in 
securing business. 
The physician works exactly in the opposite direction. 
His purpose is to cure disease, and, by bending every 
effort to prevent the spread of sickness, he limits his 
market. If he is honest, he will seek to cure his patients 
as quickly as possible and sacrifice money to render service. THE SUCCESSFUL PHYSICIAN 
16 
This sort of work requires integrity of the highest type. 
It is not at all difficult for a medical man to make money 
for a time if he is unscrupulous. There is a class of 
patients who fall an easy prey to the practitioner who 
lacks conscience. There are the neurasthenics and those 
suffering from sexual exhaustion. There are those who 
have been ill and who refuse to believe that they are cured. 
There are the women who imagine that they have some 
private ailment and who can easily be encouraged to 
believe this to be true. There are those who are readily 
frightened in an epidemic and those who believe that they 
have every new disease. There are men and women with 
guilty consciences who insist that they suffer from blood 
diseases due to indiscretions. There are the weak, who 
can quickly be frightened into believing almost anything, 
and the large family of hypochondriacs and the poor, 
unfortunate incurables. All of these will come to you. 
Every one of them may be bled white. Some will insist 
on being treated even if the physician advises against it. 
It is easy to lull one’s conscience with the solace, “If I 
do not take his money, some other doctor will.” But if 
you fall into this trap, you will lose that honesty to your- 
self which you must possess in order to be honest with 
others. Trickery may secure a successful practice, but it 
is a poor substitute for integrity. There is no halfway 
station: you are either honest or dishonest. 
In the every-day pursuits of business, honesty is a 
negative virtue. You will be considered honest if you 
do not violate the laws; if you do not break your word or 
do not defraud another of his property or valuables. But 
in medicine, integrity is decidedly positive. As a physi- 
cian, you are entrusted with the life and welfare of your 
patients. In your keeping is often placed the honor of PERSONALITY 
17 
an entire family. There can be no two forms of honesty 
in a physician’s fife. His course must be straight and in 
spite of all temptations, he must not deviate from it. 
You are not expected to go through life without making 
mistakes, but the man of the highest type will admit his 
errors and thus earn a reputation for telling the whole 
and the absolute truth. 
This reputation for complete integrity is one of the 
prime virtues on which your success must rest, and with- 
out it you can never hope to endure in your profession. 
You must give before you can receive. You must help 
others before good will come to you. 
No matter what the incentive for gain or profit may be, 
your patient’s welfare must stand first. He comes to you 
in the hour of his need, and to fail him would be as great 
a sin as for a mother to fail the child who places implicit 
confidence in her. 
Loyalty 
It is almost superfluous to enlarge on the value of 
loyalty to the recent college graduate. This quality has 
become almost second nature to him, and ever since his 
early school years the sense of loyalty has been fostered 
in him. As a child it was loyalty to father and mother— 
and this loyalty usually lasts through life. In high school 
it was loyalty to principal and teacher, and in college his 
particular instructors were the best of all to him. You 
probably well remember some heated arguments around 
the fraternity table about the superiority of this or that 
professor. 
However, as life goes on many of our ideals are thrown 
into the discard of forgotten things, and in many cases 
loyalty is among them, selfishness taking its place. And 18 
THE SUCCESSFUL PHYSICIAN 
yet loyalty is not only a virtue, but it can be made a 
valuable asset. Loyalty brings friendship, friendship 
brings confidence, and confidence brings success. 
You should be loyal to the classmates with whom you 
went through college. They can be of great assistance 
to you through life, just as you can help and cheer them. 
The associations you made in your student days should be 
continued. Your class will be scattered to the four winds, 
but you will find the keenest pleasure in maintaining rela- 
tions with your former associates, in taking an interest in 
their activities, and in turn receiving encouragement from 
them. 
Loyalty to your friends is one of the noblest virtues 
you may hope to possess. It gives you a sense of security 
and satisfaction that you cannot win in any other way. 
If you have friends,—not casual acquaintances who often 
call themselves friends, but real friends who have been 
tested through the trials of life,—you may safely assume 
that you are traveling in the right direction. 
You should also be loyal to your employers and to 
those whom you employ. You should give the best that 
is in you to those with whom you are associated, and you 
should give full credit to those who have helped you. 
When you begin practice in a new community, do not 
give the impression that those who come to you are 
inferior to you. When you hear of another physician 
who has devised something new, do not try to belittle him 
or his efforts. Give honor where it is due. If you 
acquire renown in your chosen profession and are consid- 
ered an authority, give to others who are just starting 
the same aid and the same advice that you required when 
you were a novice. There are men who are incapable of 
being loyal to any one. They only know their own selfish PERSONALITY 
19 
desires and their one aim is to make use of every one 
with whom they come in contact. These men often 
seem to be successful, and frequently are, in the material 
sense of the word, but they cannot know true happiness, 
which does not exist without friendship. It is in the 
periods of distress which every man experiences that loyal 
friends prove a blessing, and their mental and moral 
support greater value than financial aid. 
There can be no happier moment than that in which 
you find that yDur friends have remained loyal to you in 
time of need, and no disappointment can be greater than 
to find that those whom you trusted have deserted you 
when you needed thetn most. To make loyal friends one 
must first learn to be loyal to others. Because one man 
or one woman proves faithless to your confidence should 
not discourage you. Do not abandon the search; the 
miner in quest of gold has many failures, but when 
he finds the precious nuggets he appreciates them so 
much the more. And so it is with friends. They are 
not easy to find—if they were, friendship would have no 
value—but if you do find them, or even one of them, hold 
on with all your might. 
If you wish to obtain a good example of the elemental 
value of loyalty and friendship, watch a patient who is 
stricken away from home. Often, in the still of the night, 
you will see him with his eyes wide open, staring into 
vacancy, thinking of the places where his friends are, 
yearning for those who are loyal to him. Or you may 
hear him sob quietly, filled with fear that he may die 
while he is alone among strangers. This is the time when 
you will see that the sense of loyalty is really an elemental 
thing in the human being, and why you should cultivate 
it to the best of your ability. 20 
THE SUCCESSFUL PHYSICIAN 
Have you ever noticed how a patient clings to his 
nurse? She is the one human being who administers to 
him and gives him those touches of friendship that he 
needs. It may be paid friendship or it may be that fine 
sense of duty and loyalty to the cause which, thanks to 
nature, most nurses possess. Very often, when the 
physician despairs of his patient’s life, the nurse may save 
him because she supplies that infinite element which eases 
the patient’s mind and makes him susceptible of recovery. 
The physician who shows loyalty to and interest in 
his patients will find that they are more easily cured. 
Again it is that soothing feeling that you are his friend 
which makes him yield more readily to your treatment. 
Develop loyalty and friendship, and with it that 
quality of kindness and friendliness which makes life more 
easy to live and troubles less burdensome to bear. 
Your greatest asset is a loyal patient, one who will 
never think of consulting any other physician; who will 
recommend you to all his neighbors and friends; one to 
whom you are all wisdom and goodness combined. 
He is your only advertising medium; he constitutes the 
one method of publicity in which you may indulge. Cul- 
tivate your loyal patients. No matter how large the 
circulation of a newspaper or magazine may be, nothing 
travels so fast as the word of mouth; nothing brings more 
beneficial results. On the other hand, nothing is so 
dangerous, so detrimental and destructive, as the wagging 
tongue. Should one of your patients be disloyal to you— 
particularly in a small community—should even the least 
of them condemn you and attack your efficiency, you will 
soon find that the ripple of gossip and vituperation has 
become a tidal wave that will sweep away your reputation, 
your practice, and your name. PERSONALITY 
21 
Good Nature 
No seed produces such prolific flowers as the smile; 
no investment brings such ample returns as a pleasant 
countenance. 
A cheerful greeting dispels grief; it soothes pain; it 
spreads happiness. Be good natured and your company 
will be sought; be grouchy and you will be shunned. 
Why is the comic page of a newspaper so popular? 
Why do motion-picture producers pay the highest prices 
for comic scenarios, and why are the theatres crowded 
when humorous plays are billed? 
The world is a troublous place. It is full of dis- 
appointments and worries. Hence the public pays 
a high price for good cheer. 
I know a man who became leader of the state senate 
merely because he was good natured. He had no other 
qualities that made him stand out from the rest, but he 
could smile; he could clasp a man’s hand in a cheerful 
sort of way and inquire good naturedly about “the wife 
and children,” Every one liked him and was pleased to 
be in his company. 
Human beings are so constituted that likes and dis- 
likes play a very important part in their lives. Not 
infrequently a disagreeable impression created on first 
acquaintance can not be dispelled by anything that 
may occur later. A pleasant countenance and a sincere 
smile always create a good impression. Every one likes 
to feel that people are glad to see him. We are more 
apt to do business with those who appear happy when 
they are with us than with those of a solemn countenance. 
However, good nature should not be confounded with 
intimacy. While is it good to have many friendly 22 
THE SUCCESSFUL PHYSICIAN 
acquaintances, it is unwise to have too many close friends, 
particularly when one lives in a small community or when 
his life is centered in a small circle. 
The average person does not care to go to a close friend 
with his troubles, because he wants his friends to have the 
very best opinion of him. It is also a well-known fact 
that if a person knows too much about your private affairs 
he usually loses some of the confidence and respect that 
he has if he knows less about you. When a man is well 
enough acquainted with you to call you “Jim,” he will 
not be so apt to pay you five or ten or twenty dollars for a 
consultation, partly because you have become much too 
human to him, and partly because he thinks that since you 
are his friend, you will give him your advice gratis. 
I know of a case where a physician was one of the 
most popular members of his circle. He was the life of 
every party; he was invited to dinners and dances and 
was one of the social lions of the community. When his 
friends were sick, however, they did not go to him. They 
would call him up and say “ Bill, I don’t feel at all well; can 
you recommend a good doctor ? ’ ’ And since ethics forbid a 
physician to advertise himself, Bill had to send his friends 
to his competitors. 
On analyzing the situation he came to the conclusion 
that he was cursed with too many confidants but not 
enough confidence. Doctor Bill moved to another locality 
where his personality and good nature stood him in good 
stead, as they had before. He made many acquaintances 
but few friends. The result was that he not only built 
up a large practice in his new environment, but that his 
old friends, whom he saw less often now, also came to 
him with their ailments. 
Be cheerful with your patients. Leave solemnity to PERSONALITY 
23 
the undertaker; with him cheerfulness would be in bad 
taste. Optimism will often do more than medicine to 
encourage a sick person, and a pleasant smile may be a 
better remedy than an opiate. 
The patient who comes to you may fear that he is very 
ill but hopes that he is not. He watches your face as you 
examine him, and while your verdict may be only a matter 
of routine to you, to him it is a matter of the utmost 
importance. Therefore, even if you have to tell him 
unpleasant truths, do not kill his hope. 
Confidence 
Each community is made up of leaders and followers. 
In leaders you will always find that self-confidence is one of 
the outstanding characteristics. 
Self-confidence begets confidence. Before you can 
expect to lead people you must be sure that you know 
where you are leading them. But you should not assume 
a “know-it-all” attitude, and try to impress others with 
the belief that they know nothing. Self-confidence is not 
over-confidence, and conceit is as dangerous as inordinate 
modesty. The successful man is never vain. Achieve- 
ment never boasts, but it knows and it knows that it 
knows. 
Do not think that all you need is a knowledge of 
medicine, a large amount of self-confidence, and a 
shingle to bear your name. All successful physicians 
to whom I have spoken, had to work hard and climb 
slowly. They had many a lean month and many a hungry 
day, but they never lost their courage and confidence 
in their own ability, and their will power to make good 
eventually pulled them through. The physician who 
discovered anesthesia had almost to go down on his 24 
THE SUCCESSFUL PHYSICIAN 
bended knees to induce people to try it, and the surgeon 
who performed the first operation for removal of the 
ovaries was jeered and condemned. These men continued 
to employ their methods in spite of the fact that they 
knew that the mob was ready to stone them had they 
failed. They had confidence in themselves and they clim- 
bed to the top. Remember you who are about to start to 
practise, and you who have not yet received the rewards to 
which you think you are entitled, that the practice of 
medicine is not a get-rich-quick scheme, but a service to 
humanity based upon clear-cut knowledge and certain 
virtues. Each of these virtues must be developed by 
hard, laborious effort and self-confidence is one of them. 
To become a successful physician requires steady, 
persistent, unremitting labor. Opportunity will not 
come in to have a chat with you and urge you on. You 
may have only a fleeting glance at her as she passes by in 
the crowd. It is your duty to recognize and induce her 
to stay. To meet that opportunity you need self-confi- 
dence. You must be able to say—“ I can do the work ”— 
and you must be able to make good your pledge by knowl- 
edge and firm belief in yourself. The most depressing 
spectacle is the man who bears the stamp of failure. 
Men are out of work not because they cannot find it, 
but because they do not know how to do it when they 
secure it. The moment you become discouraged you lose 
the grip on yourself. 
When you make a statement to a patient, show by your 
word and manner that you have a confidence in your own 
statements. If you show the slightest sign that you, 
yourself, do not believe in it, the patient will not take 
your advice. If you are a hypocrite, your bearing, your 
eyes, the tone of your voice will betray you. Self-confi- PERSONALITY 
25 
dence breeds enthusiasm and enthusiasm makes for 
leadership. Be honest with yourself and then you can be 
honest with others. 
The very thought that you are engaged in a profession 
which helps those who are in misery should make you 
self-confident and enthusiastic. To know that you 
have been able to give comfort and happiness to others 
should be a source of the greatest happiness to you. And 
remember that hundreds of physicians have attained 
eminence by hard work where one has reached the rank 
of a genius over-night. 
When you first begin to practise you may not possess 
the necessary amount of self-confidence, since you know 
that you are walking more or less in the dark. Endeavor 
to overcome the bashfulness of the amateur, and remem- 
ber that you have been taught by men of knowledge 
and erudition. Their example should make you confident 
and spur you on to better efforts. 
The best way to acquire self-confidence, which will 
eventually give you that poise so necessary to a successful 
physician, is to work diligently, observe keenly, and study 
industriously. Do not let failure discourage you. After 
all, so many elements of uncertainty enter into fife and 
the makeup of the human body that even the most 
skilled physicians are apt to make mistakes. Profit by 
your failures. Let each error be a teacher and a guide. 
Environment 
One of the most important tasks confronting you as 
you are about to enter the practice of medicine is to 
select the proper environment. A decided advantage 
is that you are practically your own master in that 
task. 26 
THE SUCCESSFUL PHYSICIAN 
The medical man must choose his environment wisely, 
to be successful. Many a good man has failed because 
he established himself in the wrong place and associated 
with the wrong people. 
Environment is a more potent factor in molding 
success and character than most persons realize. It is 
generally conceded by medical men, as well as by the most 
eminent psychologists, that associations and surroundings 
often determine the entire makeup of a human being. 
“Even the law of heredity—a vague, foggy, uncertain 
sort of a law, if it may be called a law at all—is influenced 
by association. Heredity itself is a matter of environ- 
ment and is always secondary to it,” according to Hub- 
bard, “and it is an accepted fact that unless environment 
is propitious, propagation is impossible. And in heredity, 
with the sameness of environment, no progress is possible. 
With the human being it is just as with the plant. The 
one important factor in the evolution of a plant is environ- 
ment, and man is merely a movable plant, Burbank 
contends.”* 
You must not confound the environment of your ear- 
lier years with that of your professional career. The dif- 
ference is a radical one. During your school years you are 
placed amid certain surroundings and your associations 
are more or less thrust upon you. Little is left to your 
own selection. 
In college, away from the influence of home, you had, 
for the first time, an opportunity to adjust yourself to a 
different environment, and you probably received your 
first notion of its importance during those years. You 
found that conditions there were altogether different 
from those at home. At first you found it hard to adjust 
* Elbert Hubbard, in The Age of Common Sense. (Cosmopolitan, 1906.) PERSONALITY 
27 
yourself to them, but after due time you formed new 
friendships and acquaintances and soon became accus- 
tomed to the new life. 
Still the conditions of your college days did not pre- 
pare you for that most important part of your life where 
you had to make your own way and fight your own battle 
for existence. You were to some extent a “floater,” 
drifting happily with the tide, perhaps depending on your 
father’s money. Now, however, you have to steer your 
own ship and carve your own destiny. Your own efforts 
will feed you and clothe you; your ingenuity will determine 
your success, and every detail of your fife must be deter- 
mined by yourself. 
Choose your surroundings wisely. Select your asso- 
ciations deliberately. Do not let sentiment interfere 
with good sense. The most likable people are not always 
the most useful people. 
Your career will most certainly be molded in a very 
great measure by the people with whom you associate. 
Big men will give you big thoughts, whereas small men 
have petty ideas and little complaints and will tend to 
hold you down. 
Many physicians choose their location without giving 
sufficient thought to the existing conditions. This par- 
ticular matter will be discussed later on in this book, and 
you will be instructed how to select your field of activity 
correctly. 
Just as important as the location itself is the type of 
people with whom you will become associated in a social 
way. Aim to analyze your character. Study your weak 
points and seek to find those traits that should be im- 
proved and developed. Then choose the sort of people 
who are predominant in the characteristics which you lack 28 
THE SUCCESSFUL PHYSICIAN 
and benefit by their strength. Your companions should 
not all be medical men. To cultivate only those in your 
own profession will make you narrow minded and tire- 
some to others. The physician should be a man of the 
world. He should be versed not only in medicine, but 
should be a thorough student of human nature and of 
character. Very often a patient will come to a physician 
believing that he is ill, while in reality his ailment will be 
entirely imaginary. Here the physician’s knowledge of 
character is essential, and particularly where women are 
concerned, the physician can make much better progress 
by mental application than by any professional treatment 
that he may administer or any remedy he may prescribe. 
To be able to meet all emergencies, you must know all 
types of people. No human being is so stupid that you 
may not learn something from him. No man is so wise 
that he cannot be taught even by a child. 
Temperament 
Temperament is a somewhat inflexible endowment. 
We come into the world with certain temperament, 
and with slight modifications we will leave it with 
precisely the same temperament. 
If you realize that your temperament is not what it 
should be, only the most complete self-control and will 
power will enable you to overcome the fault. Dunglison 
defines temperament, medically speaking, as “the peculiar 
physical and mental character of an individual arising 
from the relations and proportions between the con- 
stituent parts of the body, natural organization of 
of constitution.” In other words, he establishes a dis- 
tinct connection between mind and body. You know, of 
course, the age-old maxim, “Mens sana in corpore sano.” PERSONALITY 
29 
This applies in both ways: just as there can be no sound 
mind in a sick body, so the body can not be sound if the 
mind is sick. Your temperament should be the safety- 
valve that equalizes the relation between body and mind 
and gives you that equilibrium which is absolutely neces- 
sary for the successful pursuit of the profession of 
medicine. 
By many years of study psychologists have established 
the fact that even with the most determined efforts, tem- 
peraments can be changed but little. The cheerful nature 
remains cheerful, while the morose person will continue 
to shed gloom over his own life and those with whom he 
comes in contact. The bold will be fearless and the 
timid will falter. The sly will be crafty and the emotional 
will always retain the tendency to hysteria. To make 
the best of your temperament you should study it carefully. 
You must not strive to attain something for which you 
are temperamentally unfitted. Mark Twain longed to 
be a tragedian, and Eddie Foy, the famous vaudeville 
comedian, would have given all his glory to play the role 
of Hamlet successfully. But both failed utterly in their 
desires because their temperaments had determined other 
destinies for them. To be most successful it is better to 
accentuate temperamental strength than to endeavor to 
overcome temperamental weakness. 
What sort of a temperament have you? Are you 
independent or dependent? cheerful or melancholic? 
choleric or phlegmatic? sanguine or morbid? If you are 
dependent, do not start out on your initiative. You 
would doubt your own judgment and lack the self-confi- 
dence necessary. Associate with someone who is an in- 
dependent; accept a salary in a hospital or any institution 
and rise as high as you can. If you are of the dependent 30 
THE SUCCESSFUL PHYSICIAN 
type you may become eminently successful under some- 
one’s guidance or you may fail utterly yourself. If you are 
of the melancholic type, you would never do as a specialist 
in neurasthenics, and if you are choleric, remain away, as 
much as possible, from patients who are afflicted with 
nervous disorders. 
Memory 
The development of the memory is one of the achieve- 
ments for which all schools and colleges strive. A good 
memory enables you to store up knowledge, and to 
withdraw it from your storehouse quickly when you 
have need for it. It also places you in a position to 
remember people’s names and places, and the circum- 
stance under which you may have met them in practice 
or socially. 
Most persons like to be remembered. It makes a man 
feel insignificant if he realizes that you have met him 
but have forgotten him. The faculty for remembering 
names and faces comes naturally and readily to some, 
but must be developed through hard application by others. 
Develop your memory systematically if you are not natu- 
rally endowed with this faculty. Take up a course of 
memory training, and aim to find in each human being 
you meet a point by which he will become fixed in your 
mind. You will be surprised at the good effect produced 
on a patient who has met you casually before if you remem- 
ber his name and his ailment. He will immediately feel 
that you are taking an interest in him and that his par- 
ticular trouble is a matter of importance to you. Patients 
expect physicians to have unusual mental ability. To 
most of them the science of medicine is still a deep 
mystery, and to be successful, a physician must be able PERSONALITY 
31 
to do things which the ordinary human being is not sup- 
posed to do. In large hotels the most valuable clerks are 
those who can remember names. Nothing so pleases a 
traveler as to come to a strange town and have the hotel 
clerk greet him with a pleasant, “Why how do you do, 
Mr. Smith? I’m awfully glad to see you back again.” 
I know of one young man in San Francisco who rose 
quickly from the position of information clerk to that of 
assistant manager just because he had that happy faculty 
and he knew how to make people feel at home by showing 
them that they were not forgotten. 
It seems almost unnecessary to urge physicians to 
train their memories systematically, for during all their 
years of study they were forced to do this to enable them to 
absorb knowledge. Many physicians do not study after 
they graduate: the day they are licensed by the state 
marks the close of their mental attainments. They cease 
to climb and are satisfied to jog along on the easy mental 
road. Many young doctors believe that with their 
diploma further study is needless. They «coff at the idea 
of studying further and assume the attitude that they would 
not have been given the coveted M. D. degree if they did 
not know all there was to know. The successful physi- 
cians who leave their mark on the pages of medical history 
are those who believe in self-training and self-improve- 
ment. They study constantly; they read each new book 
of importance and are ever open for improvement. It is 
the law of nature that you cannot stand still. Everything 
moves. You cannot be the same in ten years from now 
that you are today. You are either going ahead or falling 
behind. You climb or you fall. Your mind develops or 
it decays. There are only two terminals on the road of 
life: success and failure. Your success will depend entirely 32 
THE SUCCESSFUL PHYSICIAN 
on the keenness of your brain, and your brain cannot 
be keen unless you use it constantly. 
As an aid to your memory keep an index of all the 
people with whom you come in contact professionally. 
As soon as they have gone, jot down those characteristics 
that impressed you most. Then when any of them return 
and are announced to you, look at your index quickly 
before they are shown in, and use the information that 
you have previously noted to the best advantage. There 
is no standard system that can be applied to the training 
of your memory. Each must find his own method. 
Some persons remember numbers more easily; others 
faces or names or places. Some must hear things in 
order to remember, others see or feel or read them. Find 
out which is easiest for you and establish that as your 
method. 
Language 
Most professions and commercial pursuits have a 
vocabulary of their own and the medical profession is no 
exception. In fact, there are probably more technical 
terms in medicine than in any other science or business. 
It will be quite natural for you to speak to your 
patients in medical terms. You may make a very able 
diagnosis or prognosis or prescribe an excellent treatment 
that will be entirely clear to you, but to the patient will 
mean nothing. Talk to your patients in a language that 
they understand. Remember that to most people Greek 
and Latin are the same as Chinese. Very few persons 
are linguists, and if you converse with them in a foreign 
language they will consider that you are trying to show off. 
What the patient wants to know most is the nature of 
his ailment, its cause, how long it will take to cure him, PERSONALITY 
33 
and how much it will cost. All these things can be 
expressed in plain English. No one will pay you any more 
because he does not know what you are talking about. 
Use plain and simple English at all times and adjust it 
to the mental caliber and intelligence of your subject. 
Study your patient’s face. His expression will tell you 
whether he understands you or whether you are speaking 
in riddles. The best educated man is the one who can 
talk the plainest, and say a thing in the fewest words. 
Comparisons can be used to advantage. If you speak 
to an automobile mechanic, he may understand you better 
if you compare his intermittent heart with the missing 
of one cylinder. If the plumber wants to know why 
he has a large lump where a fracture occurred, it will 
be clearer to him if you tell him that that is nature’s 
way of splicing a pipe. 
Very often in court expert medical testimony has 
been worthless because the testifying physician launched 
upon a tiresome tirade of medical terms that none but he 
could understand. Remember that juries are not made 
up of college professors. 
“A surgeon of wide reputation recently testified in 
a damage case. The judge asked him what evidence 
of injury he found upon examination. The surgeon 
answered that there was a large ecchymotic tumor accom- 
panied by some extravasation of blood into the sur- 
rounding connective tissue and intercellular spaces and 
extensive ruptures of the dermal and subdermal vessels. 
‘Oh.’ said the judge, ‘you mean, Doctor, that the patient 
had a black eye’ and the doctor was laughed out of 
court.”* 
* Quoted from E. Valentine Mitchell: “The Doctor in Court” (Rebman 
Company N. Y.), 1917. 34 
THE SUCCESSFUL PHYSICIAN 
Insist that your patient understand what you mean 
to convey. Explain your statements to him until you 
are sure that he knows what you mean. The physician’s 
language should be select and his English should be 
correct. But whenever there is a choice between a 
long and a short word, use the latter. Brevity is an 
indication of brains. Many a mental weakling strives 
to cover his ignorance by verbosity, but few have suc- 
ceeded. The development by a pleasant, well-sound- 
ing voice should go hand in hand with care in the use 
of proper language. Sick people are sensitive. They 
like neither to be shouted at nor to strain their ears to 
catch a whisper. You have probably noticed how easily 
women and children are influenced by the modulation of 
your voice. A gentle voice creates confidence, whereas a 
harsh, coarse voice repels. The poorer your voice natur- 
ally, the greater care you should give toward training it. 
Here again close self-analysis and will power play impor- 
tant parts. Let me remind you of the famous case of 
Demosthenes, who was laughed out of his home forum 
because his voice was an unintelligible mumble. Deter- 
mined to overcome this handicap, he became within the 
next ten years one of the world’s greatest orators. 
Dress and Personal Appearance 
You are judged by your appearance, and first impres- 
sions are always lasting impressions. Strive above all 
things to be neat. To be a well-dressed man you do not 
need to be an expensively dressed man. Cleanliness is the 
important requisite that influences your personal appear- 
ance. You should be as clean and scrupulous about 
your person as you are about your instruments and office. PERSONALITY 
35 
A neglected appearance deprives you of your self-respect 
and of the respect of others. 
The physician should never overdress. He must 
maintain a certain degree of dignity which should be 
emphasized by his dress. The properly dressed man 
is the one whose clothes attract no attention because 
they are in such harmony and good taste that they are 
part of himself. 
Avoid cheap finery, flashy neckties, loud shirts or 
any other eccentricities of dress. Never meet a patient 
with unshined shoes, unshaven face, unwashed linen or 
hands. The best form of dress for a physician is that 
which any successful business or professional man would 
wear. Follow the advice of a famous stockbroker 
who said that when your credit becomes poor, see your 
tailor before you go to your banker. Avoid extremes. 
Be neither a tramp nor a sport. Proper dress gives you 
self-confidence, whereas faulty apparel is magnified by 
you until you believe that the whole world can see it. 
The average medical man has a tendency to be narrow- 
minded. This statement is, perhaps, somewhat blunt, 
but it is true. One of the reasons for this lies in his 
training. 
Precedent and tradition play important parts in the 
medical student’s education; books and precepts sur- 
round him. Just as in law every ruling is based upon 
authorities, so because the eminent Doctor So-and-so 
has laid down certain rules and practices, anything that 
deviates from his theories is looked upon with suspicion. 
But this very thing would close the door to progress in 
everything even the professions. Only the men with a 
Broadmindedness THE SUCCESSFUL PHYSICIAN 
36 
broad vision, the men who look forward and not back- 
ward, the men who were willing to try the untried, have 
aided civilization and helped the world to progress. 
The young practitioner takes up his life’s work with 
a handicap dating from his college days. Although he 
owes much to his Alma Mater, life in the average college 
breeds clannishness and a certain amount of snobbish- 
ness which are bound to influence him unless he is big 
enough to remould himself when he comes into touch 
with the outside world. 
The broadminded man is willing to give every human 
being credit for what he aims to do and for what he 
accomplishes. He is willing to listen to the advice of 
others and to admit that all the achievement in the world 
is not centered in himself, his immediate associates, his 
teachers, and his books. 
Many a physician who is exceedingly charitable in 
his work, who may give poor patients free treatment and 
medicine and strive to help his fellow beings who are 
suffering, may, on the other hand, be absolutely hard and 
uncharitable toward those of his own colleagues who have 
made a new discovery or have advanced a certain stage 
of medical science. 
The average business man is always willing to learn 
and to investigate. He would rather lose an hour in 
listening to an impostor than take a chance on turning 
away one who may have something worth while. 
But the physican likes to assume the “know-it-all” 
air. Usually the younger and more inexperineced he is 
the more he thinks he knows. This, however, is a short- 
coming which is not peculiar alone to physicians. Youth 
always has a certain air of cocksureness which only 
experience can eliminate. Ignorance always likes to PERSONALITY 
37 
pose as wisdom and many a fool believes that he is a 
sage. Wisdom is tolerant, knowledge is curious. Stupid- 
ity is self-satisfied and narrow-mindness is arrogant. 
I would suggest that if a new discovery is brought 
before the medical men of a community, they should 
appoint an unbaised committee, go thoroughly over the 
ground and approve it or disapprove it. No claim should 
be condemmed until is has been carefully investigated and 
found to be false. 
The function of the physican is, above all, to serve 
mankind. One cannot serve with selfishness. Self- 
aggrandisement and self-glorification have nothing to do 
with usefulness and efficiency. The physician should 
always forget himself and think only of his patients. It is 
their welfare to which he has devoted himself and he must 
sacrifice his own person to serve others. 
Your mind should be open and you should be able to 
disregard the source. Remember that many a now 
famous man was obscure and unknown when he first 
started. The best medical writers, the most adroit 
surgeons, were once struggling students, just as you and I, 
and only because broadminded people gave them an 
opportunity and a hearing did they arrive at the front. 
Habits 
All human beings are more or less subjects of habits. 
Vices may become habits just as easily as virtues, and 
good habits may lead to success just as readily as bad 
ones may lead to failure. 
The physician, exposed to more temptations than men 
in other walks of life, should avoid anything that may 
eventually develop into a dangerous habit. Many a 
brilliant career has been blasted because of pernicious 38 
THE SUCCESSFUL PHYSICIAN 
habits that developed insidiously and made wrecks of 
strong and vigorous men. 
Above all things, the physician should acquire the 
habit of regularity. Eat regularly, sleep regularly and 
keep regular hours—so long as you can. When you 
become successful you will find that no other profession 
breaks into private life so much as the medical. It is 
well, therefore, to be absolutely regular until the exigen- 
cies of your work require you to yield. You will find that 
regularity of living will give you a store of vitality and 
energy on which you will have to draw frequently in 
your more mature years. 
Form the habit of making quick decisions. Your 
patients expect you to know. They do not want you to 
guess—they can do that themselves. Did you ever notice 
the anxious look in a patient’s eyes after you have examined 
him and while he is waiting for your diagnosis? Decide 
quickly and positively. Never hesitate or doubt your 
own powers of decision and you will increase the respect of 
all with whom you come in contact. 
Shun drugs of all kinds and beware of forming the 
drug habit. It is well known that many physicians have 
become victims of the drug habit due to the intensity 
of their work and the nervous strain under which they 
had to perform it. The physician, more than anyone else, 
knows the soothing effect of drugs, and, while he also 
knows the danger that lies in their use, he often considers 
that he is immune. This is a grave mistake. The 
physician’s constitution is no stronger by nature than 
that of any other man, and if he becomes a slave to the 
habit, he will sink to the same depths as anyone else. 
Remember that opiates give only very temporary 
relief. If you have worked too hard, if you have lost PERSONALITY 
39 
sleep, don’t forget that lost hours of sleep can be made up 
only by sleeping. There is no substitute for rest. 
If you are ill or in pain, go to bed and call in another 
physician. If you begin to take self-prescribed pain- 
relievers, it will be easy for you to develop the habit. 
I know of a fine physician who had an ulcerated tooth. 
He was too busy to go to a dentist, so he used an opiate 
and continued to work. He was finally sent to a sanitar- 
ium for six months, and became so enfeebled that he had 
to give up medicine and go into some other vocation. 
He lost a lifetime of work and savings because he had 
formed a pernicious habit. 
Another eminent physician I knew was located in the 
cholera section of New Orleans. He took a small quantity 
of opium to check a light case of diarrhea, because he was 
too busy to take proper care of it. When he came to me 
he was using fifty grains of morphin and six grains of 
cocain daily. He had become a wanderer; his money was 
spent, his practice had gone, and his friends had disap- 
peared. He had become an addict to alcohol and a 
gambler and was eking out a scant living by soliciting 
subscriptions for a newspaper. 
In these days of prohibition the physician more 
easily than anyone else, may obtain alcohol and he may 
also acquire the “good fellow habit” more readily. This 
habit is another which leads to ruin. Remember that 
really worthwhile men do not sit around the drinking 
table. The so-called friends you make with liquor can 
never be of any use to you. They are never present when 
you really need them; their friendship is merely a sham. 
A physician cannot last in his community if he acquires 
the reputation of being a drinker. 
In the matter of habits in general, it is well to realize 40 
THE SUCCESSFUL PHYSICIAN 
that one of the essential things expected of a physician is 
reliability. He must be known as a man who can be 
entrusted with the lives of those who are dearest to the 
members of his community, and he must be able to inspire 
with absolute confidence those who know him. 
Live up to the highest standards and strive to be one 
of the leaders in your community. Take an active 
interest in civic affairs and make your influence felt. 
The physician stands for a certain type of man—the 
best—and you are one of this profession. CHAPTER II 
HOW TO ATTRACT AND HOLD PATIENTS 
In the practice of medicine, just as in any other busi- 
ness or profession, the most important requirement is to 
build up a sufficiently large clientele to assure one a liveli- 
hood. The income derived from such a clientele is, of 
course, variable, being based entirely upon ability, local- 
ity, population, and other circumstances. 
There are certain definite rules that must be followed 
by the physician if he wishes to be successful. These 
rules are founded upon the same simple, psychologic 
facts that apply all through fife, although in the medical 
profession they are intensified because of the very close 
relations that exist between a physician and his patients. 
The physician cannot go out and sell his wares. He 
has no samples to show, no set line of talk, no merchan- 
dise to offer. He sells his services, his knowledge, his per- 
sonality. His salesmanship must be of the subtle kind, 
and he must always remember that his success is based 
entirely upon the strength of the tie that binds his patient 
to him. 
No matter how able he may be, no matter how 
thorough his knowledge of medicine, if he cannot instil 
confidence, faith and gratitude, into his patient he 
cannot possibly climb to the top of the ladder. 
Belief, confidence, faith and gratitude: the physician 
may well fix these words firmly in his mind. They are 
the cornerstones upon which the whole structure rests, 
and no matter what class, what type, what character of 
41 THE SUCCESSFUL PHYSICIAN 
42 
patient he may have to deal with, without these four 
principles he cannot retain his clientele. 
Commonly speaking, there are four classes of patients, 
with which the doctor has to deal, and nearly all of them 
fall into one of these four classes. First, there is the 
strange patient, who arrives unannounced, unrecom- 
mended casually. Second, there is the chronic patient or 
rounder, who has you on his list among the many whom he 
consults or has consulted. Third, there is the business 
client friend, or social friend, and fourth, the old patient 
who comes back because he had consulted you before 
and who is satisfied with your services or who has been 
recommended by some other practitioner. 
The patients in these four classes come to you primar- 
ily because of a certain amount of belief which they 
already have in you. This belief may have been caused 
either by some impression which they have gained them- 
selves or which has been transmitted to them by someone 
else who knows you. This belief is the foundation on 
which to build. You must convert it into complete 
confidence and absolute trust to make your casual patients 
permanent ones; you must prove to them that their confi- 
dence and faith in you are merited and well founded, and 
lastly, you must earn their gratitude and have them feel 
that you are the man to whom they may look for their 
wellbeing. Above all, however, you must have belief 
in yourself, for without it you will be unable to inspire 
your patient with the necessary confidence and faith. 
Confidence 
To illustrate the absolute necessity of having the full 
confidence of your patient, let us take the case of a 
stranger who is seeking a doctor and does not happen HOW TO ATTRACT AND HOLD PATIENTS 
43 
to have one among his friends. He may be a visitor to 
your city or a newcomer, and his search for medical help 
will be entirely unprejudiced and based upon nothing 
but his own observations. 
The man of ample means will seek a specialist in 
an exclusive neighborhood or a high class office building. 
His past experiences will have convinced him that expert 
assistance is usually the least expensive in the end, 
and that the highly skilled physician who obtains the 
largest fees is generally found amid the best surroundings. 
The poor man, however, will probably go to a physician 
who practises in an atmosphere similar to his own, 
and he will fix the fee that he expects to pay by the 
appearance and location of the doctor’s office. For this 
reason, if for no other, the selection of your location 
will have a decided influence upon the character of the 
clientele that will come to you, and in choosing your 
offices and in furnishing them you must bear in mind 
that their appearance often creates or destroys the belief 
on which confidence is built. The strange patient may 
select you because he likes the building in which you are 
located. He may be attracted by the signs on your 
windows, or, if he has any racial or religious preference, 
on looking in the building directory your name may bring 
him to you. 
When he walks into your outer office he will again 
receive important impressions. Is your place well lighted 
and cheerful, or is it dark and forbidding? Is there about 
it an odor that is disagreeable? Is it untidy in appear- 
ance, or is it neat and fresh and clean? Is it well fur- 
nished and is there someone there to greet the patient and 
make him feel immediately that he will be well taken care 
of? 44 
THE SUCCESSFUL PHYSICIAN 
A patient usually has in his mind a picture of how a 
physician’s office should look, and while this picture may 
be hazy and indefinite, he will know instinctively when 
he enters your office whether he has found a place that 
appeals to him and agrees with his conception of what 
a capable physician would have. 
If his impression is unfavorable, his confidence in you 
will be immediately destroyed, and he may leave the office 
without knowing why, but with the belief that you are 
not the man in whom he could ever have sufficient faith 
to intrust his health. 
If, on the other hand, the first impression has been 
favorable and he remains to consult you, you have gained 
an important point and it is entirely up to you to increase 
his confidence in you and so become an important and 
permanent asset to you. The mere fact that he is seek- 
ing a medical man shows that he believes in doctors. 
Therefore, if after he comes to you, you fail to convert 
this general belief into full confidence, you lose him. 
The fault is yours, and you must diagnose your own case 
most carefully and try to remedy the defect. 
The patient who seeks you wishes to be relieved of 
some ailmen tor cured of some disease. You must be 
able to convince him that he has come to the right place, 
where he will find health, and that the end of his troubles 
is close at hand. 
Above all, it is necessary that your personality and 
your way of going about your business must be of such a 
character that the patient will be convinced of your ability 
to relieve him of his ailment. 
Sick persons, as a rule, are governed by two conflicting 
emotions. One is doubt, the other is hope. Without 
hope no effort toward a cure would be made, and without HOW TO ATTRACT AND HOLD PATIENTS 
45 
belief there would be no confidence. Your first duty is to 
dispel from your patient’s mind any doubt he may have in 
you and to encourage bis hope to the highest point. Your 
personality must be so strong that he will give himself over 
to you and do as you wish him to do. 
The most certain way to proceed with a new patient, 
to strengthen this hope and create this confidence, is to 
listen attentively as he describes his complaint and to 
make notes as he proceeds with his description. This 
will give him the impression that you are thorough and 
are interested in him. Obtain all the details of his case 
from him before you ascertain his name, residence, 
family connections, or any other points not necessary to 
assist you in diagnosing the nature of his ailment. Never 
mention the fee to be paid, or even ask his name until 
you have reached the point where he will not question 
the amount of your fee; this cannot be done until you 
have gained his absolute faith in your ability and integrity, 
and until he thoroughly understands the nature of the 
treatment or service that you will render. 
In your first interview you must employ all the medical 
skill, diplomacy and business tact at your command, and 
you must also study your patient’s character and indi- 
viduality, his likes and dislikes, and his idiosyncrasies to 
such an extent that you will be able to appeal to his 
intelligence. 
Your success in the practice of medicine will depend 
upon how successful you are in influencing your patients in 
these first interviews, for if your visitor is not pleased 
the first time, he will not return. Ones entire practice, 
then, is dependent on pleased first interview patients. 
A very important point is to break down the barrier 
of strangeness which necessarily exists when a new patient 46 
THE SUCCESSFUL PHYSICIAN 
first visits you. This is best done by showing a real inter- 
est in your patient’s troubles, by displaying friendliness 
toward him personally and by being in sympathy with 
his ailments. 
Ascertain his natural leanings, his habits and hobbies, 
his attitude toward life and his temperament and general 
makeup. This is usually accomplished by carefully 
listening to the patient’s history of his ailment. If it 
is not complete, further questioning will bring this out. 
Look pleasant, be cheerful and affable, and shake hands 
with your prospective patient, if nature has fitted you 
for doing this in a convincing way. If you watch every 
movement of your visitor and every detail connected 
with him, you may be able to make a sufficiently accurate 
estimate of his real character during the first interview 
that will astonish him. You should take in several 
things at a glance and put them down in your mental 
card index. 
Usually you can determine the environment to which 
a person is accustomed by the manner in which he acts 
in your office. At times even the chair he selects or 
the manner in which he disposes of his hat may indicate 
to you whether he is a person of refinement or of ill breed- 
ing. Clothes usually tell their own story, and often are 
good indicators as to the type of man vou are dealing 
with. 
The manner in which a patient sits down, rises from 
his chair, or walks, the color of his skin, the tissue of his 
eyes, and other details tell much to the trained eye and 
often help in arriving at a quick diagnosis. It is astonish- 
ing how favorable an impression it makes on a stranger 
to tell him some of his symptoms before he has mentioned 
any of them to the physician, and often this can be done HOW TO ATTRACT AND HOLD PATIENTS 
47 
merely by keen observation. For instance, stiffness of 
the joints may be evidenced by the manner in which the 
patient rises. His staggering gait, a careful, slow walk, 
pain in the joints or limbs or in the back, may indicate 
spinal disease. If he sits down carefully, the hands 
supporting the body, he may be suffering from lumbago, 
sciatica, or abdominal disease. The color of his skin may 
point to anemia, jaundice, nephritis or syphilis, and the 
expression of his face may indicate melancholia or liver or 
kidney disorders. 
Form the habit of asking as few questions as possible, 
and only such questions as will help you to diagnose the 
case. A physician is generally assumed to be a man of 
superior knowledge, and it will strengthen your patient’s 
confidence in you if you ask him little and tell him much. 
Your first question should generally be—“In what 
way do you feel sick?” And your second—“How long 
have you been troubled?” Then let each succeeding 
question be pertinent to the case, and let the answer give 
you additional suggestions for asking other questions 
needful to permit you to arrive at a correct conclusion. 
You should always examine your patient thoroughly 
whenever any needed information could possibly be 
gleaned by this means, and you will find that the average 
sufferer expects you to feel his pulse and take his tempera- 
ture and look at his tongue. After you have examined 
him, and the circumstances of the case will permit a 
diagnosis to be made, state the diagnosis and prognosis 
quickly and precisely. Explain to your patient what 
the diagnosis means and the entire truth as regards 
the prognosis. Show him that other similar cases have 
responded as you have a right to assume that his will 
respond. Persist in this explanation until it is understood 48 
THE SUCCESSFUL PHYSICIAN 
by the patient, for it will then be accepted and acted on 
by him. 
By the time you have reached the point where you 
give him the outline of treatment, you must have his 
confidence to such an extent that he will have absolute 
faith in you and carry out your directions to the most 
minute detail. This will generally be done when 
the facts have been explained to him and the reasons 
advanced have been accepted by him. 
Only if you have made your statements clear to him 
and your impression on him is so strong that he will 
follow you with implicit obedience, without questioning 
or doubt, can you say that you have been successful with 
him. 
Faith 
It is this element of faith, which may also be called 
trust, that a patient must have in you to be of permanent 
value to you. This faith is more than the confidence men- 
tioned in the preceding pages. The patient’s confidence 
applies primarily to your ability and knowledge. But 
faith and trust go much further. Health is the human 
being’s most sacred possession. Before a man or a woman 
will give this treasure into your keeping, he or she must 
first be sure that you are worthy of the trust. Therefore 
it is absolutely necessary for the physician to maintain 
a reputation for absolute integrity and honesty. He 
must also be known to be a man of exemplary habits and 
clean morals. No man will send his daughter to you if 
he is not absolutely certain that you are to be trusted with 
her. And no mother will confide in you if she is not sure 
that you merit her confidence. Certainly without com- 
plete confidence many a vital factor in diagnosis will HOW TO ATTRACT AND HOLD PATIENTS 
49 
be withheld; as a result, your treatment will be a failure, 
and your patient will be lost to some one who can inspire 
these factors. 
Your patients usually feel instinctively whether or not 
they are safe in your hands. The physician may simulate 
interest, but he will not be able to keep up the deception 
very long or pretend an integrity that he does not possess. 
One of the best types of patient on whom the value of 
faith may be demonstrated is the chronic case, also known 
among physicians as the ‘ ‘ rounder. ’ ’ He goes from doctor 
to doctor, has tried every variety of cure and all sorts of 
medicine; he does not believe in himself or in anyone else. 
He is an inveterate cynic, and comes to you in the full 
expectation that he will be disappointed again. And yet 
the mere fact that he does come proves that he must 
have some vestige of belief in doctors, be it ever so slight. 
After all, he hopes that someone will cure him. You 
may be the one, but you can do it only in one way. You 
must be able to change his frame of mind to such an extent 
that the doubter will become a believer and the cynic will 
have implicit faith in you. 
The only thing you have to work on with a patient of 
this sort is his meager belief in doctors and the hope 
of cure that he has left. From hope you must lead him 
on to belief; from this to confidence, and finally to faith 
and trust. Every man has an approachable spot and it 
is your duty to yourself and to your patient to find this 
spot. 
Question a patient of this type until you see, by the 
expression on his face, or by some other indication, that 
you have interested him. If you find that he has softened 
somewhat toward you, that his attitude has become more 
pleasant, that he is settling down more comfortably in 50 
THE SUCCESSFUL PHYSICIAN 
his chair and seems to feel more at ease, then you may be 
reasonably certain that you are beginning to engender con- 
fidence in him. 
When you finally strike a topic in which he is vitally 
interested, you may assume that the conversion will be 
successful and that you are about to break down the 
barrier of suspicion and antagonism which he has erected 
between you when he first came to your office. 
Every individual betrays his emotions in some way, be the 
betrayal ever so subtle. It might be some slight move- 
ment of the eyes, the mouth, the hands, or some inflection 
in his breathing. 
Observe always, and, whenever possible, makes notes 
of, the result of your observations, so that your patient’s 
mind may be an open book to you when he returns. 
Once a patient begins to ask questions he is interested, 
particularly if he seeks to learn more details on some point 
you have mentioned. 
By his questions and by the tone of his voice you can 
tell whether he is trustful or suspicious, whether he agrees 
or disagrees with you. A few of the points that are easily 
touched upon by the judicious physician are hope of cure, 
improvement of general condition, relief from pain, fear 
of death or of loss of mind, pride of appearance, preven- 
tion of premature senility, loss of the family affection, 
retention of mental ability, vanity, and the economy 
of keeping or of regaining health. 
Remember that every person that comes to a physician 
is in need of assistance. Find out what this particular 
need is, cater to it, and show sympathetic interest for it 
and you will eventually create in him the faith that you are 
the man whom he has been seeking and has finally found. 
When the “rounder” comes to you, you can usually detect HOW TO ATTRACT AND HOLD PATIENTS 
51 
him quite easily. He generally assumes the attitude that 
he knows more than you do, and while he may not admit 
that he has consulted other physicians before, you can 
readily determine this by the many technical terms that he 
will use when he states his case to you. 
To manage this type of patient you have two courses 
to follow: The first is quite easy and probably the one 
that others have pursued. You listen to his ram- 
blings for a few minutes, ask some hurried questions, write 
a perfunctory prescripton, and let him go. That will be 
the end of him, so far as you are concerned, and it will 
merely mean another disappointment to him. 
The other course is difficult, but it may lead to your 
gaining a loyal friend and a firm believer. If you succeed 
in converting this type of patient, because of his previous 
disappointment, he will be more of an asset to you than 
was the man who came to you with an open mind and was 
willing to trust you. 
This second course consists in giving the patient the 
utmost care and attention. Take his history most 
thoroughly; examine him as if your graduation from 
college depended upon it. By the time this patient 
comes to you he will manifest so many symptoms, aches 
and pains that he will consider it a privilege to be permit- 
ted to go into the minutest details in regard to himself. 
A striking case of this sort came to my attention some 
time ago. A railroad worker was disabled in a train 
wreck. He had persistently refused all settlements, 
although the maximum to which he was entitled under the 
law had been offered to him. He gave as his reason for 
refusing the settlement that he had never been given a 
proper and complete hearing. It was arranged that he 
should meet the vice-president of the company and the 52 
THE SUCCESSFUL PHYSICIAN 
physician, who would give him all the time he considered 
fair. He agreed to this and wrote out a story of his acci- 
dent, giving minute descriptions of every detail of his 
pains and aches, subsequent operations and treatments. 
According to his report his injuries were the most horrible 
ever suffered by human being and his loss and damage 
were irreparable. The meeting took place, and the 
laborer was permitted to have his manuscript read in full, 
which occupied nearly an hour, but while the gruesome 
experiences were being read the expression on his face was 
one of extreme contentment, and one could see that he 
experienced joy in reviving all the memories of the acci- 
dent. After the reading he was asked a number of ques- 
tions—all questions that he had been asked before at 
various times—and altogether the hearing consumed about 
two hours. At the end a sum of money was offered him, 
less than at a previous settlement, which he had refused. 
He accepted and departed with the proud consciousness 
that he had been victor over the vice-president of the com- 
pany in which he was only a laborer. This was entirely 
a matter of psychology, and this same psychology may be 
applied to the “rounder.” Let him revel in the sense 
of his own importance. Let him bore you with his 
tiresome narratives but let him have his way. 
Do not treat the “rounder” for the same complaints 
that other physicians did unless you are certain that the 
diagnosis is correct. They may have rested their diagno- 
sis on the patient’s narrative and neglected to examine 
him carefully. With a careful examination, you may find 
the real trouble and the underlying cause of his ailment 
and effect a cure where others have failed. 
Your principal task with this patient is to convince 
him that you can cure him. It will be a hard task, with- HOW TO ATTRACT AND HOLD PATIENTS 
53 
out doubt, for he comes to you with an almost unshake- 
able conviction that he cannot be cured; but, as stated 
before, there is some very slight hope in him and that is 
the seed which you must endeavor to help grow. 
Show genuine sincerity, earnestness and tact. Do not 
treat the patient as a crank, but as an interesting case, and 
direct all your knowledge and attention to him. 
Quite often this type of patient will tell you that 
he will pay you well if you cure him, but that he has had 
so many unfortunate experiences before that he is not 
willing to take another chance. The best argument 
to give to such a man is that you are not a speculator, 
but a professional man who has spent many years and 
much money in acquiring the knowledge which you now 
place at his disposal. You may also tell him that you 
cannot say to your landlord—“I will pay my rent if 
my patients pay me for my services.” He wants his 
money on the first of each month, and so do your grocer 
and your butcher. 
The mere fact that a patient objects to your fee is 
proof that he is lacking in faith and confidence in you and 
has not been made to understand the difficulties to be 
encountered in curing his ailment or in giving him the 
relief he seeks. When you know that the remuneration 
asked is proper and yet your patient thinks it is too High, 
it is because you have failed to convince him of your 
value to him. 
When a person argues with you about fees, speak to 
him of the great value of health, and how much it is worth 
to him to have it restored or retained for him by you. 
A good plan is to inquire his age and monthly earning 
capacity. Let us assume that his age is forty and his 
earning capacity $300.00 a month. At forty a man may 54 
THE SUCCESSFUL PHYSICIAN 
expect at least fifteen more productive years. At $3600 
a year that would be $54,000 for a period of fifteen years. 
You may say to this man—“Is it not worth a good deal 
more than what I ask to enable you to earn $54,000, while, 
on the other hand, you may be not only incapacitated but 
a burden to those who feel responsible for you P” Asa rule, 
an argument of this sort will bring the desired result, 
for the average person understands dollars and cents 
better than abstract logic. 
But remember that any fee will be considered large 
if your patient does not have absolute faith in you. 
Gratitude 
The supreme emotion for which all physicians strive 
is the gratitude of their patients. Grateful patients are 
the greatest asset a doctor can possess, and if he has a 
sufficiently large number of patients of this type his 
success is absolutely assured. 
The step from faith to gratitude is not a very long one. 
As a matter of fact, it is a logical step. 
It is a wonderful feeling to a sick person to be relieved 
of his pains and worries and to be restored to health. If 
a patient comes to a physician and he succeeds in strength- 
ening his belief in him into faith, and if this faith is followed 
by cure or relief, gratitude is the inevitable result, and it 
is just as inevitable that this patient will tell his friends 
and neighbors about his cure and that they will come to 
the same physician when they are sick. As a matter of 
fact, usually the cured patient is prone to exaggerate the 
seriousness of his illness and dwell on the ability of the 
physician who cured him when everyone else had given 
him up. It is a daily occurrence to hear people speak 
of their ailments and of how they have been cured; in HOW TO ATTRACT AND HOLD PATIENTS 
55 
almost every case they seem to take a personal pride in the 
achievement of their own particular physician. 
That is why it so often happens that persons who are 
strangers to you will come into your office and say that 
they have been sent by an acquaintance, and you will 
generally find that this acquaintance is someone whom you 
have treated and cured. Very often a patient may 
come to you on the recommendation of someone else 
without telling you about it. You will usually find, 
however, in the course of conversation, that this person’s 
visit is due to professional dealings you have had with 
someone else. 
It is not wise to ask a new patient at first how he 
happened to come to your office. That would be apt to 
make it appear that you are not accustomed to have 
patients consult you. Usually newcomers will volunteer 
this information, but if they fail to do so, you should not 
make any definite inquiries until later on in your consulta- 
tion, when more friendly relations have been established. 
Never let the fact that a patient comes to you recom- 
mended by someone else lead you to be careless or to 
assume that you will keep such a patient. You should be 
just as conscientious, if not more so, with this type of case 
as with any other, for if you show carelessness or indiffer- 
ence he will not only be lost to you, but he will make it 
a point to notify the friend who sent him and you will have 
turned a valuable asset into a dangerous liability. 
You should also observe the strictest professional 
attitude toward your acquaintances or friends who may 
come to you for medical advice. The same elements of 
confidence, faith and gratitude that apply to strangers 
must prevail with your friends. They, of course, have a 
measure of confidence and faith in you or they would not 56 
THE SUCCESSFUL PHYSICIAN 
seek your advice, but often their visits are due more to 
a certain sense of friendliness which they feel toward you 
since you are their friend and they are convinced of your 
ability to cure them. 
Often, as a matter of fact, people who know you quite 
well in a social way are less apt to take you seriously from 
a professional point of view. They may know too much 
about you. They may be too well acquainted with your 
little weaknesses, your habits and hobbies, and your 
peculiarities. When they come to you professionally, 
speak as little as possible of your social affairs, but enter 
directly into professional relations. You will find that 
this method will bring you ample reward, as you may 
make a faithful and grateful friend out of a casual ac- 
quaintance. No friend is so valuable to you as a friend 
whose gratitude you have earned and no one will spread 
your fame more enthusiastically. 
When a man is ill, he may display an entirely different 
character from what he appeared to have in business, at 
the club, or on the street. Sickness brings out character- 
istics which remain hidden when all is well. You will 
notice fears, antipathies, prejudices, likes and dislikes 
which you never noticed before. The sick person is closer 
to his real self than he is at any other time of his life. 
He is stripped of conventions and traditions, so that only 
the human side in need of help remains. 
Study your friend when he is sick and you will know 
how to handle him after he gets well. If you can develop 
gratitude in your patients, you will have much less trouble 
in obtaining reasonable fees and in collecting them than 
you would have if they were dissatisfied. 
We are all willing to pay for the things that please us, 
and no price within reason is too large if we receive more HOW TO ATTRACT AND HOLD PATIENTS 
57 
than we bargained for. If the physician not only attends 
to his patient but shows him that he is really vitally 
concerned in his welfare, and wants him to remain well 
after he cures him, then he is sure to have grateful and 
permanent patients. 
It is a common error on the part of physicians to 
assume that when they have treated a patient once he is 
their patient for life. There is only one result that will 
make a transient patient a permanent one, and that is 
satisfaction. 
You may have been recommended as the most skilful 
physician in the city, but if you do not come up to the 
patient’s expectations and prove to him that you are wor- 
thy of this recommendation, then he is lost to you forever. 
Do not make the mistake of treating minor ailments 
lightly. If a patients feels that you neglect him when his 
illness is only a mild one, he will not consult you when he 
is in serious trouble. 
Let it be repeated here that there are three factors 
which you must always bear in mind and without which 
you cannot possibly build up a successful practice. 
These factors are: 
Your patient’s belief and confidence that you can cure 
him, and that you can and will use every possible effort 
toward that end. 
His absolute faith in your honesty, sincerity and in- 
tegrity, and thereby his willingness to follow your orders. 
His gratitude for what you have done for him, which 
will make him return and send others to you. 
Selling Yourself 
All the details pointed out in the preceding pages are 
vital elements in the art of professional salesmanship. 58 
THE SUCCESSFUL PHYSICIAN 
To the professional man the thought that he must be a 
salesman may be odious, but nevertheless it is true. 
Regardless of vocation, no person can hope to be success- 
ful in anything unless he is a good salesman. The mer- 
chant must sell his goods; the painter his pictures; the 
poet must find a market for his verse; the singer must sell 
his notes to the public, and the minister of the gospel 
his doctrines to the congregation. The lawyer sells his 
arguments to the courts and the physician his personality 
and skill to the patient. 
Your hospital experience and your student days do not 
teach you salesmanship. The patients who came to you 
in those days were charity patients. You did not have 
to sell yourself to them. It made little difference to you 
whether or not they liked you or whether they came back. 
You could speak to them in any manner you chose and 
they had to accept, as all paupers must accept, what they 
received. 
You had no consuming or intense personal interest in 
their life and health. The point that usually concerned 
you most was how interesting the case was. If the patient 
recovered and left, he merely made room for another. If 
he died, no explanation had to be made to interested 
relatives. You were not compelled to consider what 
your patient wanted. He took what you gave him—that 
was all. 
But the difference between your intern days and your 
professional career is as great as that between the clerk 
selling stamps in the postoffice and the expert salesman 
who has to create a demand for his goods. 
What are the things that you must sell as a physician 
and how can you sell them? Above all, you must sell 
yourself to yourself. You must be fully convinced in HOW TO ATTRACT AND HOLD PATIENTS 
59 
your own mind that you have the skill and the knowledge 
to rise to the top of your profession, and possessed with an 
intense desire and an indomitable will to achieve this. Such 
a sincere belief in your own ability and complete earnest- 
ness of purpose to assist the patient is bound to be felt 
by him and will strongly influence him to accept your 
statements in their entirety. You then develop a strong 
enough personality to convince patients of what you 
yourself know. You must possess tact, diplomacy, 
culture, firmness of purpose, the courage of your convic- 
tion, and personal enthusiasm for your profession. 
You must have gentleness, sincerity, sympathy, inter- 
est, enthusiasm, intelligence and good judgment of sick 
people. You must be able to lead and direct your patients 
without being domineering. No patient is a valuable 
patient unless he gives himself entirely to you and believes 
in you and trusts you to such an extent that he will 
follow your suggestions and directions without any ques- 
tion or doubt. 
Remember that all human beings are vain and like to 
receive attention. The women of the United States spent 
$750,000,000 for cosmetics last year, which proves 
plainly that they want to be good looking. Tell a woman 
that she looks well and she will like you so much the better. 
One of the most famous gynecologists in America made 
it a point to study his female patients’ pet vanities. If 
he noticed that a woman used the eyebrow pencil, he 
would compliment her on her beautiful eyes. If he 
observed that she took particular pains with her finger- 
nails, he would remark on her unusual hand, and if she 
was addicted to the lip stick, he would flatter her shapely 
mouth. Men like to be complimented on their strength 
or on their mentality. They are glad to hear that they THE SUCCESSFUL PHYSICIAN 
60 
show evidence of energy, push and success. It does no 
harm to flatter a little, for everyone likes to hear nice 
things about oneself. 
Bear in mind that most persons would prefer to be what 
they are not. The short want to be tall; the fat, thin; 
the weak, strong; the pessimist would rather be an 
optimist; the tragedian, a comedian; and the man with 
brawn would prefer to have brains. 
On the impression you make on your patient; on the 
power you have over him, will entirely depend the fee 
that you may obtain. You will often notice that one 
physician receives one dollar for a visit whereas another 
charges ten. The ten dollar physician does not have ten 
times the ability of the other, but his selling ability, his 
personality and his business sense will be ten times 
greater than that of the one who has to accept the smaller 
fee. 
Whenever possible the patient should be given an 
inkling of just what the fee will be for the services that are 
to be rendered. This should be done on the first visit. 
Here the element of salesmanship enters strongly, and 
every factor in your favor should be used. 
A striking case came to my attention not long ago, 
illustrating how important it is to enlighten your patient 
in regard to, or at least prepare him for, the cost of con- 
sultation and treatment. While this happens to be a 
dental case, similar instances often occur in the medical 
profession and the example is therefore pertinent. 
A man went to this dentist, who was also his intimate 
personal friend. He wanted two teeth filled and his 
teeth cleaned. The dentist asked him if he wanted inlay 
work and a thorough prophylaxis. 
“Yes,” said the patient, “I want a good job.” HOW TO ATTRACT AND HOLD PATIENTS 
61 
And a good job it was. When the patient looked into 
the mirror after two or three weeks’ treatment, he was 
astonished. 
“You surely have given me fine work, Doctor, and I 
shall send many of my friends to you.” 
The patient was satisfied and the dentist was happy. 
Nothing was said about the cost. 
Two weeks later the patient received a bill for $125 for 
what he considered was a $25 job. He almost collapsed. 
He was absolutely dumbfounded. Then his surprise 
gave way to anger. He told all his friends about the deal, 
and they shared his attitude. Some of them said their 
teeth had been filled for $5 a tooth and all of them agreed 
that $10 was an extremely large fee for cleaning teeth. 
Irreparable damage was done. The dentist converted 
a valued friend and patient into a bitter enemy and critic. 
All this occurred because a simple, yet vitally important 
step to every professional man had been entirely neglected. 
He did not sell himself to the patient; he did not convince 
him, before the work was done, of its value; he did not 
explain the difficulty and tediousness of fine inlay work, 
nor the meaning of “thorough prophylaxis,” and he did 
not prepare the mind of the patient for the probable cost. 
This same mistake is being made by professional men 
literally every day. Many a patient will be retained as a 
grateful friend if this point is covered in advance. Many 
a physician would be spared bitter memories of litigation, 
loss of friends and of practice, by bearing in mind this 
simple but just and vital point. 
While a physician should not be overbearing, he should 
not be too modest. If you convince your patient, beyond 
any doubt, that his health is worth more to him than any- 
thing under the sun and that you are the man who can 62 
THE SUCCESSFUL PHYSICIAN 
give it to him and maintain it for him, then the limit of 
your remuneration is determined by the size of his purse. 
All these points apply, of course, only to the physician 
who possesses efficiency and knowledge. No matter 
how many of the necessary qualifications you may have, if 
you cannot make your patient grateful to you by the work 
you do for him, you can never be successful. 
In medicine, knowledge is essential to success, but 
knowledge must not be permitted to remain unobserved. 
Before you can convert your knowledge into dollars, you 
must be able to sell it to those who have the money. One 
may be entirely ethical and still have an eye to business. 
It is sad but true that often the quack with business ability 
has made more money than the eminently able physician 
who lacks the commercial instinct which the world 
requires today. But in spite of his money, the quack will 
always be an outcast among his brothers, and, after all, the 
real success of a physician lies not in the size of his bank 
account, but in the number of his satisfied and grateful 
patients. This is what all that has been said has been 
leading up to. It is the final closing act of the doctor. 
If he is not able properly to fulfill the final closing act of 
gratifying the patient, all his other valuable attainments 
are absolutely worthless. The patient cannot be gratified 
if he is charged an exorbitant fee for something which 
he believes was of little value. In other words, every 
patient that comes to you—whether he be a new case, a 
chronic case, or an old friend—must have some element 
of salesmanship practiced upon him to make him realize 
and appreciate that the services you have rendered, or in- 
tend to render, are of greater value even than the fee that you 
exact. In order to make him understand this, the diffi- 
culty of his treatment or of his operation, must be made HOW TO ATTRACT AND HOLD PATIENTS 
63 
plain to him, so that he will have a clear conception in 
his mind of all the labor entailed by the physician in 
order to prepare himself to give the patient the relief he 
is seeking. 
Having developed in the patient’s mind the proper 
idea of the science and skill that will be used in his 
behalf, the labor that will be required to effect the relief 
the patient is seeking, he will naturally be prepared for 
forming some conception of the fee he will be expected to 
pay, and the patient, knowing the valuable services he 
has received, will gladly pay it. For no professional 
transaction is a success unless both the patient and the 
doctor are benefited by it. 
A physician should never be mercenary, but he should 
keep in mind that no one can be at his best unless he 
is free from worry. Nothing will weigh so heavily 
on the mind as worry over finances, and it may be disas- 
trous if the physician performing an operation is concerned 
more with an unpaid grocer’s bill than with the case under 
his knife. The doctor, therefore, owes it not only to him- 
self, but to his patients, to place himself in such a position 
that he will be relieved from these petty and embarrassing 
cares, for he is absolutely entitled to receive such remun- 
eration as will enable him to devote all his energies and 
all his thoughts to the service which he is rendering. 
The physician must be careful not to try to oversell 
himself. A sick person wants action and not talk. 
For conversation a man will go to a lawyer, but from the 
doctor he wants treatment and results. 
Learn from Life 
The points discussed in this chapter are taught only in 
one school—the school of life. Psychology, as it must be 64 
THE SUCCESSFUL PHYSICIAN 
applied in daily work, is of an intensely practical nature, 
and while the student may be perfect in his knowledge of 
psychological science, he may at the same time be com- 
pletely lost when he is called upon to use his knowledge. 
There is no standard by which the human mind can be 
measured. We may discuss nerves and glands to our 
heart’s content; we may make all the psychological 
experiments we will, but we will always find that in the 
human mind there are so many variations, so many 
twists and turns, so many tricks and surprises, that only 
the closest individual analysis can produce satisfactory 
results. 
The physician must be an ardent student of human 
nature. He must always keep in mind that each human 
being is an individual case and is a type peculiar to himself. 
There are certain influences to which all men will respond. 
There are fundamental emotions which recur through- 
out mankind, but the reactions of the mind are so subtle 
and the impressions are so strong, that the least error in 
mind treatment may cause irreparable damage. Every 
young physician should, therefore, take a thorough post- 
graduate course in psychology. The classroom of this 
course is the world. The instructors are all men and 
women and the text-book is life. CHAPTER III 
CHOICE OF LOCATION 
While the choice of your location is but one of the 
minor steps toward your success, it is of considerable 
importance to you. It is not a step that will wreck your 
career should you make a mistake, because many men have 
made good in spite of great obstacles, but it will help you 
and make things easier for you to settle in a locality 
where you will eventually remain. 
Hundreds of men have been successful although they 
may have changed the line of their endeavor when they 
found that they were better suited for another profession. 
A change of location may, therefore, not be a very great 
disadvantage if the physician is made of the right material 
and if he has utilized his time to gain experience. If each 
day has been used to strengthen the foundation on which 
the future is built, then the mere moving from one place 
to another does not interfere with success. 
The limits of what is meant by success are naturally 
somewhat vague. To some it means the amassing of a 
large fortune; to others it means fame and power. But 
no matter what the definition may be, success always 
consists of achieving that which one sets out to do. 
To render service to the sick, to relieve the suffering, 
to add to human happiness, and to earn the gratitude of 
satisfied patients, that is real success in the medical 
profession. 
65 66 
THE SUCCESSFUL PHYSICIAN 
To undertake anything worth while and do it better 
than the average is what Charles Schwab calls success, 
and if the career of any successful man is followed, it will 
always be found that he has done his chosen task better 
than the less successful man. 
Your choice of location will bring you into a certain 
environment which will help to shape your destiny, as I 
pointed out in the first chapter of this book. What this 
environment will be and how it will act upon you can be 
learned only by actual experience. It is therefore quite 
likely that the young doctor may have to try several 
locations before he will find that happiness and content- 
ment which are necessary to a successful career. 
No one—in medicine or in any other walk of life— 
should endeavor to do anything for which he has not the 
natural inclination and ability. Before you attempt 
to settle down as a physician you should know exactly 
what your natural inclinations and latent abilities are. 
This question should really have been considered before 
you undertook the study of medicine. Think of the 
students who went through college with you who were 
utter failures in medicine and who could have achieved 
distinction if they had taken up the kind of work to which 
they were adapted and drawn by natural taste. 
Whenever you meet a physician who complains about 
his profession and declares that it has no opportunities, 
you may be sure that it is not the profession that is wrong 
but that he is out of place in it and should have taken up 
something else. 
The fact that you are a practicing physician, ready to 
settle down to your fife’s work, proves that you have 
been successful so far. But it does not mean that you 
will continue to be successful in your profession. This CHOICE OF LOCATION 
67 
you can only be if you find your place in the world and 
build your future there. 
According to the last available reports, of all the busi- 
ness ventures that started with a capital of $5000 or 
eighty-six per cent failed. Of one hundred students who 
took up medicine, seventy-five finished and sixty-five 
actually started the practice of medicine, according to 
figures supplied by the American Medical Association. 
Of those who practice, only one in eight has an income 
sufficient to make him pay an income tax. 
Many of the men who dropped out were capable men, 
and able to take their place among the leaders, but 
medicine was not their proper calling, and fortunate 
were they who found this out in time. 
It is my purpose to point out to you some of the mis- 
takes that others have made, and to light the road for 
you if you have made up your mind that it is the right 
road. But if you are traveling in the wrong direction, 
if your heart and devotion are not in your profession, then 
all the assistance, all the books, and all the advice in thd 
world will not make you a successful physician. 
Any young man who has the brains and the fixity of 
purpose to arrive at your present position must be 
considered as made of excellent mental material. To 
develop this material to its present state of perfect train- 
ing was a costly process. If you had to work your way 
through college you need not be told this—you have 
painful inside information. But if you know nothing of 
this you may secure this information very readily from 
your parents. You know just about what the absolute 
minimum is for each year, and six years of this will make 
the investment in your brains alone amount to upward of 
$3600, depending on the number of societies and fraterni- 68 
THE SUCCESSFUL PHYSICIAN 
ties you belonged to, on the amount of laboratory fees you 
extracted from your father, and upon your medical books. 
If, in addition to this, you consider your time worth at 
least as much as that of an ordinary clerk at $100 a month, 
this would make for six years an additional $7200. In 
other words you represent an investment of from $10,000 
to $20,000 in actual cash. 
Having gone so far, why not spend just a few dollars 
more in a good place and find what your real ability is 
and along what line you may reasonably expect to receive 
the best returns on this investment. 
Instead of hunting up the names of towns, ascertain the 
address of a good psychologist and let him diagnose your 
ability as you would diagnose a disease. Experience 
along this line in commercial pursuits has been a genuine 
surprise. Have yourself examined thoroughly, and this 
will do more to assist you to find yourself than anything 
else could do. Had the twenty-five students mentioned 
above who failed to finish done this, the number would 
have been only a negligible fraction. 
Learning from the psychologist what you are fitted 
for, consider the following points: 
1. What You Would Like To Do And Be 
2. What You Can Do And Be 
3. What Will Give You A Comfortable Living 
The ideal combination is tljat in which all three are 
possible and practicable, and when you have found out 
your capabilities, and considered these in connection 
with the three essentials, then only have you arrived at 
the point where you may consider the location where 
you should make your start. 
Knowing these things, having made your final decision CHOICE OF LOCATION 
69 
as to what they are to be, select the goal you intend 
to reach in ten years from now, and start on your journey. 
After this investigation, and in the light of the information 
it has given you, determine what you are going to drive 
for, and let nothing stand in your way. 
If you will be guided by this advice, there is only one 
person in the world who can prevent your success; 
his address is identical with your own, and you see his 
likeness each morning when you look into the mirror. 
Osier successfully maintained and taught that if 
one knew the physiology, symptomatology and pathology, 
each one could devise the proper treatment on the spot. 
Hubbard makes the same assertion in another way when 
he said: “Happy is that man who has found his work.” 
I maintain that if you know your own peculiar abilities 
and weaknesses, you will know how to use your good points 
to advantage in the line of your chosen work. 
If you have a natural aversion to associating with all 
sorts of people, as you would be compelled to in general 
practice, how could you possibly succeed in this field of 
work? You could not, and yet you might easily be 
a genius in laboratory research work. Consider the 
man who frightens young children when he so much as 
looks at them? They do not like him and he does not 
like them. But he may be eminently qualified for experi- 
mental surgery. So the comparisons could be extended 
indefinitely, and therefore I repeat: 
Every young man should know his own best field of 
usefulness. There is a saying in law to the effect that 
“The man who argues his own case has a fool for a client.” 
Unless you know positively where you fit in, does not this 
same rule apply to one who tries to figure all things out 
alone ? 70 
THE SUCCESSFUL PHYSICIAN 
How to Make Your Choice 
Let us assume that you have learned your natural 
inclination and that you have firmly decided on a certain 
course, so firmly that there is no chance for any change of 
mind. 
How then will you go about to determine where you 
intend to settle? 
First ask yourself whether you prefer a large or a small 
city, an agricultural or a farming community, a town or a 
country practice. 
If the large city lures you, consult the census reports 
and learn which cities have grown fastest in the last few 
years. These are the ones where you would be most likely 
to grow as the population increases and the demand for all 
sorts of human endeavor becomes greater as time goes on. 
In cities of medium size you may follow the same rule. 
Many towns have become cities within a few years and 
often the opportunities are greatest in communities of this 
type. Cities with medical colleges seem to attract the 
largest number of physicians. If you wish to make a 
place for yourself in a college, such a city is the place for you 
to go; otherwise keep as far away from it as possible. 
To the smaller towns and country places the same rule 
should be applied as to the large cities; go to that locality 
which seems to indicate the most healthy growth, that 
has the most money per capita, and the fewest number of 
doctors per thousand. You may obtain this information 
from the U. S. Census reports and from the compiled direc- 
tory of the American Medical Association. 
Be careful of Horace Greeley’s advice, “Go West!” 
So many have followed it that there are more physicians 
per thousand in the West than in the East. CHOICE OF LOCATION 
71 
According to the rate of increase of population and the 
value per man the best localities are some of the middle 
western, middle northwestern, southwestern, or southern 
communities, but not the extreme East nor the extreme 
West. 
Under proper conditions, your home community is a 
good location. Some of the advantages are rapid growth, 
a large, favorable acquaintance, the prosperous condition 
of the residents, or the fact that you may follow in the 
practice of some member of the family before you. All 
these are good reasons why you should remain in your 
home town, but there are many reasons that render this 
step of questionable value. The people are apt to know 
you too well and have the memory of you as a lad lingering 
in their minds. If that is so, they will not want to come 
to you with the story of their misfortunes and indiscretions. 
If you speak a foreign language, it may give you an 
easy start to go into one of the foreign colonies, of which 
there are so many in this country. But there are also 
reasons against this. There is usually marked clannish- 
ness in these closed communities, and you may find much 
antagonism among those who have come before you. 
To attain eminence you should not confine yourself to 
a certain limited group of people, but you must be part of 
the whole people and consider all of them, to achieve 
prominence in medicine. The outside world will not come 
to you if you are rated as part of any inner circle. 
The old-established cities have periods of growth and 
of rest. While one section may remain stationary, 
another may take on a very substantial growth. If you 
should go into one of these older cities, look for the section 
that has taken on one of these growing spurts and en- 
deavor to select the most desirable section. The most 72 
THE SUCCESSFUL PHYSICIAN 
desirable corner is usually the northeast corner of a street. 
While this does not always hold good, it will generally 
be found that the most successful store or business will be 
on this corner. If possible, therefore, engage your offices 
in such a location. 
An office at almost any corner is preferable to one in the 
middle of the block; and endeavor to secure rooms on a 
shopping street, since this is the place where the women 
will come. Some professional man has maintained that, 
if you can get the women to coming to your office, 
the men will follow. 
The residence section is a good location for those who 
intend to engage in a family and children’s practice, or to 
have only a family practice in general medicine. If 
you wish to have this form of practice, you should endeavor 
to occupy the whole house you select, or at least an entire 
floor. This can be used for your office and your home for 
a time, but it never seems professional to me to see a 
home and an office in combination, since you have neither 
a regular office nor a regular home. When you have your 
office and home apart, patients cannot come to visit 
your wife and consult you at the same time, and expect 
not to pay. If you must have both together, it is better 
to have the entrance and the exit by separate doors. 
Your office should have the best light possible, an 
ample number of windows, and the signs in the windows 
and on your door should be of the very best workmanship. 
Your office should be kept in perfect repair and be well 
painted. 
The signs and the number of your house, on the door or 
in the window should be so arranged that they may be 
readily seen and read at night. Some persons remember 
numbers better than names. Others remember a location CHOICE OF LOCATION 
73 
better than names or numbers, and still others recall a 
name more easily than they do numbers or location. 
It is your duty to offer each one of these classes something 
that they may fix in their minds. It often happens that 
patients who do not need you will not come to you for years. 
When they do come, it is well to assist them in every way 
you can. 
In all large cities there is a shopping or business center. 
If you want patients in such districts, get on the best 
corner of the best street. The expense will be greater, 
but the number of people who will come to you because 
of your central location in the best building will also be 
greater, and it will be so much greater that the added 
expense will be negligible. It matters not what your 
monthly expense amounts to if your income is sufficiently 
large. There are places in the immediate neighborhood 
of some busy street where one may find a very desirable 
office, but these places are rare. The safest plan is to 
go where you know other people go. 
In most large cities there are buildings intended for 
physicians and dentists and the allied professions alone. 
To those who have some reserve capital or a certain 
source of revenue each month, this location is the best 
of all. Do not have your office on a court. Have it on 
the outside of the building, where you will get the sun 
and proper light. Some buildings look well on bright 
days, but on the dark ones will look dismal and dreary. 
It will be better to spend a month in the city of your choice 
in looking for the right location than to waste a day in 
moving later on. Every time you move you can count on 
losing about fifteen or twenty per cent of your practice; 
every year you remain in one place is an added asset to 
you. 74 
THE SUCCESSFUL PHYSICIAN 
We are all creatures of habit. We go through the same 
processes each morning in dressing, we put the same shoe on 
first in the same way each morning, and never think 
anything about it. People are the same about physicians, 
particularly in large cities. Patients may become more 
or less dissatisfied with their doctor, but rather than hunt 
up a new one of whom they know nothing, they will 
return through habit or through timidity at starting out to 
find another. Have your office where it is easy to find, 
easily accessible, convenient to car lines, and you will 
hold your patients more readily than you will be able to 
do in some inaccessible place. 
The manufacturing centers of the larger, as well as of 
the smaller, cities are excellent locations for one who 
intends to go in for emergency and surgical work. Here 
also you will want to get on a corner near where many 
men and women pass in going to and from their work. 
After finding such a location, it will be your business to 
get in touch with the owners of the nearby places. You 
will also find it necessary to obtain the consent of the 
companies that insure workingmen for you to do the 
work that may come to you. The men to get in touch 
with are the owners. If you cannot see them, write to 
them, telling them of your qualifications for the work of 
your choice, your fitness, ability and facilities to handle 
this practice. You should become acquainted with the 
superintendents, the foremen, the yard bosses, the straw 
bosses and the men themselves, for although the work 
may come to you from the bosses, it is also necessary for 
you to please the men, just as in the home the patient as 
well as the relatives must be pleased. 
To enter the practice of medicine you will need a certain 
amount of money each month, and if you have no regular CHOICE OF LOCATION 
75 
income to provide this, you cannot exist until such time as 
you have a sufficiently large number of patients to pay 
expenses. In other words, if you have not a large enough 
capital, you are going into an enterprise with all the chances 
against you. Keep this in mind and remember that 
many capable men have failed because of a shortage of 
funds, and it has taken them years to recover from the 
effects of their first failure. And even if you have ample 
means, it will still be a waiting game unless you are a 
fortunate genius. That is something which every physi- 
cian will have to face; it will take years of tireless, con- 
scientious work to build up a career. Only the man who 
has the will power and the energy to face these years and 
to work hard can succeed as a physician. 
Occasionally in the large cities men have become 
famous over night and fame and fortune have come to them 
in a flash. We have heard of the case of the prospector who 
discovered the gold fields of Nevada when he was looking 
for a stone to throw at the mule that had kicked him. 
Such things happen—but they are not subject to calcula- 
tion and reasoning. They are accidents, and one cannot 
depend on them for success. 
Secure your office location and proceed to meet people. 
The systematic, steady, and concentrated effort will tell 
in the end. Where one has made a name for himself over 
night, a thousand have risen from the ranks by hard work. 
The methods of meeting the people you want to know and 
whom you intend to reach will be discussed in a succeeding 
chapter. 
Your time in the office should be limited to a few hours 
each day, reserving the greater part of it for visiting. 
You should select office hours in the forenoon, when most 
of the other physicians are engaged in the hospitals 76 
THE SUCCESSFUL PHYSICIAN 
and on calls. You will find, in the busy section of the 
large cities, that there are many people seeking a doctor 
in the early morning hours. The remainder of the day 
should be given entirely to going about. 
For all large and medium sized cities the same 
directions hold good and should be followed. 
The small country town is the natural place of choice 
for the young man. It gives him an easier, a quicker start 
—it compels him to do his own work and his own thinking. 
It allows him time to find himself and to gain confidence 
in himself and in his work. It permits him to be the one 
in charge rather than merely an assistant. He has to 
bear the responsibility of his own acts and there is not that 
attitude of general criticism one finds in a city; one does 
not need to be constantly measured by contrast with those 
who have an established reputation. 
People in the country are not so hurried as they are in 
the city, and for this reason one may go about the careful 
study of his cases and his work with less feverishness. 
For the small country town another method is prefer- 
able to follow. It differs only, however, in your office 
hours. These should be in the afternoon. But no hard 
and fast rule can be established at first. Attend to people 
at all times and when ever called. When not engaged in 
treating patients, your time can most profitably be used in 
meeting the people of the town and in taking a trip to the 
country, going each day in a new direction. Do this until 
you have met, talked with, and know something about all 
the people that may for any reason come to you. Do 
not ask them to come to you. All you are to do on these 
journeys is to make yourself known to them. 
In the country one is soon known for what he is rather 
than for what he pretends to be. The patients one CHOICE OF LOCATION 
77 
does have are usually of the substantial sort. If you treat 
them well, you will have constant friends who will stay 
with you and on whom you may count, whereas the city 
patient may remain and he is just as likely to be there for 
only a few days. 
State 
Wealth per 
Capita1 
State2 
Per Cent of 
Physicians per 
Thousand 
$2904.17 
North Dakota 
0.86 
2603.57 
South Carolina 
0.86 
2489.17 
North Carolina 
0.87 
2062.73 
0.98 
2159.85 
1.2 
2646 60 
1.3 
2170 83 
1.3 
1892 95 
1.4 
1832 56 
1.10 
1810.40 
1.10 
1783 14 
,1.10 
1694.49 
1.11 
1677.83 
1.13 
1670 64 
1.14 
1653.68 
1.17 
1505.72 
1.17 
1505 53 
1.18 
1347 90 
1.25 
1343.44 
1.25 
1323.64 
1.28 
1316.00 
1.29 
1193.66 
1.29 
1188.14 
1.30 
1183 00 
1.33 
1156 14 
1.33 
1145.76 
1.33 
1138.08 
1.38 
1126.73 
1.38 
1078.49 
1.40 
1069.67 
1.41 
1043.58 
1.42 
1041.69 
1.44 
1033.00 
1.44 
1015.81 
1.45 
977.99 
1.46 
963.97 
1.47 
800.93 
1.47 
792.58 
1.52 
784.65 
1.52 
760.68 
1.55 
690.37 
1.57 
687.81 
1.63 
670.75 
1.64 
572.14 
1.69 
504.48 
1.74 
476.23 
1.91 
Colorado 
1.94 
California 
1.97 
1 Reported by Chamber of Commerce and Wells Fargo Bank, San Francisco. 
2 Compiled from 1920 U. S. Census and 1920 Directory A. M. A. 
Grand Total Physicians in U. S.—145, 608. 
Total Population—105,683,118. 
Per cent of Physicians per thousand, for U. S., grand average, 1.3777, does not take into ac- 
count 30,000 Christian Science or 8000 Osteopaths more or less and the other “opothies” and 
pathies” and “ists,” colleges, hospitals, dispensaries, charities and others who care for the sick, 78 
THE SUCCESSFUL PHYSICIAN 
*FIRST 100 CITIES IN U. S. ARRANGED IN THE ORDER OF THEIR 
RATE OF GROWTH AND PER CENT OF PHYSICIANS 
PER THOUSAND 
Rate of 
Growth 
Per Cent 
of Physicians 
per Thousand 
1 
296.4 
0.74 
2 
201.8 
0.75 
3 
137.6 
0.84 
4 
114 1 
1.02 
5 
113.3 
1.06 
6 
97.4 
1.06 
7 
88.7 
1.06 
8 
80.7 
1.08 
9 
75.5 
1.09 
ID 
73.4 
1.14 
11 
72.6 
1.15 
12 
71.6 
1.16 
13 
67.4 
1.16 
14 
67.0 
1.17 
15 
58.7 
1.18 
16 
54.4 
1.21 
17 
48.9 
1.23 
18 
46.4 
1.25 
19 
45.8 
1.27 
2D 
45.2 
1.31 
21 
44.3 
1.31 
22 
44.0 
1.34 
23 
42.1 
1.37 
24 
42.1 
1.40 
25 
41.6 
1.43 
26 
40.7 
1.45 
27 
40.4 
1.45 
28 
39.6 
1.50 
29 
38.2 
1.51 
30 
37.5 
1.51 
31 
35.6 
1.53 
32 
35.4 
1.54 
33 
34.8 
1.56 
34 
34.5 
1.57 
35 
34.5 
1.57 
36 
32.9 
Troy, N. Y 
1.57 
37 
32.2 
1.58 
38 
32.2 
Utica, N. Y 
1.58 
3D 
31.4 
1.58 
4D 
30.9 
1.59 
41 
30.6 
1.60 
42 
30.6 
1.61 
43 
30.3 
1.62 
44 
29.6 
1.63 
45 
28.0 
1.64 
46 
27.3 
1.67 
47 
Utica, N Y 
26.5 
Buffalo, N. Y 
1.69 
48 
26.3 
1.71 
49 
26.1 
1.75 
50 
Wilmington, Del 
26.0 
Ft. Wayne, Ind 
1.75 
‘Compiled from 1920 U. S. Census and 1920 Directory A. M. A. 
1 Many of the N. Y. City doctors are called to and have their residence in these adjacent 
places. 
Statistical figures and government positions supplied through courtesy of Hon. Julius 
Kahn, M. C. CHOICE OF LOCATION 
79 
FIRST 100 CITIES IN U. S. ARRANGED IN THE ORDER OF THEIR 
RATE OF GROWTH AND PER CENT OF PHYSICIANS 
PER THOUSAND 
Rate of 
Growth 
Per Cent 
of Physicians 
per Thousand 
51 
52 
53 
Yonkers, N. Y 
25.5 
1.76 
25.4 
1.78 
25.1 
1.80 
54 
55 
25.0 
1.85 
24.6 
1.85 
56 
23.8 
1.86 
57 
23.6 
1.89 
58 
59 
60 
23.2 
1.90 
23.1 
1.94 
23.0 
1.94 
61 
22.9 
1.95 
62 
22.4 
1.96 
63 
22.3 
1.98 
64 
22.3 
1.98 
65 
21 8 
1.99 
66 
21.7 
1.99 
67 
21.5 
2.01 
68- 
20.5 
2.02 
69 
20.2 
2.03 
70 
Buffalo, N.Y 
19.6 
2.06 
71 
19.3 
2.07 
72 
18.3 
2.07 
73 
New York, N. Y 
17.9 
2.08 
74 
17.7 
2.09 
75 
15.8 
2.10 
76 
14.2 
2.11 
77 
13.7 
2.15 
78 
Albany, N. Y 
13.1 
Norfolk, Va 
2.17 
79 
12.5 
2.22 
80 
12.2 
2.25 
81 
11.9 
2.26 
82 
11.6 
2.27 
83 
11.3 
2.30 
84 
11.0 
2.31 
85 
86 
10.4 
2.32 
10.2 
2.33 
87 
10.0 
2.42 
88 
9.8 
2.43 
89 
9.3 
Oklahoma City, Okla 
2.57 
90 
8.2 
2.59 
91 
7.2 
2.63 
92 
6.1 
2.64 
93 
6.1 
2.75 
94 
95 
5.9 
2.80 
4.9 
2.84 
96 
97 
98 
99 
100 
4.6 
2.90 
1.0 
2.97 
0.7 
3.07 
Spokane, Wash 
Troy, N. Y 
-6.2 
San Diego, Calif 
3.35 
3.86 80 
THE SUCCESSFUL PHYSICIAN 
THE FASTEST GROWING TOWN OF 10,000 TO 25,000, IN EACH STATE 
Per Cent of 
Physicians per 
Thousand 
Rate of Growth 
1910-1920 
0.7 
6.2 
0.75 
712.5 
0.8 
36.7 
0.82 
142.3 
0.83 
795.1 
0.84 
106.8 
1.0 
56.8 
1.0 
28.5 
1.09 
67.9 
1.10 
93.9 
1.12 
116.4 
1.2 
190.4 
Ilion, N. Y 
1.4 
54.4 
1.4 
76.0 
1.5 
118.4 
1.7 
46.1 
1.73 
64.7 
1.78 
22.3 
1.8 
35.9 
1.94 
205.0 
2.0 
54.0 
2.0 
72.9 
2.0 
17.8 
2.08 
123.5 
2.11 
251.4 
2.15 
78.7 
2.2 
323.8 
2.2 
69.3 
2.2 
71.9 
2.3 
46.3 
2.5 
83.8 
2.5 
69.5 
2.6 
317.4 
2.7 
27.7 
2.84 
34.0 
2.85 
2.98 
245.0 
56.0 
3.0 
55.4 
3.45 
30.3 
3.55 
392.9 
3.6 
11.3 
14.0 
14.9 
Bristol Town, R. I., 32.8 per cent, Charlottesville, Va., 58.0 per cent, and Roosevelt borough, 
N. J., 90. 9 per cent, fastest growing towns but no statistics of the number of physicians reported. 
Figures frbm U. S. Census, 1920, and Directory A. M. A. 
Your expenses are lower in the country and your 
returns more certain. You can rent a home in the country CHOICE OF LOCATION 
81 
for a year for what it would cost you in the city for two 
months. 
Because you begin in the country is no reason why you 
should remain there, unless you choose to do so. The 
experience you gain and the better demeanor you can 
cultivate are quite as useful in one place as in another, 
and if you do not buy property when you have acquired 
enough experience and the capital to do so you can easily 
transfer your activities to the city. 
These tables show some very interesting facts. There 
is seen a great concentration of doctors in the large cities— 
100,000 and up. This concentration becomes more appar- 
ent when you compare the number of physicians per 
thousand for the state as a whole, or a large city in 
that state. For instance, Maryland has only 1.63 for 
for each thousand, while the City of Washington, D. C., 
has 3.86. 
The East and West Coast cities in which there are 
universities have a surplus of doctors, while the cities of 
from five to twenty thousand population in the wealthy 
states do not appear to have nearly so many physicians. 
Obviously the most desirable location to choose is a 
community with an even distribution of wealth and that 
has the fewest doctors. By consulting the tables these 
will be found to be the newer states generally, and those 
situated away from either coast. Climatic conditions 
may not be so agreeable as in the Coast States or the 
social environment may not appear so inviting, but it 
must be remembered that the young doctor is not seeking 
a summer resort. He is looking for a likely place in which 
to start the practice of medicine. And, further, he should 
not give more than passing consideration to the social 
side, for he will be occupied with more serious professional 
matters. 82 
THE SUCCESSFUL PHYSICIAN 
CHOICE OF LOCATIONS* 
Positions for Doctors 
How Secured 
Time Required 
Income 
Appointment by man- 
ager or owner. 
Part time 
to SI.00 a room a month 
depending on clientele of 
hotel 300 rooms and up, best 
Same as hotel. 
Part time 
Same as hotels. Those hav- 
ing less than 150 rooms of 
little value. 
Railroads, chief surg— 
Personal effort by ap- 
Time variable 
No information available 
that is definite—two in- 
stances 1000 to 10,000 per 
Only given to those 
who have established 
reputation. 
annum, depending on im- 
portance of road. 
$600 to $1500 per year, de- 
Time variable 
chief surgeon. Usu- 
ally middle aged and 
proved capable. 
pending on importance of 
road. 
Special arrangement usually 
Appointment by chief 
surgeon. 
Time variable 
includes transportation over 
the system. 
Life insurance com- 
Personal application 
Usually all 
Estimation of one to 10,000 
pany’s medical director 
and effort through 
Gen. Mgr. or 
directors. 
companies refuse to specify 
amount to public. 
Variable—companies do not 
permit quotation, average 
Appointment by 
medical director. 
Part time 
$1000 to $3000 per annum. 
Appointment by 
medical director. 
Part time 
So much an examination. 
Appointment by 
medical director. 
Part time 
Variable—special arrange- 
ments govern each case. 
Traveling examiner or 
Appointment by 
Part time 
$2000 a year, up—and 
special investigator.... 
Industrial accident in- 
medical director. 
expenses. 
surance companies: 
Application to 
board of directors. 
Part time 
Depends on size of company, 
$100 to $350 per month up. 
Surgeon, large cities 
Appointment by 
Part time 
$150 per month average or 
medical director. 
by amount of work done. 
Appointment by 
medical director. 
Part time 
Paid by amount of work 
done. 
Special appointment 
by owners. 
Usually 8 hrs. 
Variable, average $100 per 
daily 
month and expenses. 
Special appointment 
by owners 
Usually 8 hrs. 
daily 
Variable, average $75 to 
$125 per month and living 
expenses. 
Ocean steamships 
Appointment by 
manager. 
All 
$25 to $100 per month and 
expenses, major portion of 
salary derived from pas- 
sengers. Pacific and Orient 
lines best. 
Lumber companies 
Appointment by 
owners. Get names 
from lumber firms or 
lumber journals. 
All time 
$100 to $150 per month and 
board. 
Chief surgeon large mine 
Mines, chief surgeon.... 
Appointment by 
Part time 
owners or mngrs. 
$300 per month up. 
Mines, asst, surgeon 
Appointment by 
Part time 
50f to $1.00 per employee per 
owners or mngrs. 
month, or on salary average 
$100 to $150 per month. 
Construction companies. 
Appointment by 
Part time 
So much per employee a 
manager or owner. 
month or salary $100 and 
up with expenses. 
Government service: 
Vocational training 
Civil service. 
All 
$2400 to $3000. Chief asst. 
$1500 to $2400. 
All 
$2400 to $3000. 
All 
$1500 to $2400. 
All 
$1800 to $3000. 
Asst. dist. med. officer.. 
Civil service. 
All 
$1800 to $2700. 
•Army and Navy information supplied through courtesy of Hon. Julius Kahn, M. C. State 
positions through the Governor’s office, courtesy of Hon. Fred Howes. City positions through 
courtesy late Charles Forbes, Assistant Secretary, Board of Supervisors, San Francisoo. CHOICE OF LOCATION 
83 
Positions for Doctors 
How Secured 
Time Required 
Income 
Bacteriologist 
Civil service. 
All 
$130 to $180 per month 
Bacteriologist, assistant. 
Civil service. 
Part time 
$70 to $90 per month 
Bacteriologist, junior.... 
Protective social service: 
Civil service. 
Part time 
$30 to $50 per month 
Director 
Civil service. 
All time 
$3500 to $4000 per year. 
Supervisor 
Civil service. 
Part time 
$800 to $3600 per year. 
Pield Asst 
Civil service. 
Part time 
$1800 to $3600 per year. 
Special 
Civil service. 
Part time 
$900 to $1500 per year. 
Public health service:... 
Civil service. 
Part or all 
$480 to $3000 per year. 
Indian field service .... 
Civil service or ap- 
pointment. 
Part or all 
$1000 to $2000 per year and 
most living expenses. 
Geodetic survey 
Commissioner of pen- 
sions : 
Civil service or ap- 
pointment. 
Part or all 
$1020 per annum, and most 
living expenses. 
Examining surgeons 
Army: 
Appointment by 
pension commission. 
Part time 
So much per examination. 
First Lieut 
Examination. 
All 
$2000 per yr. & $600 till 1922. 
Captain 
Promotion. 
All 
$2400 peayr. & $720 till 1922. 
Major 
Promotion 
All 
$3000 per yr. & $840 till 1922. 
Lieut. Col 
Promotion. 
All 
$3500 per yr. & $600 till 1922. 
Colonel 
Navy: 
Promotion. 
All 
All salaries incr 
service till a pos 
been added, 
homes, provisio 
$4000 per yr. & $600 till 1922. 
eased 10 per cent each 5 yrs. of 
sible maxium of 40 per cent has 
41so most of expenses. Free 
ns and clothing at cost. 
Same as army 
State service: 
By examinations 
Salaries approximately the 
same as army. 
School for deaf and blind 
Civil service or ap- 
pointment. 
Write secy, of state 
for information. 
Part time 
Average salary $100 per mo. 
Industrial home adult... 
Corrective schools: 
Civil service or ap- 
pointment. 
Write secy, of state 
for information. 
Part time 
Average salary $100 per mo. 
Girls 
Civil service. 
Part time 
Average salary $200 per mo. 
Boys 
Industrial schools: 
Civil service. 
Part time 
Average salary $200 per mo. 
and board, room & laundry. 
Boys 
Civil service. 
Part time 
Average $200 per mo. 
Girls 
Civil service. 
Part time 
Average $200 per mo. and 
living expenses. 
State orphan schools 
Civil service. 
Part time 
Average $150 per mo. and 
State industrial accident 
com. med. director... . 
Appointment by Gov. 
or civil service. 
Part time 
living expenses. 
$225 to $350 per mo. 
1st asst 
Appointment by Gov. 
or civil service. 
Part time 
$150 to $250 per mo. 
2nd asst 
State board of edu- 
cation: 
Appointment by Gov. 
or civil service. 
Part time 
$150 to $250 per mo. 
1. Asst, supervisor 
Civil service or appt. 
Part time 
$200 per month and up. 
2. Asst, supervisor 
Civil service or appt. 
Part time 
$150 per month and up. 
Special Investigators 
board of medical 
examiners: 
Appointed by Gov. 
Part time 
Per diem basis, average $75 
to $100 per mo. 
Secy. & treas 
Appointed by Gov. 
Part time 
$250 per month. 
State board of health.. 
Appointed by Gov. 
Part time 
Per diem basis. Average 
$75 to $100 per mo. 
Secy. & executive officer. 
Appointed by Gov. 
Part time 
$375 per month. 
Dist. health officer 
Civil service or ap- 
pointment. 
Part time 
$300 per month. 
* Army and Navy information supplied through courtesy of Hon. Julius Kahn M. C. State 
positions through the Governor’s office, courtesy of Hon. Fred Howes. City positions through 
courtesy late Charles Forbes, Assistant Seeretarys Board of Supervisors, San Francisco. 84 
THE SUCCESSFUL PHYSICIAN 
Positions for Doctors j 
How Secured 
Time Required 
Income 
Director communicable 
diseases 
Civil service or ap- 
pointment. 
Civil service or ap- 
pointment. 
Part time 
Part time 
$300 up per month. 
$300 up per month. 
Director bureau child 
Civil service or ap- 
Part time 
$300 up per month. 
pointment. 
Civil service or ap- 
pointment. 
Part time 
$50 up per month. 
Civil service or ap- 
pointment. 
Civil service or ap- 
$200 up per month. 
$100 up per month. 
$333 per mo. and up with 
State insane hospitals, a 
All time 
pointment. 
Civil service or ap- 
pointment. 
living expenses. 
$230 to $270 and expenses. 
All time 
Civil service or ap- 
pointment. 
All time 
$170 to $225 and expenses. 
Civil service or ap- 
pointment. 
All time 
Depending on experience. 
$225 and up and expenses. 
Civil service or ap- 
pointment. 
All time 
Pathologist, one to each 
institution usually 
Civil service or ap- 
pointment. 
Civil service or ap- 
pointment. 
All time 
Part time 
$225 per mo. and up and exp. 
$400 per mo. and up and exp. 
State general super- 
Civil service or ap- 
Part time 
pointment. 
Civil service or ap- 
After-care phys. veterans 
Part time 
$175 per mo. and up and exp. 
pointment. 
Civil service or ap- 
pointment. 
Part time 
$200 per mo. and up and exp. 
Civil service or ap- 
pointment. 
Part time 
$150 per mo. and up and exp. 
Appt. by Governor or 
civil service. 
Part time 
$200 and up and expenses. 
City positions for doc- 
Most of these are ap- 
tors in cities of 100,000 
pointive or require 
some political influence. 
Appt. or civ. service. 
All time. 
Health officer (.city).... 
Appt. or civ. service. 
$7,500. 00 per annum. 
Chief surgeon 
Appt. 
Part time 
$225. 00 per mo. 
Emergency service chief 
Appointed by board 
Part time 
$200. 00 per mo. 
Part time 
Emergency Asst. 
Appointment. 
$150. 00 per mo. 
Appointment. 
Appointment. 
Sanitary inspectors 
Part time 
$175. 00 per mo. 
School inspectors chief. 
Appointment. 
Part time 
$175. 00 per mo. 
Appointment. 
Appointment. 
$120. 00 per mo. 
$250. 00 per mo. 
Venereal clinicians chief. 
Part time 
Appointment. 
$200. 00 per mo. 
$75. 00 per mo. 
$150. 00 per mo. 
Part time 
Appointment. 
Appointment by 
Visiting phys. relief 
Part time 
home (incurables) 
mayor or police 
Part time 
$150. 00 per mo. 
$200. 00 per mo. and up. 
Appt. board of health 
Aj>pt. by coroner or 
Chief 
Part time 
$300. 00 per mo. 
$275.00 per mo. 
$200.00 and up per mo. 
Appt. by coroner or 
Part time 
$150.00 and up per mo. 
doctors. 
Medical reviewers or 
Appt. by dean or 
Part time 
Variable. 
preparing papers for 
faculty. 
Appt. by doctor in 
charge. 
Appt. by faculty. 
Part time 
Variable. 
Asst, to college 
Variable. 
Civil service or ap- 
pointment. 
Part time 
Professors in colleges... 
Variable. CHOICE OF LOCATION 
85 
Start two doctors of equal ability, one in the richest 
and the other in the poorest state, or start these same 
young men in two separate cities, one in that which 
has the fewest and the other in the city that has the most 
doctors, and it will not require an expert to determine which 
one will derive the greatest benefit from his labors. 
The candidate or novice in any athletic sport does not 
aspire, much less hope, to be an expert on his first try-out, 
no matter how great may be his natural talent or how 
wonderfully nature may have endowed him for this par- 
ticular specialty. Why, then, should the young physi- 
cian go into the most crowded city and expect to match 
his inexperience with those who have become experts in 
their own field ? 
The positions for doctors in the Government, state, 
city and county can be ascertained by addressing those 
who have these matters in charge. In each state, city 
or county these positions will differ in name and number. 
This will be determined by the size of the population of 
the various places named. When positions are indi- 
cated as requiring all the time, it does not mean a twenty- 
four-hour day: it usually means an eight-hour day. The 
position that consumes all of one’s time is the exception. 
Although the Government, city and state positions 
pay very meager salaries, they are always filled and many 
of them have a long waiting list. 
One would imagine that, by merely writing to the 
federal, state or city authorities, full information would be 
forthcoming at once relative to any openings. This is not 
the case. To obtain the desired information it will generally 
be necessary to have someone make inquiries for you. 
If you are interested in a federal position, have the 
senator or representative from your district make this 86 
THE SUCCESSFUL PHYSICIAN 
inquiry for you. To him should be addressed a letter 
telling the essential facts about yourself and the reason 
for your request. Should you know him personally, so 
much the better. If you do not know him personally, 
let someone who does know him, and with whom you 
are friendly, give you a letter of recommendation. The 
reason for this is not difficult to find. The ordinary office 
holder does not appear to be any more enthusiastic about 
giving out information in regard to openings than a rail- 
road is to give free rides; besides, he frequently has some 
friend he is grooming for the place. Office holders and 
politicians generally work on the theory and hope that if they 
can put something off today, possibly someone else will 
be called on to do this work tomorrow. This will save 
them all the trouble of doing something. 
In the matter of state positions, a similar method 
should be adopted. Have an acquaintance of the rep- 
resentative from your district make this inquiry for you. 
Should you know him personally, write to him yourself. 
Cities and counties will have a representative in 
the vicinity in which you live. This man can give you 
the names of the proper persons to approach for the 
information you are seeking. If the request to the man you 
desire to see can be made through the local representative, 
it will have more weight than will an inquiry of your own. 
Certain peculiar conditions exist in each place. If you 
would be successful in your effort, it will be to your advan- 
tage to familiarize yourself with these, getting the informa- 
tion from those who make this a part of their business. 
To those who are attracted to political jobs or positions, 
a good man to become acquainted with is the chairman 
of the local Political Committee. He is a student of 
political affairs. If he is not in a position personally to CHOICE OF LOCATION 
87 
assist you in securing what you want, he is more than 
likely to know the right people for you to meet and can 
often direct or introduce you to them. 
Personal leanings as to likes and dislikes should govern 
one in the course he is to pursue. I do not find that those 
who follow the political openings get very far in a medical 
way, although there are exceptions to this rule. If one is 
to engage in general practice, no position should be con- 
sidered that does not permit one to give a part of each day 
to the improvement of his own personal practice. Politi- 
cal positions often lead one into a rut from which it is 
very difficult to extricate oneself. The very lack of personal 
responsibility in most of them naturally tends in this 
direction. One is not permitted to exercise any initiative 
of his own, which is the very basis of a private practice. 
It naturally follows that the longer one remains in these 
political positions, the less capable one becomes of filling 
the exacting duties of the private practitioner. This 
condition is most likely to follow those positions that 
allow one no time for his own work. 
To some men the excitement and the game of politics 
are the essence of life: to these political positions offer 
an opportunity found in no other sort of practice. 
Political positions are not for the timid, retiring indi- 
vidual. They are for those whose personal sensibilities 
are more or less immune to the slurs and insinuations of 
others, and who enjoy getting into arguments and having 
wordy if not other varieties of quarrels. They are for 
the restless man who craves excitement and change, who 
prefers to know many people slightly and to be meeting 
new faces—one who is fond of games of chance. Nothing 
can be more uncertain than political positions, so the man 
who likes to take uncertain ventures is fitted for the politi- 88 
THE SUCCESSFUL PHYSICIAN 
cal field. This does not imply that he must follow politi- 
cal parties. The same sort of maneuvering goes on 
in clubs, fraternities and associations as in public politics. 
The only difference is that in the clubs, fraternities, 
colleges and medical societies the politics are personal 
politics. In politics the man who has the happy faculty 
of making friends and understanding the rudiments of tact 
will certainly outdistance the one who has this faculty 
in lesser degree, even if both have the same ability. 
The timid man who insists on being certain, who is 
fearful of changes, ought to start in the line of work that 
he intends to continue—the political field is not the place 
for such an individual. He should take some position 
that carries with it a monthly salary, where constant, 
steady, persistent effort will permit him to advance to 
higher positions. The Army, insurance companies, or 
colleges would appear to offer the best chances. 
To become an active worker in the medical society 
may lead to securing positions in the society itself that 
bring a fair return, or to positions for which the society 
has the recommending power, such as members of the 
medical board, inspectors for cities or states, or positions 
in the colleges in the state. Government appointments to 
medical positions are indirectly influenced by the favor- 
able report of the Medical Society or Committee. Few 
medical men secured much recognition during the war who 
did not stand well with their local or State Medical Society. 
No matter what your endeavor in the medical field 
may be, it will be necessary for you to have for friends 
those who may be of use to you. For one man who has 
advanced to eminence without friends or the help of 
others, there are thousands who had less ability but were 
boosted along by their friends. CHAPTER IV 
HOW TO BECOME FAVORABLY KNOWN IN 
A LARGE CITY, SMALL CITY, OR 
A COUNTRY TOWN 
1. How to meet various business men under favorable 
conditions. 
2. Bankers, wholesalers, retailers, manufacturers, 
laborers, etc. 
3. How to establish credit for a beginner in a new 
locality. 
4. Societies—medical, fraternal, secret, sectarian and 
non-sectarian. 
The young doctor has a problem to solve similar to 
that of every professional man. It consists of meeting 
people and making friends of them under such conditions 
that they will have a favorable impression of him person- 
ally and as a medical man; that variety of impression 
which would possibly cause them to select him as their 
medical adviser if need arose. 
When the young boy is first taught the rudiments of 
the art of Isaak Walton, he does not start out with the 
full sporting goods fine equipment that we see advertised 
in the papers or exhibited in the hardward store, but 
usually with some improvised arrangement of his own 
making, and he goes out after the smaller fish in the little 
stream. When he has become an adept along this fine of 
endeavor, more equipment and larger game are sought. 
This illustration applies with equal force to the hunter. 
89 90 
THE SUCCESSFUL PHYSICIAN 
The young beginner does not expect on his first hunt to 
go after grizzly bear, but is more likely to seek his pastime 
in the chase for rabbits or small game. Just so, when the 
doctor goes into a new community, the first person whose 
acquaintance he seeks should not be the most influential 
man, because he has not yet acquired the adeptness of 
knowing how to meet people professionally, and create 
a favorable impression. Until he has made good he usu- 
ally does not have the capacity for meeting them on equal 
ground; those who are established will nearly always 
regard the newcomer as an intruder until he has proved 
his worth. 
This recalls the story of a young banker who had 
sought the business of a very large concern for years. 
He deferred making a call on the heads of this concern, 
or any approaches to them, until he could feel able 
to meet them under favorable conditions and possess that 
ability and knowledge and all-around equipment that 
would place him on an absolute quality with their mental 
attainments and business sagacity. Finally, when he had 
acquired this experience, the meeting took place, and 
instead of the business having to be sought it came to 
him unsolicited, all by virtue of the fact that the young 
banker had acquired the necessary experience, bearing, 
and tact to convince these men, by his general conversa- 
tion, that he was capable of handling the financial affairs 
of so large an institution. And for this same reason 
the young doctor should go about meeting people just 
as the young banker did. He must approach them in an 
entirely different way, but the conditions are more or less 
similar. Meeting people is an art that comes naturally 
to a few, is acquired by many after a great deal of applica- 
tion and effort, and to some it is impossible of attainment. HOW TO BECOME FAVORABLY KNOWN 
91 
The art, then, of meeting people and of creating a favorable 
impression is largely dependent upon the meeting taking 
place under favorable conditions. 
When a physician goes into a new community, he will 
find it desirable to acquire some experience in becoming 
acquainted with the less important people; he must seek 
to acquire, if he does not already possess it, the art of 
meeting and understanding them. After he has met 
some people and developed his ability to such a point 
that he knows his own capacity for further progress, he 
should seek out more influential people. As one progresses 
each step will suggest the other. The reason for this slow 
progress is evident. Just as we used the illustration 
of the small boy after small fish, and the young banker 
after small accounts before they sought the big ones, and 
as the athlete in his first endeavor cannot hope to compete 
with the expert professional, so the young doctor should 
not expect to match his ability with men who have had 
many years’ experience in meeting and influencing other 
people. If he seeks the best and most experienced 
citizens immediately on going into a new community, he 
will most likely encounter defeat. Their personality and 
their knowledge of the situation will outclass his. A defeat 
at the start is just as prejudicial to the doctor’s future 
progress as it is for an athlete to meet reverses in the arena 
or on the track. Once defeated, a man is nearly always 
capable of being again dominated or defeated by the same 
individual. A young practitioner should, therefore, be 
careful to select those persons on his first meeting whom 
he can meet on an absolute equality or superiority of 
intellect or stronger personal qualities. 
Assuming then that we have chosen the desirable 
method of meeting people, the next requirement is to 92 
THE SUCCESSFUL PHYSICIAN 
know how to go about doing this in a proper professional 
manner. 
On first going into a community, and for the time that 
you remain in that particular place, you should make 
it your especial business to know about all the people 
and the social, political and financial interests of the 
district. In no other way can you understand the pecu- 
liar situations that surround each family and each indi- 
vidual. If you know a man’s politics, his church, his 
business and his home life, you certainly will know what 
topic to discuss with this man to arouse his interest, to 
understand his mental problems, and how to appeal to 
him. If you are not familiar with these simple things, 
you might very readily compliment some man on his 
interesting family and be shocked by the reply that he has 
no family or that he is divorced. Or you might congratu- 
late a man on his fine business only to be told that he had 
failed and is in financial straits. It is just as important, 
just as necessary, and just as much a part of your business 
to know the smaller details of each man in your community 
as it is for the banker to do so. Even the births, deaths, 
marriages and divorces, business successes and failures, 
are all your immediate concern. A man goes to the bank 
which gives him the best service in the most agreeable 
manner, and people go to the doctor for similar reasons. 
You certainly cannot serve the people of your community 
well if you do not know all about them. 
A physician is a public personage; he should have an 
interest in the general character of the community. He 
derives his support and practice from it, and it is his obli- 
gation to do something for the welfare of the people who 
support him. He should, therefore, take an interest in, 
and become a part of, the organizations that exist there for HOW TO BECOME FAVORABLY KNOWN 
93 
the betterment of the community in general. It is in 
these organizations that the doctor may obtain, without 
effort, and without seeming to do so, minute details 
regarding the personality and surroundings of many of the 
people with whom he will possibly some time come into 
professional contact. It is not only his duty to the com- 
munity, but a duty to himself and his patients to know 
all these things. When he becomes a member of the 
various commercial bodies or clubs that are organized for 
civic betterment or any other uplifting purpose, it is his 
obligation to become active in them; but if he does not 
attend their meetings, he might as well not belong to them. 
Attend these meetings and take an interested part in 
them; give talks, when you have something of value to 
say, which will bring you before the people in a favorable 
and legitimate way. Here you will meet, at various times, 
all the active people of your locality. You can learn to 
know those of the better class; select from these those 
people who will help to bring out in you some of the 
qualities you feel you lack most. They will tend to 
develop you along lines that were not developed in your 
specialized medical career, and so will broaden your view 
of life and of people generally. In making friends with 
those who attend these gatherings your next logical step 
will be to have a weekly luncheon with one or more of the 
important personages you have selected, and thus you 
will be able to meet, under favorable conditions, one or 
more men each week at the luncheon table, where you 
can discuss general topics and become business or social 
friends. This permits you to meet the best minds and 
most active people in your particular locality, be they 
laborers, manufacturers, business men or bankers. It is 
just as necessary to know the banker as the druggist, for 94 
THE SUCCESSFUL PHYSICIAN 
the banker must come to you or to one of your profession 
for medical advice. For your own welfare and that of 
your family you should seek his advice in matters pertain- 
ing to his special line of endeavor and in solving your 
financial problems. 
If it was ever a rule that the physician should wait 
for people to come to him rather than that he should go to 
them, it holds good no longer. This does not mean that 
the doctor should now or at any time solicit patients. 
He should never do that, but his whole effort in this 
respect should be directed toward making friends and 
becoming known as a man among men. The physician 
who goes into any locality and imagines that he is a per- 
son to be set aside in a particular niche that no one but 
his kind are to occupy, is liable to find that he will have 
no acquaintances other than doctors, and it is certain 
that doctors do not exist by the patronage of those in their 
own profession. 
It was formerly the custom for the exclusive brokers 
and banking houses to cultivate this aloofness from the 
public. At the present time, the exact opposite is true. 
They now solicit customers and employ the newspapers to 
inform the people that they have all the facilities for 
giving service to any one engaged in any form of 
business endeavor. They assure them that they have all 
the expert men possible to obtain to give each caller the 
benefit of their technical training in any contingency, 
and make every effort to inform all the people that they 
are fully equipped to handle every financial transaction 
with safety and despatch. The physician cannot solicit 
or advertise, of course. But he can advertise himself by 
meeting the active minds in his home city. He can aim to 
convince them that he is upright, likeable, human, and HOW TO BECOME FAVORABLY KNOWN 
95 
knows their interests as well as his own profession. It is a 
positive certainty that when one of these business men 
becomes ill, he is going to send for the doctor he knows 
best, rather than trust to chance the most valuable thing 
he has in the world. When the doctor has utilized his 
opportunity to appear to his fellow-men as a man, and 
also one with human kindness in his make-up, this same 
business man will be inclined to give the name of this 
physician to all seekers of medical help. 
This form of recommendation of one friend to another 
is the oil on the wheels of progress. The physician who 
sits constantly in his chair poring over musty tomes is not 
likely to be the man who will first spring into the mind of 
the ordinary person in any city. 
It is not intended that the physician should be an 
entertainer or an all-round good fellow, or that he should 
neglect the serious side of his medical studies. The 
meetings that have been mentioned here are as much a 
part of his duty to the community, however, as is the 
study of his particular specialty. It is his legitimate 
means of making himself known as a medical man, on the 
one hand, and also serves as a very desirable means, on 
the other, of making him understand the aspirations of 
the people and of learning their feelings on the matters 
that pertain to their private lives. These he must know 
if he is to minister to them properly, just as surely as he 
should know the latest development in the medical field. 
It is a fact that people who are not seen or heard of 
for some time are soon forgotten. This human trait is 
thoroughly understood by the merchants of today. They 
do not stop advertising after they have become pros- 
perous ; but for the reason just mentioned they aim to keep 
up publicity for their concern. 96 
THE SUCCESSFUL PHYSICIAN 
To illustrate this point: a large firm had manufactured 
a product for years and spent enormous sums annually 
in keeping this product before the people. Their article 
was known and used in all countries. They became con- 
vinced that it now had such a hold on the people that 
force of habit would keep up the demand for their out- 
put indefinitely. They stopped advertising for a year 
and lost and never regained their former position and 
probably never will. This is but another reason why the 
medical man should keep his name and his person in the 
mind and eye of the community where he is to practice. 
Medical men, like artists, must be naturally fitted for 
their vocation. It does not follow that all who graduate 
are gifted by nature with any exceptional qualities. 
Many a man has made a good physician with only very 
mediocre ability to start with; but he must have some 
extraordinary talent if he is to be anything more than an 
ordinary practitioner. You may be ever so thoroughly 
trained in your profession, understand anatomy fully and 
perfectly, and still not make a successful surgeon. To be 
that you must have mechanical ability and manual dex- 
terity. 
Every branch of medicine calls for the intensive 
development of some form of natural talent. It is useless 
for any one to undertake a branch for which he has no 
natural ability. He will only end by having to give way 
to someone who has that real natural aptness. This is 
the age of the specialist. It is also the age of keen 
competition. In other walks of life there are combina- 
tions to corner or modify the natural channels of trade, 
but there is little of this in the practice of medicine. In 
this profession the nearest approach to this restraint of 
trade consists of cliques and groups of men who form, for HOW TO BECOME FAVORABLY KNOWN 
97 
natural or other reasons, in every large city and in some 
of the colleges. They usually admit to their circles 
only such men as the members want, and in many in- 
stances the energetic young man is confronted by one of 
these barriers and wonders why he cannot get ahead. In 
the main, however, as in other walks of life, the race is to 
the swift and the strong, and the weaklings and the 
unfit are overthrown by the forces of competition. 
You are fortunate, indeed, and it will greatly help 
your future, if you can make a proper inventory of your 
own capacities. It is highly important that you should 
exercise extreme care and painstaking thoroughness and 
make a complete analysis of your good qualities and 
capacities and cultivate these to the very maximum of 
efficiency. Shape your course in such a way that your 
best talents may find constant use. This will tend to 
develop them still further and enable you to realize the 
things you wish to achieve. CHAPTER V 
CHANGING ABILITY INTO INCOME 
“Know all about your Profession”* 
There is a business side to every profession, just as 
there is a professional side to every business. 
One would infer from some of the advertisements of 
psychologists that, by a mere act of the will, one could 
transform himself into anything. I say infer because 
any psychologist worthy of the name knows that this 
cannot be done. The man with the bull-frog voice could 
will all he wanted to and the voice would remain the 
same. All the willing in the world could not make a 
Caruso of him, nor can willing put an artistic eye into one 
who has not the fundamentals of an artist in him. Nor 
will mere willing make of you a famous practitioner unless 
real ability underlies and directs this will. 
The actual, genuine medical training that you have is 
the foundation of your medical success. This is not only 
the groundwork on which all else must be built, but the 
medical knowledge you possess at your graduation should 
be but the beginning of your studies. This knowledge 
must be considered only the groundwork on which you are 
to erect that finer and more complete superstructure which 
will make you an expert. 
To cease your medical studies the day you complete 
your state examination for the right to practise is pro- 
* Subtitles suggested by Harold Whitehead’s “The Principles of Salesman- 
ship.” The Ronald Press Co., N. Y., 1917. 
98 CHANGING ABILITY INTO INCOME 
99 
fessional and business suicide. The practice of medicine, 
just as every other profession, is changing. What is good 
practice today may be neglect and malpractice tomorrow. 
To be aware of and how to make use of these changes will 
compel you to continue your studies as long as you 
practice. To most men it is unnecessary to emphasize 
this, as it is accepted as a basic fact. The proof—if 
proof is needed—can be found by visiting physicians’ 
offices in the city or country. Not a few men are at the 
apex of their mental attainment the day they secure their 
diplomas. I include these remarks here that all may know 
my belief to be that the basic element of success must be 
genuine worth and real medical ability. This is the 
professional side of your business, with which I have not 
attempted to deal in this work. 
The business side of your profession is the one which 
we are now to consider. The profession you have chosen 
is one of human service. The elements that will make 
you successful in this field will be a generous mixture of 
work and brains with constructive enterprise and concen- 
tration. The man who selected the practice of medicine 
because he thought it would be fine to come to the office 
late and quit early chose the wrong field for his activity. 
Since the practice of medicine is one of service to man- 
kind, the first thing to do will be to find out how best 
to serve the community in which you locate. To do 
this, you should first of all become a part of the activities 
of the community that have as their object the better- 
ment of its conditions. By knowing and meeting people 
in your vicinity you are enabled to understand their 
needs, interests and leanings. In this way you have the 
first opportunity of appearing before them as one whose 
interests are identical with their own. 100 
THE SUCCESSFUL PHYSICIAN 
The inborn medical ability you possess will be of little 
value unless put to constant and energetic use. To secure 
this opportunity as quickly as possible, you must show 
that your intention is to be useful to your fellow-citizens. 
It should be your endeavor to meet people in such a 
manner that they will form a favorable opinion of you and 
learn the nature of the profession you are following. It 
is your first duty to act and appear to be what you 
say you are. Your choice of associates and your demeanor 
must conform to the best standards of the community. 
Always be busy at some task or activity connected 
in some manner with your profession. Nothing destroys 
the esteem of people for a doctor more quickly than 
to seem him occupied with something that is of no value 
to him in his profession or to find him in the companion- 
ship of idlers. 
Know the institutions and hospitals in your commun- 
ity and as soon as possible become associated with the 
best that opportunity affords. 
Become affiliated with or known to and by the best 
medical men. No man can succeed in the practice of 
medicine if he is not interested in his profession. To be 
really interested in your practice means something 
more than merely getting a living. A man is usually inter- 
ested in that form of work in which he is most proficient. 
To know your profession and to be interested in the prac- 
tice of it will make you happy, for, as Hubbard said, 
“If you do not get any happiness out of your work, 
you will never know what happiness is.” 
To be engrossed in your practice will cause you to 
overlook the smaller annoying things connected with it. 
That which makes for the final success of any under- 
taking is seeing that all the little things receive the same CHANGING ABILITY INTO INCOME 
101 
amount of painstaking care that the large ones do, 
for if the little things are not given your careful considera- 
tion, the larger ones will not be entrusted to you by a 
critical and watchful public. 
Interest in your profession means that it must be 
your principal interest. Just as you cannot be in two 
places at the same time, you cannot have two major 
interests at the same time. Be absorbed in your profes- 
sion and give your undivided time, thought, and energies 
to the performance of the practice that is before you. 
Complete and undivided interest in your practice 
implies that you must strive to do what you have under- 
taken a little better than anyone else can. 
Your Profession First! 
Merely to know your profession and to take an interest 
in it will not insure success. You must pay the strictest 
attention and give all your devotion to your practice. At- 
tending to your practice means that you must have 
no other form of interest that will interfere, even in the 
slightest, with any part of the line of endeavor in which you 
are engaged. To give all your devotion to your work 
means that you will become a part of it—that each day 
will see you on the alert to discover such conditions as are 
in need of your attention. You must not become known 
as having some fad or hobby that takes up the time that 
should be given to the more urgent things of your calling. 
You must not engage in any activity that will be detri- 
mental to your standing as a physician. If you announce 
certain office hours, you must be sure that you can be 
found in your office at those hours. If you promise to 
be at someone’s home at a certain time, you must be 
there promptly. 102 
THE SUCCESSFUL PHYSICIAN 
Patients will forget the many times you have kept 
your word and remember the solitary instance when 
you did not. A story is told of a certain business man on 
Broadway, New York, who was greatly annoyed by the 
tardiness of one of his skilled engravers: Calling him into 
the office one day he said: “Mr. Brown, I get here at 
eight thirty every morning and look over my mail. At 
nine I look out of the window and see Mr. Rockefeller 
on his way to the office; at nine thirty Mr. Stillman 
passes; at ten I see Mr. Vanderlip going by; at ten thirty 
Mr. Taft passes on the way to his office, and at eleven 
YOU come in. Who the H— are you?” 
To keep your office hours with scrupulous exactness, and 
to keep the promises you have made to your patients are 
among your most essential duties. Acquire the reputa- 
tion of being a dependable man. You can rest assured 
that this trait will become known and in turn will be 
relied upon by those who entrust you with their work. 
Make your practice your only serious concern. The 
field is so large that no man has ever mastered it. It is 
quite big enough to absorb all your thoughts and energies. 
It will take all there is in you to master even a major 
part of any branch of medicine without trying to cover 
the whole field. 
You cannot be a good doctor and at the same time 
buy farms, run apartment houses or be superintendent of 
a factory; you will not do justice to any one of them. 
You can have either a good time or be a good physician, 
but not both. To buy and sell real estate and make a 
success of the proposition require all the time, knowledge, 
experience and ingenuity of those engaged in the business. 
How can you expect to do any better? That is why 
you will need to attend strictly to your own fine of work. CHANGING ABILITY INTO INCOME 
103 
The merchant makes his money by the care with which he 
buys seasonable and marketable goods at the right figure. 
What may be the right figure today may not be the right 
one the day following. To be successful in his business 
requires his unremitting and strict attention. That is 
just what the practice of medicine will require of you. 
And it will require it to just as great a degree as it does 
of the real estate operator or the owner of a store. There 
are enough little annoyances and details for the most 
careful of men to keep track of in the medical field without 
undertaking some other line and making a failure of both. 
Sticking to your practice means that you attend to it 
the seven days of the week and every day of the year. It 
may sound paradoxic, but the one who works faithfully 
at his practice is the one who finds time regularly to leave 
it for the recreation he must have. 
Though you take recreation, you must not get so far 
away from your daily affairs that you know nothing of what 
is going on. The man who gives care to his practice and 
plans his future work is the one who will not be continu- 
ally hurried. The physician who follows some orderly 
system is the one who is able to take short recreation 
periods at stated intervals without neglecting those who 
have a right to depend upon him. 
The man who works hardest is not usually the one 
who really accomplishes the most. In fact, the man 
who is always hurried and pressed for time does not 
accomplish much in the end. As a rule, the hurried man 
is generally like a squirrel in a revolving cage. He does 
a lot of work and goes round and round but never arrives 
anywhere. To accomplish things you must have a 
workable system and use your brains. To make every 
moment and movement count most, you must have a 104 
THE SUCCESSFUL PHYSICIAN 
definite aim to accomplish by your movements. The 
most dependable man is not the one you see running to 
catch his train: it is the man who is there ready to start 
when the proper time arrives. He has planned his affairs 
and is going according to schedule. Be a few minutes 
early rather than a minute late. This is the type of 
physician that patients can and will depend upon. 
Make every effort to fill this public demand. 
A half-hearted adherence to your practice will not 
suffice. To make the most of your effort requires 
industry, enthusiasm and the application of all your 
energies. 
It is true that the general practice of medicine and of 
some of the allied branches is not conducive to the keep- 
ing of absolutely regular hours. This does not prevent 
you from making provision for some one to look after 
your office when you are not there. When it becomes 
obligatory to break an appointment, make every effort 
to locate and notify those you are forced to disappoint. 
With proper preparation for the recording of promises 
made to others, and some attention to and system in the 
planning of your movements, you will find that you will 
be able to keep more regular hours and fill your appoint- 
ments than by trying to do your work according to the 
guess-system. 
Put All Your Energy into Your Profession 
“ Men generally possess extremes of resources that they 
never use. These can be pushed farther without harm, 
if hygienic conditions are maintained. The harder you 
work, the greater are the processes of wear; but there is 
also speedier repair that follows this work. The busiest 
man requires no more sleep than the idler. CHANGING ABILITY INTO INCOME 
105 
“Whatever you might do in any day, that you leave 
undone, forever remains a total loss to you so far as the 
generation of energy is concerned. You lose by just 
as much as you fail to perform. There is a second wind 
for the mind just as there is for the muscles and body. 
“When you first get tired mentally or physically, you 
have only used the first effective layer of energy or mental 
power. If we would but push on, we could develop the 
second wind of the mind, and perform great quantities of 
work that most of us fail to develop. Once we have 
developed these deeper layers of energy, they can be 
easily maintained.”* 
Know Something Besides Medicine 
Every profession has customs peculiar to itself and 
the medical profession is no exception. The medical man 
is generally accredited with a wide range of knowledge 
not pertaining to his own calling, and he will find as he 
goes on that he has considerable need for this varied 
knowledge. 
In most other callings the personal element does not 
enter so intimately as it does in ours. 
In other vocations the relation between the parties con- 
cerned is almost always purely a business one, but the 
physician must minister not only to the ailments of the 
flesh but also to those of the spirit. 
He is called upon quite frequently to give advice on 
family affairs and on his patient’s business, and, particu- 
larly in the smaller communities, the doctor is regarded as 
the confidential adviser of the entire household. 
Some men, physicians included, are ignorant of 
* Wm. H. James: “Energies of Men and Gospel of Relaxation.” Henry Holt 
and company N. Y., 1911. 106 
THE SUCCESSFUL PHYSICIAN 
anything that does not pertain to their own line of work. 
They go through life with one fixed idea and follow nothing 
else—they know nothing else. Some of them are 
successful, but most of them are narrow minded and 
retarded through their own ignorance. However, the 
average doctor is naturally a student, and thanks to his 
early training he is a reader and an observer. 
Just as it is foolish to know too little, it is also inadvis- 
able to know too much. The average medical man will 
be kepy busy if he endeavors to keep up with the progress 
and changes in his own profession, and so he cannot 
devote very much time to topics of general interest. 
While he should be versed in other fields, in a general way, 
he should, first of all, know as much as possible about his 
own work. 
Read up on medical subjects for instruction and on 
general subjects for relaxation. A modern physician 
should be able to converse with anyone on any subject. 
He should know enough about art to be able to talk to an 
artist. He should know enough banking to interest a 
banker, and enough about business to interest the business 
man. He is not expected to know the intimate details of 
the silk industry nor to be able to give statistics about 
cotton raising, but each man has his hobbies and his incli- 
nations. The successful physician will study his patient’s 
interests and minister to them. The main requirement is 
that you conduct a pleasant conversation and thereby 
obtain a chance to study your patient’s character. 
Often more can be learned in a short social call than 
by hours of direct questioning. You may always rest 
assured of interesting your patient if you discuss his hobby. 
The most successful business man will often drop every- 
thing to talk about golf or dogs or flowers or postage CHANGING ABILITY INTO INCOME 
107 
stamps or anything else that has become his hobby, 
and if you can make him believe that you are also inter- 
ested in his pet topic, you are sure to make a friend. 
This is another fertile field where notes concerning people’s 
hobbies will be a wonderful aid to friend making. 
Men and women also like to talk about their work, 
and by listening to them and showing a real interest you 
will often be able to obtain a fund of valuable information. 
The wider the range of information that you get from 
intelligent and well-read people, the broader your range 
of vision will become. 
Every one is pleased to have an interested listener, and 
most people delight in believing that they are giving 
information to others. Moreover, you will frequently 
learn valuable things from practical people—things that 
you cannot find in books. 
Advertising 
Because the medical profession is entirely a profession 
of personality and personal efficiency, the advertising you 
do will also have to be entirely personal. It follows 
that every person you meet, in whatever manner the meet- 
ing may come about, is your advertising medium. Since 
you minister to the general public, you are of public 
interest and subject to public scrutiny and appraise- 
ment. Every act of yours is either approved or dis- 
approved by the public. Every contest you have with 
individuals, or with the community at large, will have 
some influence in shaping public judgment of you. 
The particular methods by which you may legitimately 
advertise are along the following lines: 
Societies.—Societies are not to be confounded with 
society. Society in almost every community is composed 108 
THE SUCCESSFUL PHYSICIAN 
of little cliques, each secretly jealous of its own impor- 
tance and usually of fixed ideas. The cultivation of 
society is of little value. Often the fact that you belong to 
one clique may exclude you from all others. If your birth 
and your financial and family qualifications admit you to 
society, you may derive some advantage therefrom; but 
to the ordinary man society is merely a time and money 
consuming factor and it cannot be taken into consideration 
here. 
To a physician going into a strange city, fraternal 
societies may be of value in learning some of the inner 
workings of that particular place. They are of little 
worth, however, in creating permanent practice. The 
friendships made are often so intimate that they impair 
the confidence and respect which are required, and fellow- 
members will frequently go to other doctors when they 
need medical aid; moreover, to derive any benefit at all 
from fraternal societies, one must attend the meetings reg- 
ularly and become active in the work; this will require 
too much time and interfere with your practice. 
Fraternal benefit societies are useful and may make 
you known in a medical way. Those that employ a 
physician for the members only are best. From the 
better class of these you may derive a regular income 
ranging from a few dollars to a hundred or more a month. 
You should not remain with them too long,—two or three 
years is often sufficient,—but resign when you find that 
your practice has grown so as to give you a large enough 
income without society work. 
Commercial Clubs and Civic Organizations.—These 
are the best media in which to meet the active, moving 
forces of the community. Here are gathered all the men 
who are progressive and interested in the welfare of the CHANGING ABILITY INTO INCOME 
109 
community. When you become known to the men of 
these organizations and they learn that you are an active 
worker in the same cause with them, a bond of mutual 
interest is formed, and when they need medical attention, 
they will seek you, rather than some one who is not so 
deeply interested. You will be regarded as one of their 
own sort and they will consider it their duty to support 
you, just as you support their common cause. 
Hotels and Apartments.—No advertising in hotels 
will have any value except under the following conditions: 
A position in one of them is most valuable when you are 
the resident and only physician. In this instance you 
need do but little advertising in the place. Of the 
advertising forms, the best one is to place your name on 
the holders of the pads for the telephone in each room; 
know all the owners, managers, assistants and employes 
of the place; a brass or gold plate at the registering or 
business desk, stating that you are the resident physician, 
is also useful. 
It is money wasted to advertise in any other way 
in hotels. One must have the friendship of the pro- 
prietors or managers, clerks, housekeeper, or some one 
in authority. To secure patients in any other way than 
through the parties named will be a purely personal matter 
that will be known to you. Advertising of any kind 
will not be needed in this instance, and is therefore value- 
less, for the patients would come to you in any case 
through this source. 
The Public Generally.—Every person who is employed 
in such a capacity that he meets the traveling public can 
be of service to you. People who travel prefer the 
word of recommendation of some one conversant with 
local affairs. If you make the acquaintance of some 110 
THE SUCCESSFUL PHYSICIAN 
one holding a responsible position, he can refer many 
people to you. 
Information clerks in railroad depots, clerks or pro- 
prietors of small stores on transfer corners, train conduc- 
tors, Pullman conductors, captains, first, second and 
third officers on boats, the purser, the nurse or maid, 
and janitors in buildings all are good advertising media. 
Theatre programs are of no value as an advertising 
medium unless you are the physician for the theatre 
mechanics, the union doctor, or the actors, society, union, 
or guild. 
Telephone Book.—It is desirable that you have your 
name appear in full in its proper alphabetical order, both 
for office and home service. In the classified section it is 
of some value to have your name in larger and heavier type, 
also to mention any specialty that you may be following. 
The hours you are at your office should also be stated. 
Papers.—In the smaller towns and country sections, 
it is desirable to have your card in the papers. Custom 
has made this acceptable. The same thing may not be 
done in the city. 
When you return from a vacation or move your office, 
it is permissible to send suitably printed announcements 
to patients and to other physicians. 
When you have a case that has news value in it, 
some publicity may be given your name. I would caution 
you in this regard. The papers are so eager for the new, 
unique and bizarre that they are prone to misstate facts. 
They have a tendency to exaggerate, and almost always 
distort a medical statement. The superlative degree is 
in constant use with them—either extraordinarily good 
or bad, funny or heartbreaking, a remarkable discovery 
or a discarded theory. CHANGING ABILITY INTO INCOME 
111 
You should give only written statements. These 
should be carefully reviewed before you allow them to 
appear in print. If this is not done, they will often make 
you appeal’ in a wrong light to your medical friends, or 
ridiculous to the public generally. 
Publicity of some kind is necessary. It is recog- 
nized by all advertisers that the highest and most effec- 
tive form of advertising is the disinterested word of one 
person recommending you to another. This has been 
dwelt on in the beginning of this chapter, and under 
each of the divisions that make up your personality. But 
this is not enough. It is not sufficient for one who is in 
private practice, and it certainly is not adequate for the 
one who specializes. 
Useful publicity may be secured through your member- 
ship in the public-spirited organizations and charitable 
institutions, by appointment on reception and other 
civic committees. 
It must be understood that all your activities are to 
be directed to the medical aspect of things, for if they are 
not, popularity, great or small, will probably mean nothing 
to your practice. All your activities should be directed 
to the line of work with which you are familiar. 
The medical societies, better than any other known 
method, can help to advertise you to other medical 
men. Here you will meet and become acquainted with 
other men in your own profession.. Friendships can thus 
be formed that will be of great value to you—not so 
much in bringing practice to you as in retaining what you 
do secure through your own efforts. When patients you 
may be treating make inquiries of other doctors, they 
cannot say they do not know you: you learn to know 
them and they will get to know you. Constant attend- 112 
THE SUCCESSFUL PHYSICIAN 
ance at these meetings will give you the opportunity of 
presenting a medical paper or of exhibiting cases, or you 
may review articles you have heard. It will give you a 
voice in medical affairs and membership on some of the 
committees of lesser importance—if you are a good mixer. 
Presenting a paper on any topic is advertising your 
own work and yourself. The article you prepare, to be of 
benefit, must have value to the subject on which it treats 
or to the profession. If fortunate, you may be able to 
get the paper into the local State Journal or some of the 
larger periodicals. In this event you are securing excel- 
lent advertising and experience. Reprints are often 
mailed to the doctors of your county and state. It is not 
exactly a pleasant thought to consider that nearly seventy- 
five per cent of all medical articles are personally 
conducted advertisements, but it is near the truth. 
Service to a clinic, hospital or college will also place 
your name before many other doctors of the institution 
with which you affiliate. You also meet many patients. 
Each patient has a friend. Some of these may come to 
see you at your office. These are the reasons that account 
for the great demand for such places. 
Clinics and Hospitals or Colleges.—The value you get 
from advertising to the many people you meet in these insti- 
tutions will not be so great as will the acquaintances you will 
make among students. After graduation these students 
will call you for consultations and also send cases to you 
later on. As a dispensary attendant, the opportunity of 
impressing students with your ability will not be great. 
Others at the head of the division will take most of the 
glory and credit. When you advance to the higher places 
in the staff, you will note the changed attitude. When 
you become the head of some division in a college or CHANGING ABILITY INTO INCOME 
113 
hospital staff, many cases will come to you from other 
physicians in your own and adjacent cities by virtue of 
your position alone. 
This is one of the emoluments of the office. Each 
year you serve as professor will increase the number 
of men who will go out and serve as an advertisement 
for you. The man who will get most cases from his 
former students will naturally be the one who has made 
the most friends among those he taught and who was 
able to impress them with his ability. 
Some prominent specialists employ regularly paid 
publicity men. These gather the material for articles, 
prepare them, and the doctors present them. Such men 
also see to it that each time money is donated to charity, 
proper notice of it appears in the papers. When they 
go to and return from medical meetings, mention of this 
fact gets into the daily and medical press. In other 
words, every social, medical, or political activity is 
directed and promoted for the publicity it will give. 
The drug specialty man will advertise you. Many 
doctors, are or pretend to be, too busy to see these men. 
They take up valuable time, but it is certain that each 
house has some belief in the merit of its goods or it would 
not send them out. Many men will come to your office 
and bring you nothing new, but one in ten may bring you 
some new idea or drug or a refined preparation that will 
repay you for lost time. In the meantime, if these men 
are properly treated, you can make advertisers of them. 
They will quote your name all over the state. 
The medical book salesman has the same capacity of 
good as does the drug man. Even though you buy 
nothing from him each trip, you can treat him kindly. 
When you do give an order for a book, he will exhibit this 114 
THE SUCCESSFUL PHYSICIAN 
all over your city and state, and thus advertise your 
name. 
This does not cover the whole field of legitimate 
advertising for doctors, but it will serve to suggest other 
forms to those who are interested. 
References.—Transactions of Business, by Sir Arthur Helps, and How 
to Win Fortune, by Andrew Carnegie, Edited by David E. Goe. Forbes 
and Co. (1907). CHAPTER VI 
THE VARIOUS FORMS OF PRACTICE 
Hotels and Apartments 
This form of practice is confined almost entirely to 
hotels and apartment houses in the large cities, and even 
in these, only the larger establishments will here be 
considered. The smaller houses, catering almost entirely 
to permanent guests, are usually not looked after by house 
doctors, since their tenants are chiefly residents of the 
city who have physicians among their acquaintances or, in 
cases of emergency will call a doctor who is recommended 
to them. 
If you wish to become a house doctor for a hotel, 
select one of at least two hundred rooms or more that 
caters to the general traveling public. Such a hotel is 
usually located in the downtown district, and there are, 
as a rule, a number of other hotels and apartments in its 
vicinity. From these additional work can be drawn, and 
it is a good plan to make the acquaintance of all the owners 
and managers. 
You should also cultivate the acquaintance of the 
clerks and let them know where you are located and where 
they can reach you. One visit to these places will not 
be sufficient. You should repeat your calls and stop there 
whenever you happen to pass, and at times let it appear 
that you were passing, even if your visit was in reality 
planned. 
115 116 
THE SUCCESSFUL PHYSICIAN 
Hotel practice, if properly taken care of, is not only 
remunerative, but also interesting, since it brings you 
into contact with people from every part of the globe, 
from all walks of life, and with all sorts of ailments. 
Hotel guests will either call you personally or will have 
some employee of the hotel call you. This latter will 
be the more frequent method. They will usually have 
more faith in the house physician than they would 
have in an outsider whom they may locate themselves. 
They will feel that a house doctor could not hold this 
position unless he were reliable and efficient, and they 
will, to some extent, hold the hotel responsible for your 
services. 
One secures a position as house doctor through the 
owners or managers. Unless you can find a hotel which 
does not happen to have a house physician at the time, 
you will either have to buy out the man whose post you 
seek or wait for an opening. In the former case, you will 
have to consult the manager about it, to ascertain whether 
he is willing to have you there. In the case of a large 
hotel in course of construction, communicate with or call 
on the owners or lessees and get in touch that way. 
If you have succeeded in becoming the resident physi- 
cian of a hotel, cultivate the acquaintance of those who 
may help you to build up a practice; for example, the 
manager, clerks, bell-boys, telephone operators, house- 
keeper and the permanent guests. Remember that, with 
a few exceptions, the hotel attaches depend largely on tips 
for their salary, and if they are sure that their efforts in 
your behalf will be rewarded, they will go out of their way 
to send patients to you. 
In many cases the employees will come to you with 
their ailments. If possible, it is advisable that you attend THE VARIOUS FORMS OF PRACTICE 
117 
to them without charge. This places them under obli- 
gation to you and will bring you good results. In some of 
the larger hotels a certain sum is collected each month 
from the employees for a medical fund which pays the 
physician and hospital expenses. Other hotels insure 
their help, and in that case the house physician attends 
them only when engaged by the insuring company. 
Exceptions are sometimes made of emergency and medical 
cases. 
No matter what arrangement you may have with the 
management in regard to taking care of the employees, it 
will be to your advantage to be on good terms with all of 
them and to secure their good will. You will soon find 
that the size of your practice will depend on the reputa- 
tion you have acquired among the attaches. 
Some hotels have no regular house physician, but 
distribute their house cases in rotation among all the 
doctors who may reside there. You cannot expect to 
derive much financial benefit from such an arrangement, 
but it may be of advantage to you to live in a good hotel. 
One of the first and most important essentials in hotel 
practice is to keep the house informed of your daily 
movements, so that you may be reached at any time of the 
day or night. You should see to it that all employees who 
may be consulted will know your whereabouts or where 
definite information may be had, and remember that there 
are no Sundays or holidays for you in this form of practice. 
Guests may become ill at any time, and if you cannot 
attend to an emergency case immediately, you must make 
provision for someone to act in your stead. Your failure 
to follow this rule will not only make you lose the particu- 
lar call, but will also make the management, or those who 
called you, feel that they cannot depend upon you. 118 
THE SUCCESSFUL PHYSICIAN 
Although the case may be trivial, the principle 
remains the same. If you are not “on the job,” you will 
soon forfeit the confidence of the hotel and lose out. 
There are always suicides and attempted suicides, 
fights, attacks of insanity, accidents, sudden illness and 
deaths at hotels—in fact, every variety of casualty or 
ailment that might happen in a community can and does 
happen in hotels. The best method is to regard a 
hotel as a community in itself and be prepared for any 
sort of an emergency. 
Most people want to stay as far away from a physician 
as possible when they are well, but when they are sick 
he cannot come quickly enough to suit them. When 
they do want him, they are always in a hurry, and this 
applies to hotels, where most of the people are away from 
their home and friends. 
Arrange with some reliable person to take care of 
your calls at the hotel. Keep the telephone operators 
closely informed of your comings and goings. When- 
ever you make a call, tell the operator where you are 
going and where your next stopping place will be. In 
other words, see to it that it will never take more than 
fifteen minutes to locate you. 
It is just as easy to start right as wrong, and the 
same rules that apply in other fields of medicine will 
hold good in this form of practice. Make it your unfail- 
ing rule to adopt methods of precision and promptness. 
Show people that you are dependable and they will learn 
to depend on you. If you early acquire the habit of 
attending to your practice in a slipshod manner, you will 
seldom be able to overcome this failing. Do not imagine 
that if you cannot get to a patient in the forenoon the 
afternoon may do as well. The patient may be dead in THE VARIOUS FORMS OF PRACTICE 
119 
the afternoon or some other physician will almost cer- 
tainly have been called to take your place. Procrasti- 
nation is the lazy man’s narcotic, but it will never serve as 
a tonic to the young physician who wants to succeed. 
It is a source of great satisfaction to people to know 
that they can get in touch with their physician without 
delay. It gives them a sense of comfort to feel that 
they can phone for you and be told that you are not in 
but can be reached within a few moments. They want to 
know that you can be found when you are needed and 
that you are always attending to your practice. 
I know from experience that patients will wait hours 
for you after they have reached you over the telephone, 
when they would not wait minutes if they were told that 
no one knew where to locate you. Even if you are busy 
with a case or an operation that cannot be interrupted, 
your attendant should be able to tell callers just about 
how soon you will communicate with them. As soon as 
you can get away telephone your callers, inquire about 
their condition, and give them some sort of directions that 
will keep them appeased until you can call, and, although 
your visit may be delayed for several hours, they will 
often wait. 
A great majority of calls from hotel guests will be made 
after they have tried all their usual home remedies and 
failed, and being in strange surroundings and away 
from friends and relatives, as stated before, they will, most 
likely, expect you to come at once. Get in touch with 
hotel patients as quickly as you can, and you will find 
that very often a telephone call will soothe them until 
you have chance to call in person. 
Practically every message that will come to you 
through the hotel operator will be, “Come at once to 120 
THE SUCCESSFUL PHYSICIAN 
room so and so, the patient is critically ill.” Then you 
will find that the “critical illness” is nothing but a head- 
ache or a scratch. 
A man with a cinder in his eye recently asked the hotel 
clerk for the house physician and was told to wait a few 
minutes, that the doctor was out. He refused to wait, but 
walked all over the downtown section for more than two 
hours without having located a physician. He finally 
returned to the hotel, where the house doctor had arrived 
in less than ten minutes after this patient had inquired 
for him. Transients will not wait unless it is made clear 
to them just where and how soon you can be found, and 
even then they will not wait long unless you have talked 
with them, at least over the telephone. 
From all this you will readily see the advantage of 
letting the hotel know where to find you and giving them 
an opportunity to communicate with you at a moment’s 
notice. 
Every hotel call should be treated as an emergency 
call. Guests will ring the operator every few minutes to 
find out whether or not you have been located, and after a 
while they will insist that some other doctor be called. No 
matter how friendly the management is toward you, and 
how hard it may try to hold the patient for you, they will 
finally have to accede to the guest’s request and you will 
have lost your case and hurt your reputation. 
Remember that your good name is dependent to a 
great extent upon the opinions of those with whom you 
come in contact. It will not help you to have someone ask 
if you are a good doctor and have the answer be—“He is 
alright, but he can never be found and no one knows 
anything about him.” People will quickly tire of calling 
you and will transfer their allegiance to someone who is THE VARIOUS FORMS OF PRACTICE 
121 
more dependable. If once you have lost a patient, he 
will seldom come to you again and he will often make it a 
point to see to it that his friends do not patronize you. 
This point of dependability and punctiliousness can- 
not be emphasized too strongly. Due perhaps to the 
strain under which he labors, the average physician does 
not pay sufficient attention to the business end of his 
practice, and often a good doctor has failed to succeed 
because he has never learned to keep his engagements. 
This applies not only to hotel practice, but to every 
other kind as well; no matter whether you live in a large 
or a small city, you should keep your engagements 
promptly or you will soon have no engagements to keep. 
Industrial Accident Insurance Companies 
Most of the states have some form of industrial 
insurance, and much of this work is done by private 
companies. Some of these are liberal in their manner of 
treating physicians other than those on their own staff, but 
many of them are not. If you desire to handle this 
accident work, you should learn all about the companies 
doing business in your locality, and this can best be done 
by calling on the claim agent. Every company makes 
some arrangement for the handling of accident claims, and 
each locality has a different method for accomplishing this. 
Only personal investigation on your part will teach you 
what the possibilities of this business are. 
In all the larger cities the companies have their fixed 
medical arrangements and you cannot expect to connect 
with them as Chief Medical Examiner. You may call on 
the various companies and ascertain the conditions, and 
if you can not be placed on their list of active physicians, 122 
THE SUCCESSFUL PHYSICIAN 
you may be set down among those whom they will 
recognize in the adjustment of their cases. 
If you fail to do this, you will often find that when you 
do get a case of this kind that you will not be able to treat 
it, since a certain company, as soon as it hears of the 
accident, will send the patient to its own doctor and you 
will be able to charge only the industrial rate for the 
treatment given. 
Just as some doctors have gone in for family practice, 
others have made a specialty of industrial work. The 
qualities the insurance companies seek in men for this 
work are accurate, prompt business methods, and efficient, 
economical treatment of the cases they send them. 
When you treat industrial cases you must have a 
thorough and efficient system of case recording, with full 
details noted at the time of the call on the patient. The 
reports of these cases must arrive at the office of the 
company on time and in good form, and you must be 
accurate as to the amount of the charges made and as to 
the treatment given. No “ guess work ” will be tolerated. 
Your reports should be written on the typewriter and be 
neat and legible. 
Most of the larger insurance companies have doctors 
whom they send out to investigate the nature and extent 
of injuries to persons who may be under the care of other 
physicians. These positions are also secured through the 
appointment of the claim agent. 
In industrial work you should be prepared for long 
office hours, and to be of value to the company you must 
be on call during the entire working day. To do this you 
must arrange with some other doctor to attend to your 
outside calls while you are engaged in the office work, or 
vice versa, or have an entire corps of doctors for all the THE VARIOUS FORMS OF PRACTICE 
123 
various specialties, so that you can call on any of them 
that may be needed for the wide range of cases that come 
in this work. This arrangement is becoming more com- 
mon, and the doctor in charge of this work for the com- 
pany engages a number of physicians who are on call to do 
the work in their respective fields. If you are a young 
doctor, it may be a good plan to become acquainted with 
the claim agent and the physician in charge of this work, 
and so secure an appointment to do some form of work 
along the line of your choice. 
Some of the features of this industrial work commend 
it to the attention of medical men: It is consistent with 
the work of their choice; it is day work; there are no 
unpaid bills to trouble you; it brings you in touch with 
prominent business men and will rapidly create a large 
acquaintance for you. This acquaintance will be along 
the line of the work you have selected. In time you will 
become acquainted with other doctors and companies 
engaged in this work and be able to build up a reputation 
as a surgeon, orthopedist, eye, fracture, or nerve specialist, 
diagnostician, or whatever the specialty may be. At 
this time the various forms of disease are not covered, so 
your choice will need to be in some branch of surgery or 
its allied subjects. 
Few states have laws giving compensation and care 
for the sick. The ailments that develop must be inci- 
dental to the work at which the patients are engaged, 
and experience shows that most cases of this type are of a 
surgical nature. 
It will avail you little or nothing to locate in a manu- 
facturing or industrial center if you do not become 
favorably known to the insurance companies’ claim 
agents. Hundreds of cases may be all around you and 124 
THE SUCCESSFUL PHYSICIAN 
bring you little or nothing unless you are acceptable to 
those in charge of this work for the insurance company 
or the concern. You must see these men often enough 
and long enough to create and leave a sufficiently favor- 
able impression so that they will give you their work. 
Life Insurance Companies 
Certain life insurance companies pay from $3.00 to 
$5.00 for an examination. If you locate in a small 
town you should write to all the better known companies 
and make application for the position of examiner for 
your locality. Be sure to state the place of graduation 
and give all other pertinent details. This letter should 
be typewritten on a good quality of stationery. After 
haying been appointed examiner, in the event of a move 
to another locality, you should notify them to transfer 
your name to your new location. If you do not do this, 
you will find that it will not be an easy matter to become 
affiliated with the company again. It may be remarked 
that this is a small matter, but some of the best men in the 
profession are examiners today, and you will lose none of 
your prestige by doing this work. The more companies 
you can become affiliated with the better, since it is quite 
likely that many of the men you examine may become 
your private patients. 
In the larger cities it is not an easy matter to secure an 
appointment. The way to go about it is to find the 
name of the Medical Referee of this territory and make 
application directly to him. Repeat your calls on him 
until you have become acquainted and friendly with him, 
and when a vacancy occurs, he will remember you. 
It is the general custom in the larger cities to appoint 
men who have been in practice for some years in prefer- THE VARIOUS FORMS OF PRACTICE 
125 
ence to the younger ones, but it will be good policy to 
make an effort nevertheless, even if you are just a beginner 
in medicine. 
Commercial Houses, Stores, Etc. 
In every large city there are department stores that 
employ large numbers of people and many of these have 
some arrangement for the care of employees who become 
ill while at work. These stores employ one or more 
doctors to look after their help, paying them a fixed salary 
each month. If you wish to secure some of this work, or 
become affiliated with a store, you must call on and get 
acquainted with the proper person, who is not always in 
the same department, but usually the superintendent or 
service manager is the person to be consulted. You may 
learn this by inquiring of the Secretary of the concern. 
When a store has such a service, you can obtain a position 
there only if they will take on an extra doctor, if you buy 
the place of the one there, or displace some one who does 
not please them. In some of the smaller cities you may 
induce them to install such a system, and, in that event, 
you can easily become the head of it. The stores deduct 
a small sum each month from the pay of their employees 
and make up the deficiency from some general fund set 
aside for this purpose. 
You will be able to get from such an arrangement a 
fair monthly income for your running expenses, amounting 
perhaps to about twenty cents per month for each 
employee. 
This form of practice will not be a lucratve begin- 
ning for you in the way of immediate returns, but it will 
give you an opportunity to become acquainted with a 
large number of people, many of whom will employ you 126 
THE SUCCESSFUL PHYSICIAN 
to treat themselves and their family if you have gone 
systematically about making friends of them and have 
demonstrated your ability to them. Keep an accurate 
record of their names and addresses, and if you have an 
office, make them acquainted with this fact. If you 
do not have one, by knowing their name and address you 
will be able to send them notices when you do open 
your office. 
Customers of the store will also need attention for 
any sudden ailments, and these too may become your 
friends if carefully and skilfully treated. Seize the 
opportunity to make them your friends by your courteous 
and painstaking attention. Their addresses are also to be 
noted, and in this way you can soon have a large acquaint- 
ance of responsible, substantial people. 
The stores that give this form of service usually have 
an office for the doctor in the store, thus relieving him 
of the initial expense of opening and maintaining an 
office. 
Commercial Houses and Banks 
Some of the larger banks have arrangements for the 
care of their employees similar to those of the department 
stores. To become affiliated with one of them you will 
proceed in the same manner as was directed for the 
department store. Inquire for the one who is in charge 
of this work, call on him yourself, or let one of your 
friends who knows him make an appointment for you. 
The field in this form of practice is not so large and the 
opportunities are not so great for meeting people not 
connected with the institution, but there are excellent 
openings for the making of such friends as will be of great 
help to you no matter where you may later locate in the THE VARIOUS FORMS OF PRACTICE 
127 
city. In this as in every other position in life you should 
make it a rule to do the work you have in hand well 
and make yourself indispensable, and you will soon find 
that each position will open up others for you. 
The best people of the community will, at one time or 
another, have reason to go to the bank, but, as has been 
stated before, the mere fact that they have money does 
not make them desirable as friends. Their habits do that. 
If they spend less than they make, have the wherewithal 
to meet all their obligations, and have a little left for a 
rainy day, then they are the kind of people you should 
cultivate. The other sort—the spendthrifts, who are 
always a little behind—are worthless to you. 
Your connection with the bank will, of course, put you 
in touch with all the employees. When you get farther 
along in your career it will be of advantage to you to be 
able to obtain information that cannot be secured else- 
where, on a subject of which most men in the profession 
know the least. This will be the information relative 
to the right investment of your hard-earned savings—an 
investment that may keep you and your family when you 
are no longer able to practise. 
Manufacturers 
In most of the larger cities there are various large 
factories. These have all been compelled to make 
some arrangement for the care of their employees. In 
those states that have industrial compensation laws, 
they may be divided into those who supply this medical 
attention themselves and those who have this risk carried 
by an insurance company. This topic was considered 
under the head of Industrial Accident Companies, but the 
salient features of it will be mentioned here. 128 
THE SUCCESSFUL PHYSICIAN 
To secure the work of such concerns you must receive 
your appointment from the insurance company that 
does the business, or from the concern itself if they handle 
the work directly. See the person in charge of this 
service, and if it is already organized and in the care of a 
physician, you must be appointed by him, buy him out, 
or displace him. Any insurance company that does not 
have a local staff of physicians will heed the request of 
the firms they insure. If a company makes a request for 
your services, they will usually employ you. You must 
give good service, be available at all times, and your 
qualifications must commend you to the insurance 
company. It will serve your interests best, after getting 
the manufacturing concern to treat their employees, 
to make friends with the claim agents for the insurance 
company. 
This practice does not usually bring with it a large 
income, but it is an excellent start, and assures you a 
certain monthly salary. For the larger manufacturing 
concerns which have their staff of physicians, the posi- 
tion is a good one for the reason that, as before stated, 
you get a fixed small salary, can make many friends, and 
in a short time will have a large acquaintance in the 
families of the men and in those of others. Another 
feature that is advantageous is that this work does not 
take all your time and some of it may be devoted to 
whatever individual work you may get in your town. 
In this way you can sever your connections with the 
insurance work when you find it to your advantage to 
do so. 
Railroads 
The railroads have hospitals in all the centers of 
traffic. These hospitals are devoted exclusively to the THE VARIOUS FORMS OF PRACTICE 
129 
care of the railroad employees. They are in charge of a 
Chief Physician, and if you are located in a large city and 
desire this form of work you can get your appointment 
through this Chief. Letters and the other recognized 
forms of introduction are desirable, but in their absence 
you can go directly to him with your request. These 
openings are very difficult to obtain, since there is always 
a long waiting list. The salaries are not large, but the 
returns are good, and the positions are of great value to 
young doctors, those who become affiliated with railroad 
hospitals usually remaining with them as long as they 
can. You receive a certain salary and have time to 
devote to your private work. Your treatment of the 
men will in time secure you the practice of their families, 
and your work will keep you in active practice and will 
create for you an enviable reputation in a comparatively 
short time. 
In towns situated along the railroads there is always an 
opportunity for doctors to be put on the staff for a section 
of the road. These positions carry with them no salary, 
as a rule, but a pass over any part of the line is usually 
given the physician. Certain junction points along these 
roads pay the doctors a small salary, usually not more than 
fifty dollars per month. The value of the position lies in 
the fact that you meet the men of the road and through 
them their wives and families and the traveling public, 
whom railroad men will refer to you at every opportunity 
if you make them your friends. Railroad men are pecu- 
liar—they are somewhat clannish. They may disagree 
with one another, but they are very faithful to the frater- 
nity as a whole and to those who are associated with the 
road. That is why the men will send the traveling 
public to you. If you are the kind of man they like and 130 
THE SUCCESSFUL PHYSICIAN 
treat them as they should be treated, they have a feeling 
of intimacy with you that cannot be shared by an outside 
doctor. 
Street Car Companies 
Almost every city in the United States has a street 
car system. The larger the town, the more extensive is 
the system, and almost always a medical staff is 
employed to look after the car men and those who may be 
injured. To become affiliated with the medical staff of 
one of these systems, proceed in the same manner as you 
would in the case of a railroad, the Chief Physician, in 
most cases, having the oppointive power. The salary 
paid is small—often less than one hundred dollars per 
month. Like the railroad, it does not take all your time 
and enables you to keep busy and in your spare time 
to build up your private practice. These positions are 
difficult to obtain, since doctors who have these places 
retain them in most cases as long as they can. It will 
require more than one call on the one who has the appoint- 
ive power and you will find the quest at times discour- 
aging, but if this is the work you want, persist in your 
efforts. In all the larger cities the street car companies 
have their own hospital, or a ward in a hospital set aside 
for their use. To be connected with one of these roads 
will keep you busy a part of every day and will bring 
to you every form of injury and ailment. This will 
compel you to study and work to improve your operative 
and other forms of skill. You will meet good medical 
men and also many people of the community in which you 
live. If you exert yourself to treat them in such a manner 
that you please them and their friends, you will build for 
yourself a paying practice. In this as well as in the THE VARIOUS FORMS OF PRACTICE 
131 
other positions mentioned, you should keep an accurate 
record of the names, addresses, business, likes and dislikes 
of the people you treat. In this form of practice, as in 
others mentioned, it is very easy to fall into the habit of 
paying little attention to the people themselves. Your 
interests and those of the patients you treat are not very 
close and are sometimes hostile, as one injured by the 
street car company will not have any great regard for 
those who injured him. The settlements made by the 
company are seldom generous, and this will not make it 
pleasant for you. This in no way alters the effort you 
must make to do everything you can to please the people 
you are treating. It follows that you will have many 
failures in this variety of work because of the surrounding 
difficulties. This is no excuse for not endeavoring to 
minister to the finer feelings of your patients. Though 
you may not entirely succeed in completely satisfying 
the injured person with all you do in your dealings with 
him, he will know that you aimed to please and treat him 
properly. The memory of this will linger with him long 
after the accident is forgotten. 
Laboratories 
The trend of the time appears to be to depend more 
for diagnosis on the laboratory reports than on personal 
ability. This has resulted in the establishing of many 
laboratories to which physicians resort for aid in diagnosis. 
For the young man this is a good method of increasing his 
income for a time. He can secure a position as a labor- 
atory worker and in this way receive a regular salary 
although, this is seldom more than a hundred dollars per 
month. The one serious defect in this work for the 
young man who intends to go into general practice is that 132 
THE SUCCESSFUL PHYSICIAN 
during the time he spends in the laboratory he is unable 
to meet people, which lack of acquaintance will seriously 
handicap him when he enters practice. Even if he did 
secure some of his fellow laboratory workers for his 
patients, the number would be few and therefore of little 
value. There is no advantage in this kind of work for 
the young man unless he needs the financial help. 
Laboratory work can be of distinct value only if you 
have selected it for your field of endeavor. If that is the 
case, spend some time with one acquainted with the 
commercial methods in vogue in your locality and learn 
all you can before you establish your own laboratory. 
In certain places where no laboratories are convenient 
it will be a good plan for the young man to do some of this 
work for the older men. Many of the older graduates 
have neither the time nor the inclination or ability to 
do laboratory work. The work they require done is 
usually sent to the larger cities, where there are facilities 
for doing it. Many of the ordinary tests can easily be 
performed by the younger men with a very small equip- 
ment and at little expense. This will make you favorably 
known to the men in your locality and bring you a steady, 
small income. 
Anesthesia 
In most of the city hospitals it has become the cus- 
tom to employ a physician to give the anesthetic in 
certain difficult cases. Some of the visiting doctors often 
prefer to have the anesthetic administered by some one 
who has had more experience than the internes. This is 
a good field for the young man and will occupy most of his 
forenoons, leaving the afternoons free for private work. 
The position is usually appointive, resting with the THE VARIOUS FORMS OF PRACTICE 
133 
Board of Directors of the hospital or the superintendent, 
but each hospital will have some arrangement peculiar 
to itself and inquiry must be made to ascertain who the 
proper person is to approach. The compensation that 
these positions carry is a matter of arrangement with 
each institution; usually it is a certain sum for each case 
anesthetized, rather than a monthly salary. 
If you intend to make a specialty of anesthesia, the 
larger the institution you can get into, the better. But if 
this is undertaken to add to your income until you get 
a start, it will not be wise to continue long at this work for 
it gives you no opportunity to get acquainted with 
patients. All it may do is to familiarize you with the 
operative methods of different surgeons and to gain their 
friendship. The money you receive, the friendship of the 
doctors you meet, and the acquaintance of the hospital 
management are all the benefit you will derive from this 
work if you intend to go into practice for yourself. This 
is good so far as it goes, but will not carry you very far 
in securing work of your own. 
Mines 
Many of the large and well-established mines in this 
country have a hospital and a medical staff of their own, 
paying the latter a monthly salary in most cases. These 
positions are valuable, and the young men who are 
fortunate enough to get the places hold on to them. The 
value of the position is similar to those in industrial 
insurance concerns, the large railroad hospitals, and the 
street railroads. Such a position enables one to do the 
work of the company and still have time to devote to 
private practice. It gives one an income from the start, 
and in addition relieves one of the expense of fitting up an 134 
THE SUCCESSFUL PHYSICIAN 
office, with the other incidentals that naturally follow. 
Another feature of this work is that you can definitely 
determine the kind of work you like best and for which 
you are best fitted. Mines usually have a medical 
adviser and other physicians for women, children, and 
other branches of practice. 
There are many smaller mining concerns and mining 
sections that do not have a hospital or a staff. In such 
a community one may do this work on contract with one 
or more companies, the charge generally being so much per 
man per month. 
In the case of the large companies, the positions are 
appointive by the chief physician or the secretary. In 
the smaller mining concerns, a connection may be secured 
through your own efforts by means of the officials or the 
manager. 
The secretary of the chamber of commerce of your 
city will be able to give you the names of all the mining 
sections and also those of the larger and smaller mines. 
From this same source or from the stock exchange you 
can ascertain which are the successful and busy locations 
and firms. 
A properly written letter sent to a number of mines and 
mining communities will soon permit you to decide which 
one offers the best opportunities for your purpose. The 
first letter should be written on the best grade of stationery 
and should state full details as regards your schooling, 
recommendations, etc. 
Ships 
Ocean liners offer a good opening for certain kinds of 
men, such as those who do not wish to settle down at 
once or who do not have the money to do so. These THE VARIOUS FORMS OF PRACTICE 
135 
positions pay a small salary—about fifty dollars per 
month and all equipment furnished. The main income 
from this practice comes in the way of gratuities or 
tips from the passengers. The men on some of the 
larger vessels are able to earn from a hundred to a thou- 
sand dollars per month from this source, but, of course, the 
larger incomes are the great exception and the majority 
of them do well if they make an additional revenue of 
from one to two hundred and fifty dollars per month. 
The worst feature of this practice is that you have no home, 
and can not acquire any private practice. The people 
you meet you may never see again, and the best function 
of ship practice is to give you some experience with the 
world and to enable you to collect enough to give you a 
start in private practice. 
The positions are appointive, usually through the 
manager. A letter to him or to who ever does the 
appointing is the best method of approach. 
Societies 
Beneficial societies that employ a physician for exam- 
inations and for medical services to their members, and 
perhaps to their families, serve a very useful purpose in 
enlarging your acquaintance. Such a connection will 
give you a certain small fixed income for your early start. 
The best type of fraternal order is one that does not give 
services to the family, but only to the members. By treat- 
ing the members, you will naturally become acquainted 
with the remainder of the family and you will thus be 
able to treat them for a fee, perhaps a smaller one than 
usual, but which will bring you some income and make 
you better known. 
You should not make the mistake made by many 136 
THE SUCCESSFUL PHYSICIAN 
doctors of serving the same order for years. The best 
you can get out of any society will be to make acquaint- 
ances and the opportunity it gives the members of 
becoming familiar with the character of your work. If 
you remain too long they will have less respect for you as 
time goes on, and you will become known as the “lodge 
doctor.” Past experience has shown that you will not be 
able to retain these lodge members for your private 
practice after you leave the order. Out of a membership 
of two or three hundred you will do well if you can keep 
four or five families for your private practice when you are 
no longer the lodge doctor. No matter how popular 
or how successful you may have been, they will not 
follow you. 
If you know just what you are best fitted for in your 
life work, it is an excellent plan to associate yourself with 
some established physician, one whom you have met dur- 
ing your college career, and act as his assistant. More can 
be learned of the intimate things that go to make up some 
specialty in this way in a short time than in any other, 
if you are fortunate enough to get with the right man. 
You will be able to observe things that it would take 
you many months or years to learn in your own practice. 
To be a really good assistant you should, of course, 
study the needs and desires of the man you are working 
with and endeavor to anticipate his wants. This applies 
to operations in which you may be assisting and to the 
calls to be made on patients. You will learn of your 
preceptor his manner of meeting, treating, influencing 
and directing patients, which is an art. Each man, with 
practice, will develop methods that serve him well, 
Assistant to Another Doctor THE VARIOUS FORMS OF PRACTICE 
137 
methods suited to his personality and that of his patient. 
The fact that he can do and say things in a certain way 
does not mean that you will be able to do the same, or, 
that it would even be advisable for you to attempt to do 
so; but it will serve as an example of how important are 
the meeting, handling and influencing of patients. 
While the opportunity to observe the closer details of 
operations performed by your preceptor and the results he 
obtains will be a great aid to you in your own work, you 
should not remain an assistant too long. You can assist 
for years and not become an operator or whatever the 
men with whom you are associated may be. Only by 
doing the work on your own initiative and your own 
responsibility will you gain that quality of judgment and 
expertness required to make you a success. There is 
still another reason why this association should not 
continue indefinitely. You can secure a practice only 
from among the patients of the man you are assisting, 
and to the right-minded physician this is not the thing 
to do. After you have learned the methods and practices 
of your preceptor you should go to some location of your 
choice and work on your own responsibility. CHAPTER VII 
OFFICE EQUIPMENT AND MANAGEMENT 
The Office 
It is folly to expect a ten thousand dollar man to 
exhibit his wares properly in an office with a hundred 
dollar equipment. This is what many medical men try 
to do and they wonder why results are so poor. A 
diamond looks out of place among a lot of shabby finery. 
Properly mounted and placed alone in a window, and the 
person most ignorant of the value of jewels will be attracted. 
This is the same position that the young doctor occupies. 
His start should not be marred by a poor office and poorer 
furniture. Just as I have shown that his clothes, his 
shoes, and everything about him should be clean and in 
good taste, so should his office be of the best selection and 
harmonize with the occupant. This will give him that 
opportunity to display his skill and to receive the reward 
to which he is entitled. This principle applies to the 
large city and to the small city and to every place where 
a man is to get the best he can out of practice. There 
are communities that do not require the same precision 
and excellence demanded in the cities. The people who 
live there, however, did not always live there, perhaps, 
and they know what is the right and proper thing. It is 
to your interest to be of the best rather than of the poorest. 
It is much easier to furnish your rooms with taste and 
refinement in the beginning than to start with poor fur- 
nishings with the expectation of getting better ones later. 
To start badly will create an unfavorable impression 
138 OFFICE EQUIPMENT AND MANAGEMENT 
139 
which may be lasting. It is better to have a few good 
things than many cheap ones. Furnishings of good 
taste for a small reception room will not cost very much 
more than poor ones. If you cannot pay cash, you will 
probably be able to obtain credit. 
No community in the country is so far removed from 
civilization that many of its inhabitants do not know 
what the offices in the cities are like. 
Every effort should be directed toward making your 
reception room what its name implies—a place to receive 
people. It should be an inviting, home-like place and 
not suggestive of operations, pains, aches, and blood. 
Let the colors of the walls, rugs, furniture, pictures, 
shades and curtains harmonize. The room should be 
kept in the same order you would keep your own library 
or that of the best people who might come to you for 
service. 
The reception room should contain most or all of the 
following things: a center table, a jardiniere with a 
potted plant or an ornamental lamp. If your building 
is lighted electrically, the globes should be of the decora- 
tive variety, not the plain, cold, and ugly things that are 
ordinarily seen in such offices. There should be a good 
rug or carpet to harmonize with the color scheme of the 
furniture and the walls, one or two comfortable rockers 
for nervous persons to work off some of their excess 
energy or nervousness upon, and a few straight-back 
chairs; plain clean curtains at the windows, and a few good 
pictures or paintings on your walls. Do not have the 
old standard picture of the bewhiskered doctor sitting at 
the side of a sick youngster on an improvised bed of 
chairs. Patients have enough miseries of their own 
without inflicting those of others on them, even in the 140 
THE SUCCESSFUL PHYSICIAN 
form of pictures. A tray on the center table holding your 
business cards, a book-case filled with medical and 
other works, a hat-rack and an umbrella rack should also 
be provided. Current numbers of picture and short story 
magazines should be on the center table. Many doctors 
keep a large quantity of old dog-eared literature scattered 
all over the place. 
The consultation room should be furnished in the 
same harmonious fashion as the reception room. Roll- 
top desks have some advantage over flat-top ones. 
The room should be well carpeted or there should be a 
good rug. The diplomas of your school, the license of the 
state, and other papers of value are to be hung here. A 
case record cabinet containing patients’ records and two 
simple chairs of good material for your patients should be 
part of the furniture. 
If you start with but two rooms, your examining table 
and other operating paraphernalia should be arranged 
in an attractive manner about the room. If you can, 
by all means have three rooms, your operating or treat- 
ment room opening off the consultation room. If this 
cannot be had, the next best arrangement is to have 
the consultation room divided off with a screen, so that 
your patients may undress and prepare for their exam- 
inations in partial privacy, at least. 
The consultation room should have the best light, a 
good natural light being almost essential for diagnostic 
work. Many of the finer points of the skin, eyes and 
other details will not be visible under artificial light. 
Let your desk or chair be so arranged that the light will 
be at your back and in the patient’s face. This gives 
you the advantage of making a better inspection and of 
screening your own face from them when you wish to do so. OFFICE EQUIPMENT AND MANAGEMENT 
141 
Another strict rule you should adopt from the begin- 
ning is to have a place for everything and see that 
everything is in its place. Do not make your desk the re- 
pository of the odds and ends of your office. Have it clear 
of papers, drugs, samples and literature. Do not let 
your unfinished correspondence accumulate on your desk. 
Do each day’s work on that day. Write your letters 
when they should be written and file your answers in 
your letter file. Have your desk clean at the close of 
the day, just like the counter of a good store. Arrange 
your desk so that you can find things when you want them 
and people will soon learn that you are careful. 
Label drawers and pigeon-holes of your desk and 
see that they contain nothing but their proper contents. 
In this way you will be able to go to your desk at any 
time and find the things you want. Thus, when a patient 
is observing you, he will note that you have complete 
mastery over your affairs. Knowing where things are 
will be a source of complete satisfaction and lack of 
worry to you, and will create in the minds of your patients 
the belief that you are a careful and methodical man. This 
is what you should aim to be, and it is just as easy as 
always to be hunting and never to be able to find the 
things you want when in a hurry. 
The Operating Room or Treatment Room.—The ideal 
arrangement for the treatment room is one by which your 
patients may go from your consultation room into the 
treatment room and out of your office without passing 
through the reception room. A very desirable addition 
to the operating room is to have one or two very small 
dressing rooms for your patients, situated between the 
consultation room and the treatment room. These will 
enable you to treat one patient while another is undressing, 142 
THE SUCCESSFUL PHYSICIAN 
or one can be dressing while another is preparing for 
the examination or treatment. I have known some genito- 
urinary specialists to have four or five of these tiny 
rooms, and they were able, by this method, to go from 
one to another without the loss of time occasioned by 
having but one room. This may not be possible to the 
beginner, however, but can be borne in mind for the time 
when such need arises. 
One thing every treatment room should contain is a 
corner shut off by a small screen where the women may 
arrange their things and adjust their apparel. On a 
stand should be some of the small toilet articles that 
women commonly use—a large mirror and a hand-mirror, 
comb and brush, powder jar and puffs. 
The time consumed by patients in preparing for or in 
dressing after examination may be utilized in completing 
your case records, writing your prescriptions, or ushering 
the next patient into the other dressing room, if you are so 
equipped. Even if you have none of these, the interval 
elapsing between the close of the treatment or examination 
and the return of the patient can be used by you in 
giving thought to their treatment or for planning the 
further handling of the case. 
This arrangement will depend entirely upon the type 
of practice you are engaged in and will differ in the cities 
and in the smaller country towns. In the larger cities it 
should never be used for more than a treatment room and 
for the smaller of the minor operations. This is not 
because operations cannot be performed here just as well 
as in hospitals, but because people do not think they can 
be. More than this, if anything should happen in the 
office—the death of a patient, infection, or any other 
unfortunate termination—you will at least be open to OFFICE EQUIPMENT AND MANAGEMENT 
143 
censure—you will, in case of death, receive undesirable 
and harmful publicity, and most likely will have a damage 
suit on your hands as well. It is presumed that you are 
to give the cases that come to you as good treatment as 
any other physician in your community. In the event of 
untoward circumstances or death, the opposing attorneys 
can show that you did not use the necessary care and 
may cause you considerable trouble. Do not take any 
chances by treating the patient in your office if the case is 
one that could better be handled in a hospital. I know 
of many who have done this and regretted the day they 
ever started the practice. Some of them never lived 
down the injury such a suit had caused them. 
Your equipment should be complete, so as to enable 
you to treat all cases that may come to your office. The 
variety will depend somewhat on the character of work 
you are doing. 
The city man in general work should have a good oper- 
ating table, a sterilizer, instrument cabinet, dressing 
stand and medical preparations, instruments of treatment 
and examination, examination chair, settee, irrigating 
stand, office medicines, and such instruments as will 
meet the particular need of the work in which he is 
engaged. 
The instruments needed in your office for city work 
should include the following: 
Specula for the eye, ear, nose, vagina, rectum. Sounds 
—graduated from No. 6 French to No. 30. 
Catheters from No. 6 to 24, with two filiform solid silk 
catheters. One dozen fine filiform whalebone bougies, 
with one carrier No. 16 French. 
One metal catheter with filiform bougie attached. 
Three Guyon catheters—Nos. 12, 14, 16. 144 
THE SUCCESSFUL PHYSICIAN 
One good razor kept in such condition that you can 
shave instead of scrape or pull hairs. 
One magnifying glass for locating particles in eyes. 
Shears: bandage, straight, curved, curved sharp, 
Dressing forceps: rat tooth, plain, ear, splinter, uterine, 
of the Hegar type. 
Assorted needles, and catgut and other sutures for 
minor wounds. 
Needle-holder, small retractors, hemostats: plain and 
mouse tooth, and curved. 
Two 6-inch probes, and a grooved director. 
Tongue depressor, wooden applicators, head mirror. 
Knives, one fine cataract, three operating knives gradu- 
ated sizes upward; small carborundum hone. 
Esmarch tourniquet. 
One and five cubic centimeter Record syringes, with 
gold and iridium needles. 
Medicines, antiseptics, bandages, gauze, splints, 3 
in. adhesive 5 yds. 
Dental syringe with long gold iridium needle for inject- 
ing tough skin of hands or feet. 
Office antiseptics will be in your dressing or specialist’s 
cabinet. 
Stomach pump. 
Curettes—for ear, and small and large for wounds. 
Snellen’s test letters. 
Office Dispensing of Drugs.—For those who go far into 
the country or those who take up some form of contract 
practice, there are large firms who supply a full line of 
tablets, containers, stickers, labels, etc., and who will fur- 
nish these to you. They have special cabinets also for 
holding their preparations. In the smaller towns and 
large cities one should not attempt to go into the drug OFFICE EQUIPMENT AND MANAGEMENT 
145 
business. The field of medicine is quite large enough 
for any one. 
Signs.—The signs on the doors and windows in the 
cities are usually regulated by the building into which you 
move. Many office buildings will not permit signs to be 
placed on the outside while those that do usually have a 
sign painter put these up for you. They have a uniform 
size for each floor. Buildings which have no regula- 
tion in this matter allow you to use your own judgment. 
If you do have signs on your window, have them lettered 
in gold and of the best workmanship. Signs will not be 
of much value above the third or fourth floors, for while 
they may be made large enough to be read, the great 
majority of people will not look up high enough to see 
them. 
The signs on your door should be of good workman- 
ship, and should give your name, office hours and residence. 
The doors leading to your office should also be labeled 
to show which is the consultation and operating room and 
the rooms that should not be opened should be marked 
“Private.” 
Your Personal Cards.—Your cards should be printed 
on a good quality of board, so that when they are handed 
out, they will not create the impression that you are cheap 
or poor. They should be printed by the best printer 
you can find. If you wish to have them engraved 
have the lettering in such type that no one will have to 
guess what your name really is. The letters should be 
plain, of tasteful workmanship and conservative as to 
form. In other words, have your cards show that you 
represent a refined, legitimate, dignified calling. 
Your card should contain the pertinent matters about 
your business, which include your name, address, business 146 
THE SUCCESSFUL PHYSICIAN 
hours, and telephone number. Your home address and 
hours there may be used, but it is a good plan not to have 
so much on your card that it presents a crowded 
appearance. 
Office or Business Stationery.—Professional stationery 
is not given the attention that it deserves. When you 
write a letter to a stranger, your letterhead and what 
you say are made to represent yourself. In beginning 
practice, in country or city, many letters must be written. 
Communications must be sent to the various concerns 
that you are not able to call upon in person. Your 
letterhead and its contents will often determine whether 
your proposition is to be accepted or refused. Few 
people will admit so simple a thing as good stationery 
made them give one proposition more consideration than 
if it had been made on poor material, but it is a fact. All 
business men know and are influenced by the character 
of the communications they receive. 
Compare the letterhead of the best jewelry store in 
town and the letterhead of the kitchen mechanic or ice 
man or any of those who do not pay attention to the 
finer influences that tend to make for favorable opinion. 
Have your letterhead of good quality paper, properly 
engraved, embossed, or printed in the best possible 
manner. Let it state only your name, title, business 
and location. 
Telephone.—This instrument has become of equal 
importance in practice as the stethoscope. It is necessary 
that you have your arrangements made for the listing of your 
name in the telephone directory before you establish 
an office. It takes weeks, and sometimes months, before 
one’s name appears in the directory. Try to make the 
reservation for your office phone so that your name will OFFICE EQUIPMENT AND MANAGEMENT 
147 
appear in the directory in time for the opening of your 
office. Be sure to make an application for the right 
number; that is, a number that is easily given and easily 
remembered by your patients. This can readily be done 
if you proceed about it properly. Go to the telephone 
company direct, tell them in what building you are 
going to have your office, and ask them to give you the 
numbers of phones it is possible to assign to you. Out of 
these you can then select the one that will be most readily 
called and most easily remembered. The numbers, one, 
three, six, and seven are heard with the least difficulty. 
Therefore try to get one, three, six or seven hundred or 
thousand. Next to the numbers ending in thousands are 
the hundreds, like one three hundred, one four hundred, 
etc.; after these come the serial numbers, 1230,2340,4560; 
after these the serials 1234, 2345, 4567, etc. The number 
of your phone may appear a small matter, but a thing 
you may use for a number of years becomes important. 
Everything that may be of aid to you is important. 
People are generally lazy minded. If you can assist 
them to remember your number, it is certain to mean 
many calls that a number difficult to remember or to hear 
would cause you to miss. 
Imagine the woman who has an emergency case 
at home. She rushes to the phone and calls the number 
that she can first bring to mind. If you have a number 
easy to remember, this would greatly influence her in your 
favor. She would rather have someone that she can call 
at once than to have to hunt through the book. Picture 
a man going to the phone and calling a number hard for 
the telephone operator to understand and getting the 
wrong party two or three times. He gets angry and calls 
someone else. 148 
THE SUCCESSFUL PHYSICIAN 
The number that is easily called and easily understood 
by central will save you many a useless answering of the 
phone that is intended for the number that sounds just 
like your own. 
The Office Nurse or Attendant.—When you first take 
up practice there will be no real need for an office nurse. 
But when you go into the office of another doctor and can 
afford a nurse it will lend tone to your office and will 
also relieve you of a great many cares. A good office 
attendant is rare and difficult to find. She can make 
appointments for you, keep out the idlers, agents you do 
not want to see, assist in keeping a record of your appoint- 
ments, and in general be your representative when you 
are not in the office. I would advise every man to have 
some one in the office to attend to his affairs as soon as he 
possibly can. If you do not feel that you can afford one 
at once, endeavor at least to make arrangements to have 
your telephone calls answered until you can afford to have 
someone do this work for you exclusively. 
In the matter of age, an attendant who has passed her 
early youth should be selected, one whose habits are 
reasonably steady and who has need of the income the 
work may give. A regular graduate nurse whose health 
does not permit her to do regular duty is an excellent 
help in an office, or a married woman who wishes to 
augment the family income and is a good reliable worker 
is a useful adjunct. 
The selection of the office assistant should be made 
with the purpose of supplementing some of your own 
personal dificiencies, such as inability to remember names, 
diseases, circumstances, to look over your patients and 
note mental and other characteristics, to overcome 
careless habits as to appointments or office accounts. A OFFICE EQUIPMENT AND MANAGEMENT 
149 
good office attendant is a great help. It is poor policy to 
make many changes in your attendants. Every change 
means additional work for you and is an element of 
strangeness for your patients. The main things to look 
for in an attendant in addition to those mentioned are 
neat appearance, cheerful temperament and voice, and the 
ability to greet patients graciously and make them feel at 
ease. 
To be of real value, the office nurse must have still 
other qualities. One of them is an interest in her work 
and in your practice. If she does not have this interest, it 
will be shown in her actions. She will give patients the 
impression that she is doing them a favor by taking their 
message over the phone. She must have a voice of good 
quality, business like and insistent. She needs this to 
convey to your telephone callers that there is someone in 
your office who is interested in their wants. She must be 
not only willing but have a desire to accommodate them 
and learn their wants. The calls will be for you person- 
ally or to make appointments. When these calls are for 
you, she must be able to give them definite information 
about you. She can do this only if you cooperate by keep- 
ing her informed of your movements. 
No patient should ever be told to try to get you anywhere. 
Your attendant should make the effort herself and let the 
caller know that your office will be pleased to send definite 
word in a few minutes. By showing this helpful interest 
the patient will usually give the nurse an inkling of what 
she desires information about. This will enable the 
office nurse to give you the details and, more than likely, 
make it possible for your nurse to complete the answer- 
ing call with the full information desired without troubling 
you. 150 
THE SUCCESSFUL PHYSICIAN 
The making of appointments should be so arranged 
between you that the nurse need not hesitate as to the 
time a patient may call at the office and expect to find 
you. When a patient is given a quick, positive reply 
that the doctor will see you at such a time, this is fixed 
in her mind. She feels that she can depend on a man 
who has such an obliging and business-like person to 
attend to his affairs. It now devolves on you to see 
that these appointments are kept. If you do not keep 
the appointment at the office or the residence in a reason- 
ably prompt time, you lose the call and the confidence of 
the patient. 
The next important point to consider is the transient 
stranger who wanders into your office. No matter how 
efficient your office nurse may be or how well appointed 
your offices, strangers will not wait for you unless they can 
be definitely assured as to when you will return. Even 
then they will not wait very long. Of the transient 
patients who come to your office and leave without receiv- 
ing attention, but who promise to return, you will see not 
more than one out of the ten. I do not know why—you 
just don’t. If you want transient practice, you must 
keep in touch with and attend to it. Everyone can be 
made into a prospective, steady patient, if given service. 
The Automobile.—The automobile has taken the place 
of old trusty Dobbin. For your early start in practice 
in the city it will be the better plan for you to hire your 
machines for those calls that must be made in a hurry, 
than to buy one of your own. No matter how cheap or 
expensive a car you buy, they are costly to maintain. 
They are indeed a luxury until you can have sufficient 
need for one to warrant you in buying one. The average 
car will cost you six hundred dollars per year to maintain. OFFICE EQUIPMENT AND MANAGEMENT 
151 
This would pay for many rides in hired taxicabs. In 
the country it is a different story. Some means of 
getting about you must have. The small cars that are 
light and give good mileage on tires have a low upkeep 
and a good second hand value are the cars to select. 
Enclosed cars are better than any other for the doctor. 
They tend to keep clothes, hands, face and general 
appearance neater and cleaner than the open car. In rainy 
or cold weather the physician does not get so cold and 
wet as in the open car, and when he goes in to see his 
patient, his hands are not icy and rough. 
To be of the greatest value to you in the cities your 
garage should be in or near your residence. If you do not 
have such an arrangement, you will make many a useless 
night call. Patients in the city will call several doctors 
at once and take the first one who arrives. Unless your 
car is close at hand and immediately available, it will be 
best to make hurry calls in a taxicab, rather than to try to 
get your own car and find another physician attending the 
patient when you arrive. This does not hold good in the 
country. Here patients will know you better and are not 
in such a hurry as are most patients in the city. This 
does not mean that you can take your own time to 
answer calls in the country. Hurry calls come there as 
elsewhere, and you must make adequate provision 
to give the patients the service to which they are entitled 
—a service that is as prompt as any other doctor can give. 
Library.—The books you used in your studies will 
form the nucleus of your library. They may be all 
that you can afford. If you can afford other works 
you certainly should have a book on each of the medical 
and surgical specialties. It is only rarely that one has 
these on finishing school. Get the single volume works on 152 
THE SUCCESSFUL PHYSICIAN 
the subjects that are not covered in your present library. 
In this list should be included a good general dictionary 
and a reliable medical dictionary. 
The copyrights of the works are changing so rapidly at 
this time that one should buy the cloth-bound books. 
Systems soon get out of date, and the information they 
contain cannot always absolutely be relied upon. For this 
and other reasons it is not good policy to buy them at 
first if at all. 
Books are usually more reliable than periodicals. 
They are not so completely abreast of the times, but they 
do not contain so many conflicting opinions. The subject 
matter of books has a slight advantage over that in the 
magazines, in that the authors have usually taken more 
time to prepare the statements they contain. 
Medical Journals.—The Journal of the American 
Medical Association and one or two others will furnish 
you with all the literature you absolutely require for your 
start. As you go along and find the need of some other 
special journals, this can be added. 
Periodicals for the Reception Room.—One or more 
magazines for your patients to read should be on your 
center table. The picture magazines appear to be more 
interesting than those containing simple reading matter. 
Most patients are not in condition or in the mood to pur- 
sue any lengthy article to the end. Pictures and some 
short reading matter of current events attract most of the 
office callers. 
Whatever magazine you have on the center table, see 
that it is the current number. Do not allow old, dog- 
eared, out-of-date magazines to clutter up your place. 
If you cannot have magazines of the current issue, and in 
good condition, on your table, do not have any. OFFICE EQUIPMENT AND MANAGEMENT 
153 
The Medical Bag.—The bag the general practitioner 
of the city will find of the most value is the one known as 
the Chicago Bag. This bag affords sufficient space and 
facilities for carrying all the things most often needed in 
general work. 
The many pharmacies of the city render the carrying 
about of remedies useless. The bag is used for holding 
the instruments and antiseptics most common employed— 
the diagnostic instruments, minor operating instruments, 
treatment material, and antiseptics. It is divided into 
two compartments: The upper one is intended for the 
antiseptics, the dressing material, bandages, diagnostic 
instruments, such as the stethoscope and blood-pressure 
apparatus. The lower compartment contains a sterilizer. 
In this sterilizer the minor surgical instruments and 
specula may be carried. 
With this form of outfit one may treat the minor 
ailments, medical or surgical, without an extra trip to 
the office. 
An excellent plan is to ascertain from the one calling 
you the nature of the ailment, if possible. Most of these 
will know something of the character of the ailment of the 
one they are calling for, and whether it is an accident, 
a hemorrhage, etc. This information will enable you to 
take with you the things likely to be needed to give the 
ailing one proper attention without the trouble of return- 
ing to your office or sending some one to the druggist. 
This will save you time and also relieve the patients of the 
anxiety induced by delays. 
Those men who may be more fastidious about the size 
of the bag they carry will want their diagnostic instru- 
ments in one bag and the minor operating and dressing 
materials in another. The first plan is the better for the 154 
THE SUCCESSFUL PHYSICIAN 
beginner. The particular instruments to be carried are 
matters of individual choice. The list will vary with the 
case to which you are called and the tastes of the doctor. 
I have found excellent use for the following articles: 
Wooden applicators, minor surgical pocket case, specula 
for the ear, nose, vagina and rectum, flashlight, small 
magnifying glass, uterine dressing forceps (Hegar type), 
uterine packer, Record hypodermic syringes, one c.c. and 
five c.c. hypodermic tablet case, horsehair, catgut and 
needles, hemostats, curved and straight, stethoscope, 
blood-pressure apparatus, soft rubber and silk catheters, 
adhesive plaster, bandage, surgical gauze gloves, head- 
mirror and lubricant. 
With this outfit all the examinations can be made 
with relative thoroughness. All the minor surgical 
ailments can be treated and the minor surgical dressings 
applied. The minor accidents can be attended to and 
prompt temporary dressings applied. Any other more 
extensive operating can then be taken care of in the 
usual way. The reason for carrying the large assortment 
is that you will find that the great majority of people 
have about the same regard for the hospital as you would 
have for a maimed hand. They dread hospitals on 
general principles. Hence you should aim to serve them 
without making it necessary for them to go there. Of 
course, certain cases must go there to be properly treated. 
All the cases you do treat must be treated right—this you 
would, of course, do of your own accord—the minor cases 
can and should be treated without subjecting them to the 
ordeal of going to a hospital. 
The Strictly Medical Bag of City Use.—This will not 
need to hold more than the diagnostic instruments, light, 
head-mirror hypodermic tube case, and hypodermic OFFICE EQUIPMENT AND MANAGEMENT 
155 
syringe. Each one will have his antiseptic as well as his 
lubricant of choice, and each of these should be included. 
Every man must select for himself the medicaments he 
will carry in the city. I would advise the carrying of 
none, with the possible exception of some good purgative 
pill that you may give those for whom you prescribe 
other medicines. 
The Surgical and Obstetrical Bag for Country Use.—For 
the obstetrical case, in country work, a reasonably com- 
plete outfit should be carried. Facilities for sterilizing 
your instruments and the various things needed in this 
work should be included. Each one will have his own pet 
variety of forceps and other surgical instruments he may 
need in this work, as well as an antiseptic and anesthetic, 
gauze, cotton, gloves, etc. 
The surgical bag for isolated country work should 
contain the same instruments and in addition those that 
were advised for city work. Some of the most successful 
of the country practitioners make it the rule to carry 
all three bags in their machines. This enables them to 
to go to each case and always have their entire outfit 
with them. Thus they are prepared for any emergency 
that may arise in making the distant trips to patients, 
without the necessity of returning to the office for some 
essential that is in another bag. CHAPTER VIII 
OFFICE SYSTEMS AND ACCOUNTS 
You must have some system of keeping accounts. 
Whatever system you select, should be started when you 
first take up practice. The most perfect system devised 
requires attention and work—none of them will operate 
automatically. Some require greater amounts of time 
and duplication of effort than others. Every system has 
certain features connected with its operation that may 
not be ideal. This may be said of the old systems—they 
are not suited to present-day requirements. The Daily 
Journal Ledger and pocket visiting list, so long employed 
and commonly used at the present day, are no more 
practical or efficient than the methods of surgery that 
were in vogue a hundred years ago. Their defects are 
many and their advantages few. 
The defects of the pocket visiting list are: It necessi- 
tates writing the name of your patient on a page with all 
the others visited or to be visited for the week. The lines 
are cramped, the space is small, and little provision is 
made for the address of your patient, none for history, 
diagnosis, prognosis, or treatment. No adequate space 
is left for the entry of the charges for your services or 
what may have been paid you on account, there being 
only two spaces provided for the services for the week. 
Symbols must necessarily be employed if any note is to 
be taken of the character of the services rendered, and 
156 OFFICE SYSTEMS AND ACCOUNTS 
157 
one’s memory of each case must supply the missing 
facts when these are needed. 
By having all the names together it is difficult at 
times to make the entries when they should be made, be- 
cause of the presence of the patients friends who can 
thus see the number of people you are treating. This 
form of book also requires that one carry a prescription 
book. When you make up your record of the case in the 
ledger, you have the facts of each patient scattered in four 
places—on your visiting list, prescription pad, daily 
journal, and ledger. Four different entries have been 
made to complete one visit, and after you have gone to 
all this trouble, all you have in your ledger will most likely 
be a date, name and the charges (11/17/ 20—John Doe— 
$3.00). How you received the call, the character of the 
ailment, the symptoms of the patient, how you treated 
him, and what you prescribed are left to your memory. 
Should occasion ever arise to refer to your treatment, or 
to what was done for him, it would necessitate looking up 
this case in four different places, and, if past experience 
is any guide, finding nothing of an explicit nature, written 
at the time the services were rendered, to refresh your 
memory of the case. 
The essential thing in any system is that all the 
matters pertaining to any case should finally be found 
together. In addition to being together, the records 
should be in proper sequence, and the events, circum- 
stances and treatment should appear in the order in which 
they occurred. 
The daily office journal has the same deficiencies. 
There are provision and space only for the patient’s name, 
address, and charges made. The reasons for the charges, 
the history, and the other essentials are left to memory. 158 
THE SUCCESSFUL PHYSICIAN 
There remains the task of transferring these names, dates, 
etc., to the ledger. It is natural, that with each new 
writing of a name or other detail there will be a tendency 
to abbreviate rather than enlarge on the previous nota- 
tions. This daily journal has the same disadvantages as 
the pocket visiting list. Patients who may be consulting 
you can learn the number of people that you are treating. 
This knowledge tends to cause you to postpone the writing 
in of the name of the patient until after they have left. 
About this time perhaps someone calls you on the phone, 
a hurried caller knocks at your door, mail arrives, a 
package is delivered, and the last call is forgotten. Every 
call so lost means more than the loss of the value of the 
services you have rendered—when your statement is 
given to the patient, he will frequently notice the over- 
sight on your part. This will be pleasant to many, but 
you will at the same time suffer in their estimation, for they 
will know you to be careless in your methods. Though 
they have the advantage this time, they may feel that 
you might over change them the next time. You owe 
your patients as careful attention regarding the keeping 
of their accounts as you do to treating their ailments, 
and just as certainly you owe to yourself proper returns 
for services rendered. 
A further objection is that your receipts that are given 
to patients cannot be filed in your ledger or journal or 
visiting list. As a result, many disputes will arise with 
patients over the alleged payment of bills, and over the 
amounts and the number of visits. 
All receipts should be made out in duplicate—a copy 
for the patient and an original for your own records. 
By this system, when money is paid to you while on a 
call, a receipt is given. It should be written in your OFFICE SYSTEMS AND ACCOUNTS 
159 
record, in your journal for the day’s work at the office, 
and transferred to the ledger. Again you have duplica- 
tion of effort to no advantage. 
The Card System and the Special Daily Chart 
Method 
The essentials in considering the system for your use 
should meet the following requirements: It should (1) be 
portable, (2) complete, (3) practical and (4) legal. 
1. Portable—since a large part of your work is done 
outside your office. Experience has shown that one’s 
records, to be accurate and complete, must be made 
at the time of the visit. 
If you have a combination history sheet, prescription 
blank etc., with you, everything will tend to facilitate your 
making note of what the conditions were, the symptoms, 
and what was done for the patient. Such a sheet will 
aid you in making notes on how your patient is pro- 
gressing, and the prescriptions you write become a 
part of your daily record of the case. Should a pay- 
ment be made you, this also becomes a part of your daily 
record, because of the fact that you issued a receipt for 
the same. 
Provision is made for a note as to your next visit. In 
this way you safeguard yourself by having a reminder, and 
your patients by making more certain of giving them 
attention at the time promised. 
2. Complete.—All the details of every visit should be 
capable of being completed at one writing, so that your 
first entry is all that will need to be done. Thus when 
you return to your office all that remains to complete the 
clerical part of your day’s work is properly to file your 
records which are already made. 160 
THE SUCCESSFUL PHYSICIAN 
3. Practical.—Any system that is not practical and 
does not meet your whole need is valueless. It is possible 
to have such a complicated system and such extensive 
detail as to impede rather than assist you in your work. 
4. Legal.—For the reason that every case you take 
carries with it an obligation, your records, properly kept, 
will assist you in the care of the worthy and protect you 
against the schemes of the vicious. Copies of your pre- 
scriptions, with the cases for which they were given, will 
serve to correct errors that the druggist may call to your 
attention. They will also protect you from any errors 
that he may make. 
This plan of having copies of all recipes, directions, 
diagnoses, and any remarks the patient may have made 
protects you in your dealings with the patient, hospital 
nurse, or friends. 
These things are patently not possible with any system 
that does not permit you to make the records at the time 
of the transaction. 
The card system is excellent for a purely office practice, 
but even in this case no provision is made for filing 
the prescription with the card, but necessitates writing 
it on the card in addition to writing the original prescrip- 
tion. No provision is made for the receipts for money. 
No adequate space is allowed for the making of notes 
of symptoms or other items of importance. The lack 
of these two essentials makes the card system trouble- 
some and laborious even for office work. An office 
nurse who is careful and methodical will overcome this 
part of the defect, but this does not make up for the 
lack of having a duplicate of all prescriptions, appoint- 
ments, notes as to condition, conversation, and receipts 
for payments on account. OFFICE SYSTEMS AND ACCOUNTS 
161 
The following suggestions for an up-to-date and 
practical office system have been prepared especially for 
this book by the McCaskey Register Company, of Affiance, 
Ohio, probably the largest manufacturers of this kind in 
the country. 
Paramount in its importance to the physician and 
surgeon of today is an office system of accounts and col- 
lections that will rank with the most modern devices 
used in the commercial world for safeguarding the finan- 
cial affairs of the individual or concern. The old methods 
used by physicians in handling accounts are responsible 
for the reputation the doctor has as a poor business man. 
Memory is an unreliable monitor when dealing with 
financial obligations. The Daily Journal Ledger belongs 
to the stage-coach days of American pioneer life. Today 
we use the automobile. The world moves on wheels. 
The up-to-date system of accounts is the development of 
the past decade; it is a single entry, method with but “one 
writing,” keeping every record, serving every need. 
Many of the profession today permit themselves to 
use the “old way.” They still scribble the names of 
patients on a tiny page of a pocket booklet, using signs 
and symbols known only to themselves to aid a decrepit 
memory work account plan. They are known as “the 
doctor” and they get their reward in money when all 
other bills have been paid. This too often means that 
past due accounts are never paid, for the legal standing of 
a physician’s accounts which are purely verbal and written 
in sign language, do not hold good in court. 
As the years roll on medical journals fill their pages 
with the need that exists for better business management 
of the doctor’s affairs by himself. Certain states have 
passed laws requiring that all doctors caring for cases of 162 
THE SUCCESSFUL PHYSICIAN 
industrial disease keep case histories. Other states have 
gone even further, and bills have been presented urging 
that every case handled by a doctor be recorded by him 
in a permanent manner. The call for the awakening of 
the doctor is sounding louder and clearer, and the system 
of modern business accounting is forcing its way into the 
doctor’s financial affairs and thus raising the plane of his 
business standing. 
Modern business efficiency demands a system for the 
doctor that would stand, hold in court, show charges 
and histories, prescriptions and details. The system 
must be complete. The doctor should be able at all 
times to put his hand on any case, past or present, and 
without depending on his memory to aid him as to definite 
conditions in the past. Leaks in memory can become 
leaks in life to the patients, and result in leaks in hard- 
earned dollars to the doctor. A practical plan is the only 
one which the doctor can afford to follow. Cumbersome 
records require repeated rewriting, and any method which 
does not fill the entire need is valueless. Finally, the 
system must come up to legal requirements. The original 
entry, made within less than twenty-four hours after 
service is rendered, and preferably at the same time, must 
be available for legal situations. The original entry is 
the only one that will stand in court. Further, the 
original entry can and will check the doctor’s and the 
druggist’s mistakes in the handling of prescriptions. 
What systems are available? Not the daily office 
journal; this is a relic of yesterday and of poor business 
methods. The card index plan? This is not complete, 
does not offer satisfactory settlement of financial obliga- 
tions, fails to provide for new developments or give space 
for the recording of prescriptions, etc. There are many OFFICE SYSTEMS AND ACCOUNTS 
163 
methods by which doctors keep their accounts, but there 
is a new and modern way that is being favored and 
accepted by the most enterprising physicians and surgeons 
all over the country—the one-writing system. 
This system, which is known as the McCaskey “One 
Writing” Method, operates with automatic precision in 
caring for the doctor’s accounts and case histories. Inas- 
much as no system will run itself, this method requires 
attention at the proper time, but with the original entry 
of facts concerning the cases no repetition is necessary. 
The entire record is available from the first entry, and 
little time is required by the doctor to keep the system 
working. 
There is a size and a style to fit every man’s practice 
and specialty, and they may be had at a price to fit almost 
every man’s purse. 
In conjunction with the secretaries, cabinets or safes 
which are furnished to hold the system, as used in the 
office, is the leather pocket history case, which furnishes 
the portable requirements of the system, and the pocket 
ledger, a collection adjunct of unusual service to the 
doctor. The successful outcome of this system has been 
to remove the last vestige of slovenly business methods 
from the doctor’s office. 
Its simple manner of operation is explained in the 
following paragraph: 
In order to visualize the action of this system a typical 
demonstration can well be made. The names, of course, 
are fictitious: Dr. Henderson of Sacramento is called to 
the home of Mrs. Sharpe. Her daughter Ethel is sick. 
Since Dr. Henderson is a follower of the McCaskey 
Method, he carries with him his pocket history case. In 
the case is a slip in a pocket marked “ Calls to be Made.” 164 
THE SUCCESSFUL PHYSICIAN 
Mrs. Sharpe’s name is at the head of the slip, because she 
is the one to whom the account will be charged. At the 
bedside of the patient Dr. Henderson takes out this slip, 
the details of which, perhaps, were taken over the phone. 
He records in the blanks provided the necessary facts 
covering the history of the case, his diagnosis, etc. If he 
wishes to prescribe for the patient, he turns this record 
slip over on the carbon of a duplicating pad in another 
pocket of the case, makes out the prescription at one 
writing, gives the duplicate to Mrs. Sharpe, and places 
his slip containing the diagnosis, etc., on one side, and the 
original of the prescription on the other, in the “Calls 
Made” pocket of the case, and departs. 
In this case Dr. Henderson is to keep a running charge 
of the visits to the case. Opposite Mrs. Sharpe’s name 
he places the balance due. Below that are spaces for 
amount paid, total owing, amount charged, and account 
carried forward. He is a business-like doctor and notes 
these charges at the time of the call. There is no 
further posting to do. The next time he calls he will 
produce a new slip with Mrs. Sharpe’s name at the 
top, and the balance owing carried forward from the 
last slip. 
What has become of the last slip? In his master 
secretary, the home of the office end of the system, it is 
properly cared for. Mrs. Sharpe has a family account 
compartment in the doctor’s visible metal file. Her 
account is among the S’s the top line across the last slip 
showing her name and the balance owing. The slips are 
kept in place by a metal spring clip, and as long as the 
account is active the total amount owed is always before 
the doctor. When he has collected the account the slip 
is filed away in one of the drawers of the desk. OFFICE SYSTEMS AND ACCOUNTS 
165 
In the drawer the files are boxed. A cardboard is 
folded to give a box-like effect, and across the top, easily 
visible, Mrs. Sharpe’s name is inscribed. In this box the 
slips are placed. This is the case history section of the 
system. Similar box folders are used in the unpaid 
account section. 
It is probable that calls have come in for Dr. Hender- 
son while he was out on this trip. The names of the 
parties concerned are placed on the slips, and held for him 
so that he can make the calls at once or as soon as possible. 
The slips are placed in the “Calls to be Made” section of 
the pocket case, and he is enabled to care for them all. 
When the calls are made the slips are transferred. Thus he 
misses no calls. The slips are filed either when he returns 
to the office or, more generally, the first thing each morn- 
ing. It is a matter of less than ten minutes to file every- 
thing away within reach for further consideration. 
Collection of Old Accounts 
A question arises about the accounts unpaid section of 
the system. All doctors have such accounts, and often 
too many of them. With the McCaskey method the 
Pocket Ledger solves this problem to an exceptional 
degree. Let us return to Dr. Henderson. When he 
installed the McCaskey Method he had some thirty 
past due accounts. He immediately entered these names 
with the amounts owing in his pocket ledger. Below was 
a space for amounts paid, in full or in part. Meeting 
one of these old patients on the street, the latter accosts 
him with: 
“Well, Doctor, what do I owe you?” 
Times were when most doctors didn’t know; they still 
exist. 166 
THE SUCCESSFUL PHYSICIAN 
But Dr. Henderson reaches for his pocket ledger 
and frankly states the amount due. His former patient, 
perhaps surprised, pays him a little on account. He 
probably would never have hunted up the doctor and 
paid him. But when he met the doctor, asked him the 
amount, and was readily told, he was inclined to make a 
payment. 
In the case of the estate of a certain man, Dr. Hender- 
son had cause to bring suit for the large bill long past due 
and not settled owing to delay in administering the estate. 
The original records in Dr. Henderson’s unpaid accounts 
section were available for court action. They were 
legally correct. There were no unpleasant arguments 
over verbal agreements or old ledger figures. His system 
was indisputable and the court recognized it to be so. 
Among the forms used for the McCaskey Method are 
the following: The General Purpose blank, to be used in 
making first calls where there is any possible excuse for 
establishing a case history. The Daily Call Blank, which 
is used on second and subsequent calls, unless a more 
extended history is desired. 
Provision is made for every variety of case and for 
each specialty, for prescriptions, obstetrical, accident, 
surgical, T. B., gynecologic, pediatric, etc. These 
explain their own uses. All can be carried with conven- 
ience in the doctor’s pocket history case, where they are 
available at all times. 
The Day’s Work 
As calls are made the slips are transferred to the 
pocket history case from the pocket “Calls to be Made” 
to “Calls Made.” 
All duplicate receipts are also placed in this pocket. OFFICE SYSTEMS AND ACCOUNTS 
167 
When the pocket “Calls to be Made” is empty, the 
doctor knows that none have been forgotten. 
On returning to the office after making calls, the slips 
are placed in the pocket “Calls Made,” in the file marked 
“Today,” together with all slips covering business done 
in the office. 
Next, the pocket history case is refilled with blanks 
to take the place of those used during the day. 
System for New and Old Cases 
Slips are filed in their proper place in the System. If 
any active cases have paid up and become inactive, 
they are placed in the Case History Section. If not paid, 
but inactive, they are placed in the Past Due account 
drawer. If still active, they are returned to the Active 
Case file. 
Should a dismissed case again become active, whether 
an office or an outside call, and the account be still unpaid, 
the balance due is entered on the new blank, so that the 
account will always be posted to date. 
The Monthly Summary Book furnishes the most sim- 
ple way of keeping a daily, monthly, and yearly record of 
the charges and money received. Before filing the records 
for any day the blanks are separated into three groups— 
(1) charges; (2) cash received for work done at time of 
treatment; and (3) money received on account. These 
are totaled and entered in the proper column of the 
summary sheet opposite the number indicating the day 
of the month. Daily credit and cash business added 
together give the total daily business done—the total to be 
entered in the column provided. Daily cash and receiv- 
ed on account amounts are added, giving the total 
daily cash receipts. Deducting the total of the received 168 
THE SUCCESSFUL PHYSICIAN 
on account column from the total daily credit column 
gives the amount of unsettled accounts. 
The success of the McCaskey Method lies in the 
“Do it now” feature. The system will not run itself; 
but with a little attention at the proper time it will give 
the user an absolute case history and a full financial 
record. Importance is attached to entering the charge 
for services at the time of making the call. 
The name of the person to whom the bill is to go, 
the one who is to pay, should be placed at the top of the 
slip. The name of the patient treated should be placed in 
a line headed “Service to.” These names, once written 
in, and the charge made, there is no further entry to be 
made on that case for record. There is no tiresome 
bookkeeping to occupy hours at the office. The system 
was originated to give the doctor time for leisure and 
study, as well as to establish him as a business man and 
enhance his financial standing. 
The proper use of such a system cannot fail to make a 
better doctor of the one who follows it. He will collect 
most of his past due accounts. The details of his business 
will be at his finger-tips, and he will rank with the success- 
ful business man because he is absolutely in touch with 
every phase of his business. CHAPTER IX 
THE DOCTOR AND HIS INVESTMENTS 
The most essential thing to do when you first start into 
practice is to adopt the proper system. This will enable 
you to start right, and it is a generally accepted fact that 
if one starts right the end will also be right. One of the 
first items in one’s system should be the adoption of a 
budget of expenditures. After figuring out what your 
expenditures each month are to be, do not allow yourself 
to depart from this schedule. Emergencies may arise 
which will compel you to vary from this plan, but other 
things being equal, you should hold to your plan most te- 
naciously that the system adopted may, in theory and 
fact, be carried out to its logical completion. 
Thrift 
This is one of the rungs of the ladder that nearly all 
men must tread in their climb toward a competence for 
their old age. It must of necessity from the scientific 
as well as the practical standpoint, be one of the used 
rungs in your climb toward success. One cannot carry on 
the many investigations toward which he may be inclined, 
attend medical societies, and take post-graduate courses, 
prepare articles and supply the illustrations, unless 
funds are available. Other men or societies may do 
this for one, but this is not the field of scientific research 
that we are covering—we are considering the field of one’s 
activity in private practice. Few people do not consider 
169 170 
THE SUCCESSFUL PHYSICIAN 
thrift except as a laudable quality, yet few of us seem 
inclined to apply this desirable trait to our own activities. 
This lack of thrift and failure to look to the future may 
almost be regarded as the prevailing American fault. 
Thrift in any calling is a matter of education, habit, 
and system. There is nothing mysterious in its applica- 
tion. It merely amounts to spending a little less than 
one earns—it is not stinginess, it is foresight. The most 
important thing for one to do at the start is to apply 
system to his practice and continue this application of 
system throughout his entire practice; it is one of the most 
important parts of this system. The particular amount 
one may save out of his earnings in any specified period of 
time is not material, but it must be a matter of routine 
that is constantly adhered to with faithful regularity. 
This will naturally become a fixed habit, and as a result of 
this habit there will soon accumulate sufficient for one 
to seek a reliable place in which to place this savings fund. 
The practice of medicine is similar to many of the 
other professions—it is either a feast or a famine. A real 
estate operator once said his business was either ninety 
dollars a day or ninety days without a dollar. This is 
very true of the beginning of the private practice of medi- 
cine and during the time one continues in practice, and 
it is the most essential reason why one should have 
system in the matter of recording his monthly expenses. 
This irregularity of income makes it imperative for one 
to determine beforehand how much he may spend in any 
week or month, for if one is not careful in prosperous times 
and becomes too prodigal in his expenditures, he will not 
have sufficient to tide him over some of the unexpected 
slow spells that come along at the most inconvenient and 
inauspicious times. THE DOCTOR AND HIS INVESTMENTS 
171 
No single instance of the result of lack of thrift ever 
struck me more forcibly than an experience I had when a 
lad. A former employee on my father’s farm went into a 
factory and earned six dollars a day where he had formerly 
made only one. He called on my father decked out in all 
the finery that could find a place of lodgment on him, and 
when asked why he did not save some of his money, said he 
would when he had made a sufficient amount to make a 
respectable showing. “When I can save two hundred or 
more a month will be the time that I will start.” That 
man died a pauper. 
Instances without end might be cited of men who 
later became the leaders of the finances of this country 
who saved a little from their income of three dollars a 
week. Rockefeller, Woolworth, and Sage are notable 
examples. A fifteen-year-old boy supported his mother 
and four younger brothers selling matches on the streets 
of New York, and this same boy later became one of the 
leading manufacturers of clothing in that city. 
The First Investment 
Carnegie stated that “one good investment was 
worth a lifetime of savings,” and the first investment one 
makes is the most important one he ever will make, for 
its favorable termination will have a decided tendency to 
make one optimistic, while an unfavorable one will lead 
to discouragement and lost hope. 
There is one investment that can be made that will 
pay you a hundred or a thousand percent, and this form 
of investment has the additional delightful advantage of 
being almost a hundred percent certain. To make this 
form of investment, all one need do is to exercise a reason- 
able amount of common sense in its selection. The invest- 172 
THE SUCCESSFUL PHYSICIAN 
ment that one should make first, that will bring in best 
returns, is in office equipment and appliances necessary to 
your profession. Many physicians do not have the proper 
atmosphere in their offices nor the proper amount of equip- 
ment to treat the various cases that come to them. The 
first budget you make and those that are to follow should 
contain a certain small amount set aside constantly to 
improve and add to this equipment. Please note that 
it is suggested that this be a small amount, for a time 
will come when a full office equipment will be assembled 
and further articles would be useless. They would 
only clutter up your offices, and instead of making them 
appear up to date and create a good impression, they 
would offend the eye and make them resemble the office 
of a fakir. 
The only test of whether or not to buy an article is the 
amount of need there may exist for it and the ability on 
your part to use the things you purchase. Not infre- 
quently many offices present a very crowded appearance 
and are filled with appliances covered with cobwebs and 
dust. This creates the sort of impression that one 
is trying to avoid. It is obvious that a constant effort 
must be made to keep the office up to and abreast of the 
best developments in the profession. The mere presence 
in your office of things that are known by patients and 
others to be modern, approved, and useful and which you 
do employ, will add to their estimation of your worth and 
will give them greater confidence in your ability properly 
to treat them irrespective of the nature of their ailment. 
Now that the office and its equipment are properly 
provided for, there remains the other item of your budget 
to consider, and this is the savings you have accumu- 
lated over and above the provision made for the ordinary THE DOCTOR AND HIS INVESTMENTS 
173 
things of life. Let it be assumed—irrespective of the hard- 
ships you have encountered and the numerous open- 
ings that presented themselves to you as an adequate 
excuse for saving nothing “this week”—that you do 
actually present yourself each week at the teller’s window 
with your deposit. Whether this deposit be large or 
small is of little moment—what does count is that the 
habit has been acquired by persistent and constant 
effort, and will be retained if persisted in, and that finally 
you will realize that you have been successful in saving 
your first and most difficult thousand dollars. 
How to Invest Your Money 
An enterprising banker has demonstrated that if one 
will save but twenty-five dollars a week for twenty years 
and invest it at six per cent, that the interest and savings 
will have amounted to about forty-nine thousand dollars. 
This is based on the assumption that one actually saved 
this amount and that each and every one of his invest- 
ments were good. A life insurance company has demon- 
strated that only three men in one hundred do this. But 
now there comes along another concern that specializes 
on calamities, like the undertaker, and tells us that only 
one business venture in ten is a success, and makes the 
picture still darker by stating that incompetence and inex- 
perience alone account for nearly half of all failures. 
Bradstreet has shown that eighty-six per cent of all fail- 
ures result from causes originating in the individual. 
The prospects for the young doctor of selecting the 
right sort of an investment or speculation solely on the 
representations of a person in some business enterprise 
do not appear very inviting for placing the first hard- 
earned thousand at work for him with any certainty 174 
THE SUCCESSFUL PHYSICIAN 
that he will ever see it again or get any returns for it, 
because he has no accurate means of ascertaining the 
capacity of the individual or of watching the investment 
after it is made. 
There is no reason to expect that the young doctor 
will of his own accord, be able to discover a way to avoid 
all the pitfalls that are set for the feet of the unwary 
in the matter of investments. Unfortunately, there is 
a host of people who have found out that the doctor likes to 
take a chance. His profession makes him a gambler in 
the most uncertain thing in the world—which is human 
life. He has worked so hard to accumulate his small 
savings and the possibility of making prodigious returns 
are presented to him so plausibly by some glib talker that 
all too frequently this nest egg is frittered away on some 
unsavory scheme, for he seldom has the time, inclination 
and facilities to make the essential investigation. 
The physician often considers that a patient shows 
very poor mental caliber who tries to treat an infected 
finger himself and loses the hand from resultant blood 
poison. The first question he is tempted to ask such a 
patient is, “Why did you not come to me at first? I 
could have saved your hand.” This is the same thought 
that comes to the mind of the banker or other man of 
financial affairs regarding the mistakes of the doctor’s 
investments. 
It is not my purpose to make any attempt to give 
complete instructions to the young man so that he might, 
by following me, invest his money wisely—the task is too 
great even for one fitted to give this advice, and even if it 
were properly given, the field is too large adequately to 
convey to anyone who has not been trained in any more 
than the bare fundamentals of investment. It would be THE DOCTOR AND HIS INVESTMENTS 
175 
about as easy as it would be to teach the essentials of the 
practice of medicine in one chapter. The task is obviously 
impossible, and cannot be accomplished by any book 
alone, for there must be practical experience as well. It 
is the same with investment—if the young man is wise, he 
will not attempt to do his own investing without compe- 
tent advice. 
Why Do Doctors Fail to Choose the Right 
Investments? 
A physician had a patient who was a very prosperous 
rancher, and who specialized in raising walnuts. This 
rancher had begun his project with almost no capital, 
and had succeeded in developing his ranch and its product 
to such an extent that he had a reasonably certain income 
of twenty thousand dollars annually, and which involved 
but little personal labor. This appealed to the doctor, 
and after some investigation he bought, developed, and 
cared for a similar holding for some eight years and 
invested sixty thousand dollars in the venture, finally 
losing the ranch by foreclosure because of his inability 
to meet the payments. The wheat he raised was allowed 
to spoil, the trees were not given the necessary attention 
at the proper season, so that instead of the place bringing 
in a revenue, it was a constant drain in the matter of 
expense. The neighbors called him a “check-book” 
farmer. The doctor was a recognized expert in his line, 
but absolutely incompetent and inexperienced when it 
came to running a ranch and raising grain and walnuts. 
A practical mining man interested some doctors in a 
real gold mine that had produced over a million for its 
former owners. The estimate for the financing of the new 
company was worked out by the doctors who were direc- 176 
THE SUCCESSFUL PHYSICIAN 
tors and officers of the company, and they would not heed 
the advice of the miner to raise double the amount of 
the first estimate of the doctors. Three short seasons 
were wasted in abortive attempts to open and work 
the mine, but each season they ran out of funds, and 
the project was finally abandoned. Another group of 
men with more funds opened and ran this same mine, 
and this was continued for eight years, during which 
time the same property that the doctors failed to make 
even self-supporting has paid the subsequent owners 
sixty thousand dollars annually. They have developed 
this property to such an extent that the mine, is likely 
to produce a similar amount for another twenty years. 
To continue the subject of mining a little further, one 
might say that the essentials for deriving profit out of 
mines differ in no single particular from those involved in 
selling shoes or raising pigs. One must have the shoes to 
sell and the place to raise the pigs and a thorough under- 
standing of all the attendant details to make either 
venture a success. 
A chef of international reputation was giving explicit 
directions for preparing a sea-bass in a most delectable 
manner. The first step in the directions was to secure the 
sea bass. This very slight detail of actually having a 
mine before investing, and the right people to run it, 
appears to be overlooked by many doctors in buying 
mining stock. 
The main fault with most investors who choose poorly 
is that they take too much for granted. They do not 
intend to make an investment of such an amount of money 
as would warrant them in giving the project so careful an 
examination as investment houses do. Such an investiga- 
tion often costs as much as the small investor has to put THE DOCTOR AND HIS INVESTMENTS 
177 
into the enterprise. It becomes a question of accepting 
the offering without investigation or letting it pass. The 
statements that the salesman presents are apparently 
so genuine that they are taken for granted—there is most 
often some cleverly hidden point in his story that would 
mark the whole as worthless, but not being discernible 
the result is that the investor soon parts with his money. 
With your progress in the matter of equipment and the 
building up of your practice will come also financial 
success. Another form of investment will then present 
itself as necessary to further progress and one quite as 
important as the necessity of securing correct equipment. 
At this point in your career serious thought should be 
given to the future, your age, present and anticipated 
earning power, physical endurance, and how long you 
believe you will be able to withstand the fatigue of prac- 
tice. You must keep in mind the time when you will 
want to slacken the pace a little—possibly quit entirely— 
and have a competence for the inactive years that follow. 
It is obviously essential then that you should save and 
invest your savings wisely. Let me say this—a doctor's 
business is to be a doctor, and if he expects to make a success 
of his calling it will take all his time and study to do so. I 
lay particular emphasis on this point for the reason that 
physicians are so often the prey of promoters who mislead 
them into believing that because they are brilliant in their 
profession, they should, by instinct or otherwise, be 
thoroughly capable of selecting securities. Except in rare 
cases this is absurd. It takes the banker and broker (as 
it does the physician or lawyer) a lifetime to study and 
become proficient in their fine. Therefore, the logical 
thing to do in making an investment is to consult your 
banker. The knowledge that a banker secures through THE SUCCESSFUL PHYSICIAN 
178 
constant contact with business, financial, and economic 
conditions is in itself of great value to the vast majority of 
those not brought directly in touch with business affairs. 
Physicians as a class concentrate so thoroughly upon 
their professional duties that if any one of them becomes 
a good business man, it is usually through natural talent 
rather than because of a commercial education. 
About every share of mining and oil stock that physi- 
cians buy is purchased without consideration of the 
personal qualities, antecedents, reputation, character or 
efficiency of the men and organizations offering the 
securities. You should consult some bank for the purpose 
of checking up on investments. Nearly every bank has 
the facilities for making an independent and unbiased 
survey of any situation, whether it be the purpose of a 
promotion enterprise, the progress of a manufacturing 
concern, or the stability of an investment. Most banks 
place their facilities at the disposal of their depositors. 
Many changes take place in business each day, and 
quite naturally this has an effect on investments. The 
business of a banker is to know all about investments and 
the changes that take place, just as it is the business of the 
physician to know all about disease and the means of 
preventing and remedying human ills. The investment 
that is safe today may be risky tomorrow and worthless in 
a short time, just as the healthy patient today may be 
injured or ill tomorrow and dead in a week. 
The three common forms of investment are: 
1. Directly in a business enterprise. 
2. By purchase of stocks and bonds. 
3. Through mortgages. 
In deciding upon an investment, one must choose between 
the different characteristics—merit on the one hand and THE DOCTOR AND HIS INVESTMENTS 
179 
deficiency on the other—before coming to a final decision 
on the qualities of the securities and the requirements of 
the investor. 
Let me quote from an authority on this subject. 
The five chief points to be considered in the selection of 
an investment: 
“1. Security of principal and interest, or the assurance 
of receiving the principal and interest when due.” 
This point can best be illustrated by using, for example, 
the very coin that you intend to invest. Safety naturally 
is your first thought in the handling of money actually 
in your possession (by that I mean on your person 
or at your office). You would not carry the money care- 
lessly or have it scattered promiscuously about on your 
desk. You would use every precaution to see that it was 
carefully concealed in your clothing or placed in a safe 
or other secure place in your office, so that the possibility 
of loss would be practically eliminated. So it is with the 
investing of money. You must give a great deal of con- 
sideration to the security of the enterprise or project in 
which you are to become an investor, for if the future of 
the enterprise is not in trustworthy and efficient hands, 
your money is as unsafe in the form of stocks and bonds 
of the company as it would be if carelessly handled by 
you. 
“2. Rate of income or the net return which is realized 
on the amount of money invested.” 
In all your investments it is important carefully to con- 
sider the matter of return on the principal, i.e., the interest 
yield. In simpler terms, the rate of interest. With 
bonds, the market price determines the yield; for example: 
A 5 per cent one thousand dollar bond due in ten years, 
selling on the market at ninety-seven dollars, will yield 180 
THE SUCCESSFUL PHYSICIAN 
5.4 per cent return on the actual amount invested. In 
practically every case the yield will indicate the grade 
of the investment. For the sake of earning one or one 
and one-half per cent more, when there is a doubt, it 
would be wiser to accept a lower return on your money 
and insure safety. 
You would not deposit your money in a savings bank 
without expecting the payment of interest periodically; 
similarly in investing in stocks, be sure that the earnings 
of the company are ample to meet all expenses, to build up 
a surplus or reserve, and to pay to its stockholders a fair 
rate of interest on the capital invested. 
“3. Convertibility into cash, with which is included 
availability as collateral.” 
Despite the many instances of people losing huge sums 
of money in fraudulent stocks, we continually find pro- 
fessional men and those who do not keep in close touch 
with business affairs investing in enterprises which 
hold out hopes of great riches, but which never realize 
even the smallest return. In fact, they very seldom 
are able to recover even a small part of the principal. 
When investing your funds, therefore, be sure to purchase 
stocks and bonds with which the banks are familiar, 
so that when emergencies arise, you can go to your 
bank and borrow a certain percentage of the market value 
for a short period, or, if necessary, sell the securities out- 
right and realize approximately the amount you invested. 
“4. Minimum fluctuation, or the stability of market 
price.” 
In the case of high-grade industrial stocks, the steady 
progress of the company, due to experience and the effi- 
cient handling of its affairs, will manifest a steady increase 
in price in the market quotation. Occasionally there will THE DOCTOR AND HIS INVESTMENTS 
181 
be fluctuations due to general financial conditions; that is, 
for example, when in the business cycle a period of depres- 
sion quickly follows a period of spirited business activity. 
If there is a wide range of prices or instability of 
the market value, this is often an indication of uncertainty 
in the affairs of the company. 
High-grade bonds vary little in market price. When 
they do, it is owing to the condition of the money market. 
The ratio of the intrinsic value of the security of high- 
grade bonds to the funded debt is usually sufficient to 
preclude any change in the market value of the bond 
except for the reason just mentioned. 
“ 5. Prospect of appreciation in value. ’ ’ 
Of the three means of capitalizing a large company— 
by bonds, preferred stock, and common stock—the last form 
has the least security. The interest of common stock- 
holders lies principally in the profits of the business, the 
progress being made being measured in dollars and cents. 
Every dollar laid aside as surplus means that much greater 
book value per share of common stock, and consequently 
an increase in market value. 
When you buy common stock, be sure to determine 
that the requirements of a good, healthy business are 
apparent, and that the business will beyond any reason- 
able doubt flourish, thereby enhancing the prospect 
of appreciation in the value of your holdings. 
With the numerous sources for securing information 
that a bank has, it is a comparatively easy matter for it to 
make the necessary investigation in connection with 
contemplated investments and to furnish reports upon 
which to base a decision. 
Not only should investigation be made before purchas- 
ing stocks or bonds and in making other investments, 182 
THE SUCCESSFUL PHYSICIAN 
but they should be checked up periodically, and are so 
checked by careful institutions. 
There are many other ways also in which your banker 
may render valuable service, but if you do not cultivate 
his acquaintance you will never benefit by his 
cooperation. 
In conclusion let me repeat—think seriously now of the 
future, save and invest wisely, making use of the best 
possible counsel you can get, so that you and your 
dependents will be well provided for in later years. 
How Money Grows 
The following table shows how money grows by saving 
a certain amount of the weekly income, depositing it at 
three per cent and investing it in a six percent first mort- 
gage bond. Such a saving will enable you to build a 
competence for the time when you wish to retire. 
$5 per 
$10 per 
$20 per 
$50 per 
week 
week 
week 
week 
$264.24 
$528.48 
531.48 
$1,056.96 
1,062.96 
$2,642.40 
2,657.40 
One year 
\ 6 % 1st Mortgage bonds . 
265.74 
Two years.... 
536.47 
1,072.93 
2,145.98 
2,196.80 
5,364.00 
5,492.00 
6 % 1st Mortgage bonds.. 
546.44 
1,095.64 
Three years.. • 
816.92 
1,633.84 
1,691.96 
3,267.68 
3,396.60 
8,169.20 
8,491.50 
t 6 % 1st Mortgage bonds... 
842.81 
1,403.51 
1,493.69 
Five years. .. 4 
2,807.02 
2,998.74 
5,614.04 
6,020.20 
14,035.10 
15,050.50 
6 % 1st Mortgage boDds.. 
Ten years.... < 
3,032.34 
3,505.30 
6,064.68 
7,025.91 
12,129.36 
14,082.44 
30,323.40 
35,206.10 
6 % 1st Mortgage bonds.. 
Fifteen years. < 
4,922.66 
6,208.20 
9,844.72 
12,440.13 
19,689.44 
24,927.72 
49,226.60 
62,319.30 
6 % 1st Mortgage bonds.. 
Twenty years < 
7,116.46 
9,839.12 
14,232.92 
28,465.84 
39,611.76 
71,164.46 
98,779.40 
6 % 1st Mortgage bonds.. 
19,717.06 CHAPTER X 
THE PHYSICIAN AND THE PHARMACIST 
—THE PHYSICIAN AND THE HOSPITAL— 
THE PHYSICIAN AND THE SPECIAL NURSE 
The Physician and the Pharmacist 
It will be quite natural for you, when first starting out, 
to feel that your mental equipment is superior to that of 
the druggist. It is superior in one way—you have been 
intensively developed along one line—the practice of 
medicine. The very immensity of the work in view com- 
pelled you to do this. The college that trained you was 
forced to give you this intensive training because of the 
great scope of the subject to be covered. Considering 
everything, it succeeded remarkably well. At the very 
best, all that it could be expected to do was to lay the 
ground-work, leaving it to your own efforts to complete 
the structure. The colleges know this but not all gradu- 
ates understand it. You have the foundation work for 
practice and a smattering of pharmacy. The druggist 
has an intensive experience in pharmacy and a smattering 
of medicine. This is the ground on which you will meet. 
These are grave differences in viewpoints. These must 
be smoothed out so that a mutual ground of interest 
between you will be established. You and the druggist 
are co-partners in an enterprise. This enterprise is the 
curing of the patient. You have a point of advantage 
if properly utilized and he has the best position if it is not. 
183 184 
THE SUCCESSFUL PHYSICIAN 
This is particularly true in the larger cities. If your 
patient goes to a druggist whom you do not know and 
who does not know you, what reason has he to protect 
you or recommend you to the patient? He has medical 
friends of his own, and if the patient is on very good terms 
with the druggist, he is certain to ask if the prescription is 
right and proper. So in the large city it will be found 
generally to your advantage to have the patient go to 
a druggist whom you know—some one who is friendly to 
you. You will thus have the assurance that the patient 
will get what you want him to have, which will be benefi- 
cial to you and to the patient. If the outcome is good, it 
will be said that you made a correct diagnosis and that 
your prescription benefited your patient. 
If the results are not satisfactory, you will have to 
change the treatment, convinced, in this instance, that the 
patient received what you ordered. It has already been 
shown that intense competition exists in practice, and 
every druggist who is not your friend has one or more 
medical men to whom he is friendly. If you allow your 
patients to drift at all, do not be surprised if you lose a 
goodly number during the year. 
There is another thing in which the druggist has the 
advantage over you. He has been in business some 
time. He has learned to study people in a commercial 
way. He is able to tell when the patient is pleased 
with the way you went over his case and what kind of an 
impression you made. Suppose you did not succeed very 
well and the druggist infers this, perhaps from a remark 
made by the patient, such as asking the druggist if you are 
well known, if you are a good doctor for such ailments as 
he has, and if the remedy prescribed is the proper one? 
How do you believe you would be treated if the druggist THE PHYSICIAN AND PHARMACIST 
185 
should happen to be any but the best and most honorable 
type of man? I have seen doctors who belong in the 
fraternity of confidence men, and there are too many 
who are not fitted for the calling they have chosen and do 
many things that are wrong. Just so you will find 
sharpers among the druggists. They know many ways of 
harming you, and if you give them the opportunity, many 
will do so, if thereby, gain will come to them. You should 
be on guard to protect your own interests. It is your 
duty to yourself and to the patient as well. 
In the small country town or in small cities con- 
ditions are entirely different. The small country druggist 
will know you and it is your business to know him. You 
will need to do more than to just be acquainted with 
him. It will be a part of your business to make yourself 
familiar with him and the things that interest him. In 
the small town you will make enemies if you play favorites. 
The number of druggists in towns of from three thousand 
to twenty thousand population will not be so great that 
you can neglect to call on them personally—not once, but 
on some of the better ones several times. After you have 
made the personal acquaintance of some of the best, do 
not allow them to forget you. Make it a practice to call 
on them at intervals. Study each man just as you 
would a patient. If some one with an ordinary amount of 
tact is interested in you and your profession, it is natural 
for you to return this friendliness. That is the way the 
druggist will feel toward you. If you know his business 
slightly, his troubles, joys and his hobbies, he will talk 
to you more intimately in a business way. From him you 
can learn the peculiarities of the people of the neighbor- 
hood. Seek to learn the position each one occupies in the 
community. Ascertain who are good, reliable and honest 186 
THE SUCCESSFUL PHYSICIAN 
and who are not. All these details will be of personal 
interest and use to you. 
Diseases peculiar to your locality will be known to the 
druggist and he in turn can pass the information on to you. 
In this way also, the local prejudices will be learned 
more accurately than from almost any other source. 
These prejudices or leanings may be racial, religious, or 
political. In any event, such information will add to 
your knowledge and ofttimes save you from making a 
blunder. 
The druggist who does solely a drug business is the 
exception today. As a rule, their stores are drug and 
general merchandise stores combined. This need not con- 
cern you, but it will concern you if the druggist is an 
extensive manufacturer of preparations of his own and is 
virtually treating people on a large scale over the counter. 
Try to locate one who attends to his own line of work 
and permits you to attend to yours. 
In the cities where you can have access to good drug 
stores it is a waste of time and money to carry your own 
drugs. You will have to carry drugs for office use, 
but to attempt to be a pharmacist and a doctor is too 
much. You will find it to your personal advantage to con- 
fine yourself to treating people and have the filling of 
your prescriptions done elsewhere. There is an exception 
to this general rule. Do not send any patient with a 
placebo prescription to the druggist. Fill these yourself. 
Let the patient know that it is made by your own hands 
for his peculiar and special case, and as you are treating 
his mind, be sure that you are emphatic about his under- 
standing just how you want the medicine taken. This 
can best be accomplished by having the patient repeat 
to you the instructions you have just given him. Do THE PHYSICIAN AND PHARMACIST 
187 
not allow him to leave the office until you have reason 
to know that he feels the importance of the character 
of his case and the need to follow your directions. The 
last thing in these instructions will be the strong sugges- 
tion you are to give him. You are to assure him definitely 
and positively that he is going to be benefited, that 
you will certainly and positively cure him, provided 
he follows your instructions implicitly. An eminent 
doctor assures such patients that the medicine is powerful 
—one pill will cure, two are dangerous, and three are 
fatal, if taken at once. 
From the Physician’s Viewpoint.—The majority of 
doctors write a very poor hand because the hurried 
taking of notes in lectures and clinics has made them 
careless of their penmanship. I do not expect to be able 
to make a Spencerian artist of you by giving you advice, 
and it is not necessary for you to write a copper-plate 
hand. It is vitally necessary, however, that you write a 
plain hand, and in addition to writing legibly the names of 
drugs, it is a legal obligation on you to write out the names 
of the integral parts of your prescriptions clearly and 
fully. The courts hold the physician to this performance 
of his duty. You should write out the drugs to be used 
so that no mistake can be made by the druggist. Not 
only should the drug you prescribe be written plainly 
but also the quantity. These should be written so that 
if a mistake is made, it cannot be laid to you. The 
errors that physicians so frequently make are in writing 
unusual abbreviations. If you must abbreviate, be cer- 
tain that the form of contraction you use is the one 
recognized by the Pharmacopoeia or Formulary. 
If you do otherwise, you are taking a long chance of 
the druggist guessing at what you mean. If he guesses 188 
THE SUCCESSFUL PHYSICIAN 
wrongly, he cannot be held, but the blame falls on you, 
where it belongs, and he is under no legal obligation to call 
you on the phone or otherwise notify you of his uncer- 
tainty. It is your duty to write your specifications 
plainly. The druggist is not required to be a mind reader 
nor an unraveller of cryptographic puzzles. All that he is 
required to know is the Latin and the chemical names of 
drugs, and you are the one who writes them for him. 
See to it that your prescriptions can be read easily. The 
druggist will have a high regard for you for this reason 
alone. The life of your patient will not be placed in 
jeopardy, and you will know positively that the patient 
is going to receive just what you order. If the druggist 
does make an error when things are clearly written, then 
the liability is entirely his. 
In the beginning of your practice start right in this 
regard. The habit of writing your prescriptions in 
a clear, legible hand will be of benefit to you in every way. 
It will increase not only the respect of the druggist, but 
will be an added assurance for the patient and will make 
you more discriminating in your selection of drugs; it 
will also be useful training in carefulness in other things. 
An excellent rule to follow is to write out your prescrip- 
tion as you would make out a check in payment of a bill. 
In this instance you certainly would write so that 
the name of the party the check was intended for would 
be easily read. You would write out the amount of the 
face of the check in full, and write out the figures as well, 
and you would not think of sending a check out that 
called for a sum that looked like ninety dollars when you 
only wanted to pay nine. Follow this same idea when 
you write out the names of drugs and the amounts you 
want to prescribe. THE PHYSICIAN AND PHARMACIST 
189 
It is a dangerous practice to use abbreviations of an 
important drug. W. Gnerich, past president of the San 
Francisco Pharmaceutical Association, gives an illustra- 
tion: 
R: Bar. Sulph. 5 iv 
Sig: As directed 
In this instance barium sulphide was dispensed instead 
of the desired sulphate. The addition of three words 
was all that was needed to make the prescription definite. 
The above mixture resulted in the death of the patient 
and in $10,000 damages against the physician—failure to 
add three words cost a patient’s life, the doctor’s practice, 
and ten years of the doctor’s hard labor. 
The lesson: Do not abbreviate the names of drugs. 
Another common and careless error of many doctors 
is to write the instructions for the patient this cryptic 
expression: “Take as directed.” The question that 
always comes up in these cases that go to court is— 
“Just how was this medicine directed to be taken?” 
The doctor presumably gave the other essential directions 
to the patient by word of mouth. He depended on the 
memory of the patient to follow his orders to the letter, 
and must have further assumed that the memory of every 
patient so directed was perfect. This we know is not the 
case, yet many thousands of doctors resort to this time- 
worn-trouble-making and trouble-breeding expedient. 
Was this medicine to be taken straight or diluted with 
water ? How great was this dilution to be ? Was it to be 
swallowed, injected hypodermically, by enema tube, 
rubbed on the outside the body, or used as a gargle ? 
Most important of all, how often was this medicine to be 
taken and how long was this to be continued? Suppose 190 
THE SUCCESSFUL PHYSICIAN 
the patient had a poor memory—there are such people— 
and he took too much and died of the effects. Just who 
would there be to determine how much he actually did 
take at one time and what defense would you have in this 
event? It will be your word against that of his whole 
hostile family, for they would be most extraordinary 
people if they did not resent injury to their own kin. 
“Take as directed!” was the direction on a bottle con- 
taining a strong solution of silver nitrate that was to be 
used as drops for the eye. The doctor told the patient 
orally that he was to follow this by an immediate washing 
with normal salt solution—this very important part of the 
needful directions was intrusted to his patients memory— 
the memory was defective in this instance, and as a result 
the patient lost his eye, the doctor lost the patronage of an 
influential family, a suit for two thousand dollars was 
instituted, and the patient recovered this amount from 
the absent-minded and negligent doctor. His directions 
should have been, so many drops in the eye, followed by 
salt solution. The four additional words could have been 
written and would have saved the doctor five hundred 
dollars a word. This is only a part of what it cost this 
physician. 
Write out your directions for your patients in full. 
It is a dangerous practice to depend on the memory of 
your patients to cover your own negligence. They may 
be just as lazy in mind as you are in body. Do more than 
merely write them out. Write them out so clearly that 
the least intelligent of them cannot make an error that can 
be chargeable to your own neglect. The directions to 
take medicines should unfailingly state how much the 
patient should take, how often, in what manner he is to 
take it, and many times it is wise to add the time for which THE PHYSICIAN AND PHARMACIST 
191 
you expect him to continue. One cannot write on the 
prescription in each case what the medicine is intended to 
do or the effect one expects to get from its use, but even 
these things should be supplied when there is any possi- 
bility of the medicine being taken over too long a time. 
Many a patient has become a drug addict because of this 
failure on the doctor’s part. Let your directions be so 
clear and explicit that they will stand of themselves and 
not need to have their deficiencies supplied by someone’s 
memory or imagination. 
When you write a prescription for expensive drugs, 
give the smallest amount you believe the patient will 
require and let him know that it is costly. He will 
want to know how much it will cost, and your invariable 
answer should be, “I do not know the cost price of drugs; 
moreover, the prices are changing daily, and it is quite 
impossible for me to follow them.” Under no circum- 
stances put a price on drugs for a patient. You will have 
quite all you can do to determine your own fees and 
collect the same, and should allow the druggist to do 
the same. It would not please you to learn from a patient 
that the druggist had told him that the fee you charged 
was exorbitant, and the druggist is made no happier to be 
informed by a patient that you told him the cost for the 
drugs was too great. You stick to medicine and let him 
handle his drugs. 
Don’t assume an air of wounded dignity when 
the druggist calls you on the phone and wants to know 
what some of your “hen tracks” on a paper stand for. 
Instead of assuming this attitude, thank him for the care 
he has taken and apologize for your poor efforts at writing. 
The druggist is doing you a favor. He is trying to 
protect you. The law does not compel him to call you at 192 
THE SUCCESSFUL PHYSICIAN 
all. If your writing is not perfectly plain, you are the one 
placed in jeopardy by the mistake—not him. Thank 
the man and apologize for putting him to so much trouble. 
Know your narcotic laws. A prescription containing 
a narcotic must be written correctly. The druggist has 
no option except to refuse to fill one of any other kind. 
Make his work as easy as it lies in your power to do by 
having your prescription written correctly. 
Do not give physicians’ drug samples to your patient. 
If the samples do the work, you lose your patient and such 
friends as he may have. The need of coming to see you 
for his ailment exists no longer, since he has now found a 
cure for his ailment, and the same applies to his friends. 
If the medicine does not work, he will feel that you slighted 
him by working off some old samples on him, instead of 
giving him the attention he should have received. You 
injure both yourself and the druggist and it is doubtful if 
you will do the patient any good. 
If you want to try out some new remedy, be sure that 
your druggist has it in stock. Often these new remedies 
are not even in the local market or wholesale drug houses. 
If your case is urgent, you properly ask for a hurried 
delivery of the medicine. Should you call for capsules or 
pills, have a few sent out, for it takes time to make them 
up and the ordinary pharmacist cannot keep a special 
delivery service all the time. 
The writing of a good prescription is an art. It is 
also a difficult undertaking if you are distracted by 
patients who insist on continuing the conversation with 
you while you are writing. When you start to write a 
prescription, concentrate your mind on the task and allow 
nothing to interrupt you. When the prescription is 
finished, look it over carefully to see that no essential THE PHYSICIAN AND PHARMACIST 
193 
has been omitted and that the quantities are correct. 
Careful consideration should be given to the form of the 
medicine—whether the patient can take it best in liquid 
or in solid form. Many adults are like children in this 
respect, and are unable to take any form of pill, whereas 
others can take nothing else. It is right and proper that 
these personal peculiarities should be catered to in every 
way possible. You will make many friends and find the 
way easier for you if you make special effort to have your 
medicines given in the form of a pleasant-tasting mixture. 
Here again your druggist can be of great assistance to 
you by advising additions that will disguise the taste of 
nauseous drugs. When you have a very serious case on 
hand that you know to be in a critical condition, super- 
vise the matter of where the prescription is to be taken. 
Assure yourself that it goes to a first-class druggist on 
whom you may depend for the quality of the drug 
prescribed. 
It is proper for you to secure drugs for your personal 
and family’s use without cost from your regular druggist 
because of your assistance to him, but do not accept 
commissions in any form. 
Have your own prescription blanks and advertise 
only yourself. 
A most important addition to all the prescriptions 
you write for external use is to have them so labeled. 
The Relation of Physician to Nurse from the 
Physician’s Standpoint 
General Demeanor Toward Nurses.—Some physicians 
adopt an attitude toward student and other nurses in a 
hospital that is not to their advantage. They either 
ignore them or make it appear that their position and 194 
THE SUCCESSFUL PHYSICIAN 
learning are superior to the nurse’s. This may be true, 
but it does not excuse their behavior and nurses resent it. 
They know their position and deficiencies. These 
are called to their attention so often by other nurses 
that it is unnecessary for you to add to their burdens. 
They are not in a position to protest to you, but they can 
and do resent slurs. They also let you feel their dis- 
pleasure by making disparaging remarks about you to 
your patients. You may or may not hear of these 
remarks, but they will reach the ears of your patients in 
some manner and not add luster to your fame. The 
memory of a slight will linger in nurses’ minds long 
after graduation and they will hold it against you. There 
is only one method of treating them and that is to be kind 
and courteous to them all. Speak to them as you pass 
them in the course of your visits from floor to floor. 
They do not appreciate being treated like an inanimate 
object any more than you would. When they have 
performed some service for you, see that they receive 
your thanks. Do not take their assistance as a matter 
of course. They are compelled to do the assisting and it 
is certain that it will be better and more efficiently done; 
moreover, if you recognize their work they will do more 
for you the next time you need their help. It is not 
sufficient for you to be just civil to them—you should 
be friendly as well. Conduct yourself so that you will 
make friends of them, for they can be of great help to you 
or do you much harm. This is not accomplished by 
being either intimate or coldly reserved. New men in the 
wards and elsewhere have observed how some “big one” 
will do certain things to the contrary and the young man 
often tries and instead of making an impression he earns 
the contempt of those who have watched him. THE PHYSICIAN AND NURSE 
195 
The student nurse, floor superintendent, superintend- 
ent and graduates will respond to the same actions that 
will cause others to like or dislike you. Take a friendly 
interest in them and their affairs as well as in their pro- 
gress. 
Probably no single action of yours is more liable 
to arouse the nurse’s wrath than for you to storm and 
rave around demanding attention when the floor nurses 
are otherwise engaged. Many physicians of good 
reputation do this. Some who do not have an extensive 
practice try to do the same. All that either of them get 
from such actions is dislike. There are doctors who have 
such an idea of their own importance that they begin 
ringing the bell the minute they arrive on the floor and 
expect instant attention. It does not appear to make 
any difference whether or not the nurse is engaged else- 
where—they act as if they expected them to drop every- 
thing and attend to them. 
Another example of this demand for personal attention 
is the man who rushes into a ward in a manner intended to 
give the impression that he is hours behind in making his 
calls and for this reason must have immediate attention— 
his case on that floor being merely an interruption in his 
strenuous flight from place to place. This is often 
done solely for show and because he wishes preference 
over all others. 
It is right and proper for you to expect and to insist 
upon receiving attention in your turn—not otherwise— 
and to demand that you receive the deference to which 
your position entitles you. But a physician of the right 
sort does not attempt this at the expense of a colleague, 
or for the more trivial reason—his personal whim. It 
is your obvious duty to show the same consideration to 196 
THE SUCCESSFUL PHYSICIAN 
nurses and others as you have a right to demand for 
yourself. 
Another cause for bitter complaint, and rightfully so, 
is for some trifling thing to happen in the operating room 
and the doctor fly into a rage, sometimes using profane 
language to the nurse. Even if the nurse is to blame for 
the incident, there is no excuse for such a display of 
temper. One prominent surgeon requested a sharp 
scalpel. He was handed an instrument that was improp- 
erly prepared by the mechanic. He made one stroke, 
the edge turned, and the doctor threw the knife violently 
to the floor, swore at the nurse and at all who had any- 
thing to do with the instrument. He so humiliated the 
nurse and used such profane language that the nurse has 
never forgiven him to this day—some ten years after the 
incident. This explosion of temper cost that doctor many 
a patient that this nurse might have sent him. 
Physicians often do not give their orders clearly enough 
so that others may thoroughly understand them. This 
accounts for many of the mistakes of nurses in the opera- 
ting room. Perhaps the things prepared for any operation 
are not just as the doctor would have them. This hap- 
pens too often to be looked on altogether as an oversight of 
the nurse. She is no more a mind reader than is the doctor. 
If he has some particular instrument that he wants to 
use for an operation, it is his business to write out this 
order and hand it to the nurse. If some new operation, 
or some unusual mode of doing an old operation, may be 
contemplated, one that is not the routine method in this 
hospital, it becomes the duty of the doctor to write out 
the names of the things he may require and some of the 
departures he will make from the routine. Such a list 
should never be left to the nurse’s memory alone. She is THE PHYSICIAN AND NURSE 
197 
no more likely to get things right the first time she hears 
them than the doctor would be to have some one give 
him a long talk about something in which he has only a 
passing interest. 
The Graduate Nurse in Private and Hospital 
Practice 
In the larger cities it is an excellent practice to keep a 
list of nurses whom experience has shown to be adapted 
to your line of work and who can please the particular 
patient who has need of their services. 
It is not to be expected that all nurses will be found 
agreeable to all patients. It is quite as much to your 
interest to select the nurse for your patient as it is to 
choose the medicine you are to prescribe. Nurses can not 
be expected to please all patients any more than you 
have found it possible to please them all. Some nurses, 
like some doctors, have a happy faculty of getting along 
with almost any one. It does not appear to matter 
whether a patient is grouchy, agreeable, prudish or liberal, 
it is all the same to this sort of nurse. But such a person 
is seldom found, and it is for this reason that one will need 
a list of nurses from which to choose, so that the relations 
of the nurse and patient may be harmonious. I have 
often sent to alcoholic cases nurses who were shocked at 
the language or things the patient might say or do. They 
would be on the case for a day and ask to be relieved, 
whereas the next nurse would have no trouble with the 
same patient. 
It has been a not unusual happening to have a chronic 
invalid tell me that his nurse knew nothing about nursing, 
when my personal knowledge of her work was to the 
contrary. This attitude of a patient is brought about 198 
THE SUCCESSFUL PHYSICIAN 
by the nurse’s failure to humor the patient properly. 
He belongs to the class that needed coaxing instead of 
being commanded. 
Another capable nurse “talked herself” out of her 
position. The patient was nervous and irritable. The 
nurse persisted in telling the patient her own history and 
troubles. This so irritated the patient that she had to 
be displaced for one who was not so talkative. 
There is also the working nurse, who writes so little 
that you are unable to learn the condition of your patient 
or what has happened since your last call. Of those 
who write everything and those who write too little, 
the one who puts down the least is more likely to please 
than the one who writes too extensively. A well-placed 
suggestion to the real worker is often all one need do to 
remedy the matter. Often the writing nurse had best be 
removed from your list. Suggestions may tend to alter 
their ways, but it will not teach them to understand the 
wants of patients without being told. 
There is the visiting nurse who is just passing through 
your city. She usually wants to work only on easy cases 
and is not particular how she treats your patient so long 
as she is paid for her services. They are like other birds 
of passage—working only long enough to earn sufficient 
to take them to their next objective. Some few of 
these are capable workers—most of them are not. Many 
of them leave a case half way for one more to their liking, 
or give notice and move on to some other city. One of 
these nurses was on a case of what was diagnosed as 
exhaustion. The patient caught a cold, pneumonia 
developed, and the nurse became tired at once and 
requested a relief. She never reappeared to finish the 
case. Another spoke to the patient of her salary after THE PHYSICIAN AND NURSE 
199 
the first day. Another came on the case late in the 
afternoon and called me to find out who was to take the 
night shift. It is my experience that only those nurses 
who live in your city and who have some standing and a 
personal reputation to maintain are reliable and to be 
depended upon. 
It will often happen that you will exhaust the names on 
your list of capable nurses and be unable to secure one. 
An hour is often consumed in such a hunt. This makes 
it desirable to have recourse to the nursing directories to 
supply one for your needs. Select those that have the 
regular graduates on their list. The “practical” nurses 
are often capable women up to a certain point, but when 
placed on a case that takes a sudden turn for the worse, 
they are. unable to handle it. This makes it appear that 
you did not get the right nurse for the patient and when 
your patient finds out she is not a regular nurse, you may 
be censured for something the nurse should have done. 
It comes to this—you should not only be careful in the 
choice of your nurses, but you must also watch them after 
they are on the case. Supervise everything they are 
supposed to do, or, something that should be done is 
sure to be left undone and you may get the blame for 
the mistake or oversight. 
Besides making your own observations it is good policy 
to use tact and learn from the patient just how he feels 
about what is being done for him by the nurse. You will 
find that it is quite as much to your interest to watch the 
nurse as it is to watch your patient. 
A nurse must not be kept on a certain case for too long 
a time. The patient may have liked the nurse when 
she first came, but after long association a change may 
take place. The nurse may grow tired of the patient, 200 
THE SUCCESSFUL PHYSICIAN 
or the patient of the nurse, or some other trivial thing 
may turn up that will make it to the best interest of all 
to make a change. In old chronic cases in hospitals this 
is not so essential, or so liable to happen, as it is in the 
home, but it may happen in either place. To give the 
patient the best chance for recovery and for your own 
interest it is best to change your nurses on the long cases 
where there is the least evidence that this is desirable. 
If you do not, the patient is very likely to make a change 
on his own accord, perhaps of doctor, nurse and hospital. 
It is a duty you owe to yourself and to your patient to 
know just how things are going with patient and nurse. 
With this idea in mind it is often well to spend some time 
alone with each patient to ascertain for yourself if every- 
thing is going satisfactorily. 
One prominent gynecologist makes it a rule to ask 
the patient if everything is all right—if she is getting all 
she wishes or if there is anything further that she would 
like to have. This gives the patient the opportunity to 
tell the doctor what is on her mind and permits him to 
correct any error that may have been made before it 
progresses too far. 
When oversights on the nurse’s part have been made, 
it is usually best to make your complaints to the nurse 
alone. This does not humiliate her in the eyes of the 
patient and may also prevent you from being blamed by 
the patient for whatever error has been made. Instances 
will arise when it is best to do this correcting in the 
presence of the patient. This will be in those cases where 
the patient must know that some certain thing has 
been done without your order, and the possible failure 
of the patient thoroughly to understand this might bring 
blame on you personally. THE PHYSICIAN AND NURSE 
201 
More than merely blame often accrues in these 
instances—suits for damages are frequently instituted 
once the patient gets the idea that you are in any way 
responsible. The best way to avoid these undesirable 
happenings is to give your orders for the patient’s care 
in some detail. It is an error to give your orders orally. 
They should be written on the chart in such a manner 
that their meaning is clear and the directions are explicit. 
All possible contingencies cannot be covered in these 
orders, nor is it expected that they will be. Only the 
usual or common things can thus be met. Some discre- 
tion must rest with the nurse. The obvious things, 
however, are expected to be considered by you, and ade- 
quate provision be made to care for the patient. If you 
give these orders orally, do not blame any one but yourself 
if some needed matter is overlooked or your medicines 
are forgotten altogether. 
No matter how competent a nurse may be, it is a 
mistake to assume that she is capable of applying a 
surgical dressing as well as you or one as satisfactory to 
the patient. Patients will be better satisfied to have you 
do the major part of their dressings or at least inspect the 
wound and supervise the dressing. If patients require 
more than one dressing daily and you are not in a position 
to give it individual attention, it is proper to have your 
nurse attend to it. Full particulars of the way in which 
this should be done should be left in each instance, 
remembering that the patient looks to you and holds you 
responsible. 
The more information you can secure from your nurse 
about your patient, regarding either sickness or surround- 
ing details, the better. On the other hand, the less the 
nurse knows about the arrangements that exist between 202 
THE SUCCESSFUL PHYSICIAN 
yourself and the patient the better. Do not discuss the 
intimate details of the family with a nurse, for they do 
not concern her in the management of the case in hand. 
The reasons for these observations are not far to seek. 
Nurses are not bound by the same rules of confidential 
communications that apply to you, and moreover the less 
the nurse knows of the surrounding conditions, the less 
will she be able to say if it should become necessary to 
displace her by another. 
The capable nurse is a most valued friend, and by the 
same token she can become a most inconvenient enemy. 
A consistent effort should be made, while treating the 
patient, to create the belief in the mind of the nurse 
that you are the sort of doctor she herself would select 
if she needed attention. Putting a nurse on a case then 
offers another opportunity to demonstrate your fitness to 
practise and to add to the list of friends one who may be 
of great professional benefit to you. This applies to 
nearly all nurses, but most particularly to the elderly 
nurse who has an extensive acquaintance among doctors 
and patients in the community. To make a good impres- 
sion on her is quite as much to your benefit as it is to 
please the patient. To have impressed her favorably 
will make of her a constant assistant to increase your 
reputation. She can spread your name more rapidly 
and successfully than almost any other person. Nurses 
generally know physicians more intimately than anybody 
else does—they see their good and poor qualities—they 
see them at their best and at their worst—and often see a 
side of the doctor that is hid from the public. 
It is very common for the nurse to become more 
intimately acquainted than the doctor with the patient. 
To antagonize the nurse or fail to make her your friend THE PHYSICIAN AND THE NURSE 
203 
is to have someone whose influence with the patient may 
alter his opinion of you at will. 
An experienced nurse can be of assistance to a young 
physician in making suggestions for the treatment of 
obscure diseases and for making patients more readily 
resigned to their condition. The physician need not 
appear to depend on these suggestions, but it is a mistake 
to regard the matter in such a way that a nurse will 
hesitate to mention some important new development. 
The nurse can take better care of a patient when she 
knows what has been done at an operation than if she is 
told nothing about it. In the latter case the nurse often 
fears to do things for the patient’s comfort that she 
would not hesitate to do if she knew all the details. 
Intelligent cooperation cannot be expected unless she has 
this information. This appears too obvious a fact to 
need mention, yet many physicians fail to profit by it. 
One poor fellow believed he must he flat on his back after 
an exploratory operation, and the nurse knew no better, 
for she was told nothing as to what had been done. She 
was simply told what medicines to give and nothing about 
the care of the patient. This went on for three days 
before the error was discovered. 
Another patient with gall-stone colic was given 
morphin at stated intervals for relief. Nothing was said 
to the nurse about stopping the administration after the 
pain was relieved—and the man is sleeping yet. 
Compliment your nurses on their management on 
every occasion where this is deserved. She is just as 
proud of her ability as a nurse as your are of a successful 
operation or at making a clever diagnosis. Nothing will 
cause a nurse to put forth the maximum of effort for you 
and for the patient as well-deserved commendation. 204 
THE SUCCESSFUL PHYSICIAN 
Certainly nothing is so disheartening, and causes such 
loss of interest, as to have all their hard work go unnoticed. 
Be generous and liberal in your praise of the conscientious 
efforts of your nurse and she will feel grateful to you and 
become your devoted ally. 
When an examination is to be made or dressing done, 
in the home or the hospital, place your order for the 
required articles in the nurse’s hands in time for 
them to be assembled and ready. This will save you 
many moments, and obviate scurrying around for the 
necessary articles. If unexpected contingencies necessi- 
tate that other instruments be brought, do not fly into a 
temper and blame the nurse for something about which 
you had given her no information. A certain doctor was 
to do a dressing on a patient on whom he had operated 
for hemorrhoids and there was a little bleeding. He 
asked for only a needle-holder and suture to make 
this repair. Before he had finished a severe hemor- 
rhage occurred and the entire department was in a 
state of excitement by his outbreaks, and most of the 
operating-room instruments and all the help in this room 
were called into service. 
Physicians and Patients 
One Patient's Point of View.—Let me give in her own 
words the point of view of one of my patients: “ 1. The 
thing that has appealed to me most in a doctor was his 
rapidity in answering my calls. Nothing is more wearing 
to a patient than ‘waiting for a doctor to come.’ Many 
doctors fail to take into consideration that most people 
wait till the last moment before calling him in and then 
minutes seem hours. Of course no one can expect a 
physician to drop everything else and rush to that particu- PHYSICIANS AND PATIENTS 
205 
lar ‘case,’ but surely no physician has an excuse for coming 
24 hours after he is called, and yet they do it. Did they 
but know what the patient—and family—thought, physi- 
cians would make a practice of making the call as soon as 
possible. 
“2. Telling a patient the truth regarding ailments and 
operations. If you don’t intend to operate, don’t keep 
one buoyed up from week to week, month to month. 
Be strong enough to come out with the truth. If the 
patient is not strong enough to be told the truth, surely 
some one close to him should be told and then the patient 
can be informed gradually 
“3. A genuine cheerfulness of manner has a great 
effect on a patient—not just that professional boisterous, 
‘My, this wonderful day!’ and ‘How our dear girl is look- 
ing!’ ‘Why, we can’t be ill,’ and other expressions lacking 
sincerity, but there is a happy medium. 
“4. Non-discussion of patient’s ailments and idiosyn- 
crasies with friends or even relatives. No physician 
should allow himself to be questioned closely about 
patients. He should turn a deaf ear to every one desiring 
information that should not be granted. (I think this 
should go so far as even to exclude the ailments from 
either husband or wife, if in the physician’s judgment, 
trouble would result from such knowledge.) 
“5. A physician should have an intimate knowledge of 
his patients’ ailments and what he has done for them. 
Nothing is more irritating to a patient than to have a 
doctor ‘feel around’ as it were, trusting to get a lead from 
the patient, he has previously treated, about any phase of 
the treatment or the disease. It surely is very easy to 
keep a card index or other system, and two minutes will 
suffice to put the doctor in touch with his patient, even 206 
THE SUCCESSFUL PHYSICIAN 
to the prescription he has given this particular patient— 
but how many physicians do this? Unless a patient’s 
ailments have become ‘moss grown’ the doctor cannot be 
expected to carry everyone’s sickness in his mind. 
“6. Bills. A physician should make a practice of 
sending his accounts the first of every month, the same 
as butcher, baker, and candlestick maker. (However, I 
don’t think in our stirring times doctors err as much in 
this regard as they formerly did.) This particular patient 
has had doctors who seemed to take pride in ‘never 
sending out bills,’ ‘paying no attention to such matters,’ 
and I have always found that these same gentlemen, 
when a bill was finally forced from them, never neglected 
to charge for every visit to these cases where they were 
passing the house and ‘just ran in to say “ Good evening, 
and how is the family?”’ For my part I can’t see why 
a physician shouldn’t call on his regular patients now and 
then—a little social call—showing that he bears them in 
mind—and not make a charge, but such gentlemen doctors 
are few and far between. 
“ 7. Nurses. Doctors don’t believe everything a nurse 
reports or ‘charts.’ Some nurses work best on a chart, 
and they are utterly unscrupulous in what they put down, 
and if the doctor does not go into the matter with the 
patient, considerable harm may result. Get both sides 
of the story. For instance, in one of my numerous ill- 
nesses I had a trained nurse on 24-hour duty. I liked 
her very much, and in all the time I had her I never called 
her at night. Her sleeping room adjoined mine, with 
folding doors between. Every night these doors were 
tightly closed and heavy portieres drawn over them. 
After this nurse’s departure one day I happened to glance 
over her ‘charts’ and I beheld ‘Patient up and stamping PHYSICIANS AND PATIENTS 
207 
up and down room, muttering to self—on the rampage all 
night, and practically no sleep for self (nurse); very diffi- 
cult to soothe patient, etc.’ Unfortunately, the nurse had 
selected a very poor night for this report, as I had pre- 
sented her with two tickets to a very important show 
and she had not returned until 1:30—evidently had a very 
gay time and after retiring had slept like one dead. (I 
doubt if an earthquake would have aroused her.) She 
arose the next morning between 9:30 and 10. Had the 
physician in attendance mentioned anything of the 
matter to me, the whole thing would have come to light, 
and my ‘grateful’ nurse immediately discharged. As it 
was, I didn’t see the ‘charts’ until a couple of months 
after, and only the theatre tickets fixed the date. 
“Another nurse when she knew that she had just 
about reached the limits of my patience, would have the 
floor nurse knock at my door. This knock advised her 
that my doctor was in the building and would be up 
shortly. Then my nurse would meet him in the hall and 
report to him, usually, that I was asleep and he would pass 
on (and any little disturbance pass over). Notation on 
chart—‘Patient asleep—Dr. called.’ To this, however, I 
caught on, and at a particularly flagrant overstepping 
on the nurse’s part, which occurred at 11 A. M., the nurse 
trying to force the patient to do something the nurse 
wanted done and refusing to give a narcotic which had 
been ordered by the doctor. The need of this narcotic 
was occasioned by an extensive sloughing wound of the 
abdomen which was followed by general peritonitis, 
causing severe colicky pains, running over a period of three 
weeks. 
“The doctor came in, gave me one look and said— 
‘What is the matter?’ I explained, and the nurse also 208 
THE SUCCESSFUL PHYSICIAN 
tried to say something, but he waived her aside. He had 
given no such orders and then he asked the nurse for an 
explanation. 
“ I could cite instance after instance, so it behooves the 
physician not to believe the nurse too implicitly. 
“Furthermore, in operative cases watch the handling 
of your sterile dressings, and particularly how they are 
handled by your patient’s own nurse. 
“For instance, in one of my many operations the sur- 
geon who had my case was so particular he did all his own 
dressings. Despite all his precaution, I was infected. 
“At that time I was not ‘up’ on operations, hospitals, 
nurses, etc., as I have since become, and how that doctor 
would have raved had he known that his ‘A-l’ nurse 
would take the bag of ‘sterile’ bandages, sponges and 
what-not and open every package and paw through 
them, forgetting where this size was and was there 
such a sponge in this roll?’ and over them she would go 
until she would have the bed partly covered with pads of 
all sizes and shapes. When she had it fixed in her mind 
where they were she would roll them all back in their little 
covers, and when the doctor appeared calling for sterile 
towels all around the wound, and picking up each pad and 
sponge with tongs that had been dipped in alcohol, 
what a farce it was and he doing his very best! To this 
day he doesn’t know what his graduate nurse, 15 or 17 
years at nursing, was doing to his patient, and why he had 
to use Carrel and Dakin solution on that case. 
“Change your nurses frequently. My observation 
has led me to believe that in a private home six weeks 
is as long as a nurse should remain on a case. I myself 
would not keep a nurse so long. In the hospital it is 
not so bad, but if a “change of pasture is good,” a change PHYSICIANS AND PATIENTS 
209 
of nurses is better. The first and second weeks they 
are interested and they do everything possible for the 
patient’s comfort; the third week they become indifferent, 
and from the fourth or fifth on they become unbearable. 
“And so it goes—watch your nurses as much as you 
watch your patients—and sometimes, I think, watch 
them more.” CHAPTER XI 
THE PHYSICIAN AND THE LAW 
How to Avoid a Malpractice Suit 
This question, to our minds, permits of no answer. 
If a patient is disgruntled and determined, nothing 
will dissuade him from his purpose, and even though 
his claim is not founded on reason or fact, it is an easy 
matter to retain an unscrupulous attorney to present the 
case to the court. One of the greatest safeguards for 
the practising physician is to carry malpractice insurance. 
The Doctor's Duty to His Patient.—The physician is 
never compelled to accept employment, but having once 
undertaken the treatment of a case, he is bound to con- 
tinue with it until he is dismissed, or until, by the exercise 
of his sound judgment, his services are no longer required. 
Should the physician desire to leave the case, he must give 
his patient notice and afford him an opportunity to engage 
another doctor, and if the patient leaves the selection of 
his successor to the doctor, he must select a physician of 
reasonable capabilities. 
* If he is to perform any surgical work, it is imperative 
that he have the patient’s consent and it is well to have 
witnesses present when this is obtained. If the operation 
is to be a major one, a written consent to such operative 
procedure or to “everything which the surgeon finds 
necessary” should be signed by the patient. If the 
patient is a minor, it should be signed by the parents, 
or if the patient does not understand the language of 
210 THE PHYSICIAN AND THE LAW 
211 
the surgeon, the consent should not only be signed by 
the patient, but by the interpreter, who should make a 
statement that he has read the paper to the patient and 
that the other understands it. 
If a consent to operation specifies a particular thing, 
and after the operation is begun the surgeon finds an 
additional graver condition, he is not, under the law, at 
liberty to operate upon the newly discovered lesion, 
but must confine himself to the particular operation con- 
sented to by the patient. What has been said relative to 
operations applies also to postmortems and autopsies. 
The insanity inquest is slightly different, as the mode 
of holding such inquisition is usually regulated by State 
statute, which the physician should fully understand. 
There should be no collusion between the inquisitor and 
the relatives, nor should the physician diverge in any way 
in his professional conduct. It goes without saying that 
the physician should never sign a questionable certificate 
of any kind or character, be it a death certificate, a birth 
certificate, a health certificate, or other paper. 
In general we might sum up the conduct of the phy- 
sician as follows: 
First he must be a gentleman, and must act cautiously 
and honestly. He must give to his patient the full benefit 
of his learning and experience, exercising the highest 
measure of that care and skill of which he may be pos- 
sessed. Having done this, he has discharged his full duty. 
A further suggestion should be made as to his relations 
toward other physicians, surgeons, dentists or hospitals. 
He should at no time be overcritical of, nor should he 
ever express an opinion on, the conduct of a colleague. 
That is to say, he should not wantonly condemn a fellow 
practitioner’s mode or method of treatment in any given 212 
THE SUCCESSFUL PHYSICIAN 
case. A malpractice case could never be sustained in 
court if physicians refused to testify. If the case is 
flagrant, the profession should array itself to condemn 
and exclude from their midst, an unworthy brother, but 
for mere petty grievances they should not seize upon 
slight opportunities to avenge themselves, through the 
medium of a malpractice suit, upon another disciple 
of Hippocrates. 
This last suggestion is more psychological or humane 
than we have any conception of. In almost every field of 
human endeavor he that is first must perpetually five in 
the white fight of publicity; whether that leadership be 
vested in a man or in a manufactured product, simulation 
and envy are ever at work. This is especially true in 
medicine. When a man’s work sets a standard for the 
whole world, it also becomes a target for the shafts of the 
envious few. If his work is merely mediocre, he will not 
be molested; but if he becomes eminent in the science of 
medicine or surgery, he is usually made the subject of 
gossiping tongues. No jealousy annoys the obscure 
physician who has attained no prominence or fame. 
Among the profession there may be found a form of 
selfish interest, and a leader of the profession is sometimes 
assailed merely because he is a leader. When a practi- 
tioner fails to equal or surpass another doctor who may 
have risen to prominence, the leader is usually assailed 
and the former seeks to underrate or to destroy the 
latter’s reputation. It is just this spirit that is the moving 
factor in malpractice litigation. It is nothing more than 
a wrangle between members of the profession and never 
serves to elevate the practice of medicine to higher 
standards, but brings the profession and practice itself 
into disrepute. THE PHYSICIAN AND THE LAW 
213 
Importance of Insurance.—To return to our sugges- 
tion that the practitioner should carry malpractice 
insurance. This statement is born of experience. The 
physician is ever subject to the peril of malpractice litiga- 
tion. The defense of such an action, regardless of its 
merits, means the expenditure of time, labor and money. 
Even if the defense is successful, there is usually a financial 
loss. If unsuccessful, the amount of the judgment must 
be added to the initial loss. Judgment in favor of a 
defendant always leaves him a loser, because only a part 
of the actual expense of litigation is taxable as costs 
against the plaintiff, and about 75 per cent of malpractice 
plaintiffs are usually of the insolvent type and are com- 
monly called “ judgment-proof.” In any case the practi- 
tioner who is a defendant in a malpractice suit is a loser 
at the end, unless he is protected by adequately written 
insurance. To the physician this protection is just as 
essential as is an insurance policy upon his home or his 
life. 
How to Prepare for One's Defense.—The physician 
should first review with those whom he anticipates using 
as experts, the patient’s history, the diagnosis and the 
treatment rendered. The patient’s history should be 
carefully written down by the physician. Every fact, 
conversation, statement and circumstance should be given 
in full detail. This statement should then be carefully 
reviewed; it should contain every detail of the essential 
facts as disclosed by records, memory, witnesses or other 
corroborative circumstances, and this material should be 
carried with him into court. He should put into the 
hands of the attorney defending him all the available 
standard medical authorities that substantiate his method 
of treatment. 214 
THE SUCCESSFUL PHYSICIAN 
If any particular authority disagrees or condemns his 
treatment, he should explain to his attorney wherein the 
statement of the medical book is not in accordance with 
the general practice on the subject. He should dis- 
criminate keenly between his treatment and the state- 
ment. The defendant and his experts must be thoroughly 
grounded in the medical aspect of the case. The anatomy 
of the parts under consideration should be thoroughly 
known to all the physicians, so that a capable attorney 
could not embarrass the expert when he appears as a 
witness. 
If nerves, muscles or the like are involved, the origin, 
point of distribution, function, whether motor or sen- 
sory, etc., should be known, and all the experts should be 
able to trace the origin and exits of these particular 
structures. If a bad result was obtained in any given case 
and this is attributed to the defendant’s manner of 
treating the patient, a good explanation should be given 
why the result was not good. The defendant’s attorney 
should be thoroughly grounded in the anatomy and 
treatment, should be abreast of what the authorities say 
on the subject, and in short should know as much about 
the case and its treatment as any physician who is to 
appear at the trial. 
Essentials of an Expert.—In order to qualify him to 
testify, the essentials of an expert are first that he be a 
graduate, that he be licensed to practise, that he be 
familiar with the case, the medical treatment and sur- 
gery, etc., under consideration, that he be acquainted with 
the care and skill ordinarily required and exercised in the 
profession in the community where he is to testify, and 
that his statements be the result of experience rather 
than theoretic knowledge gained from books. THE PHYSICIAN AND THE LAW 
215 
For your information we wish to state, that the great 
majority of malpractice cases grow out of the treatment of 
fractures, or out of operations, the use of X-rays or other 
electrical contrivances and hot-water bottle burns. 
The Physician in Court* 
The physician appears in court as a witness to testify 
to facts that have been brought to his knowledge by 
means of his senses. 
Hearsay evidence is not admissible, since the person 
quoted is not under oath, cannot be put under cross- 
examination, nor be brought before a jury to pass on his 
veracity. 
Exceptions are made in the case of dying declarations. 
For these to be admissible certain conditions must be 
present. These are: 
These statements must be made by a person who 
knows or believes he is about to die and makes the 
declaration under this belief. Death must be imminent 
in belief and in fact, and must have resulted without 
delay after the injury. 
At the time of making the declaration the dying person 
must have been competent and rational; he must refer 
to the circumstances of the injury and cover all the points 
to which he could testify. 
When a doctor appears as an ordinary witness, he 
should state all the facts in plain English. He should 
use qualifying words only very seldom, if at all. When it 
is not possible to state the facts without the use of medical 
terms, he should immediately follow these words with 
their equivalent in non-technical language. Too many 
* Excerpted by permission from “The Doctor In Court.” E. Valentine 
Mitchell. Rebman Company, New York, 1917. 216 
THE SUCCESSFUL PHYSICIAN 
doctors resort to the use of medical terms, and the court, 
attorneys, jurors, or other witnesses do not know what 
in reality is being stated. 
Attorneys seldom demand the whole truth. Ordi- 
narily they seek only such information as is beneficial to 
their case. It follows that there are times when one is not 
permitted to tell the whole truth. One should be very 
careful to see that the statements he is permitted to make 
carry the intended meaning. He should make few dog- 
matic assertions and be certain of his ability to sustain 
them. 
Expert Witnesses to Quality.—All experts must qualify 
as such before the court; their status is finally decided by 
the judge. No particular school is recognized in law. 
Each one is judged by the practices of the school to which 
he belongs. 
The endeavor is always made to show that the expert is 
a paid and therefore a prejudiced and interested witness. 
The paid expert will appear to better advantage if this 
question is raised by stating frankly by whom he is 
employed and how much he is to receive. In far too 
many instances the expert testimony, as it is now under- 
stood and practised, has little value. All the court hears 
is involved medical theories produced by one group of 
experts and equally numerous antagonistic theories from 
the other. A medical adviser to and officer of the court 
could help to clear the foggy atmosphere. 
Discrediting Testimony.—To discredit the physician or 
the effect of his testimony, two general methods are used: 
The direct and the indirect, or “Flank Attack.” 
The double question or the hypothetical question is the 
direct method of attack. 
1. What is the physician’s personal knowledge of the THE PHYSICIAN AND THE LAW 
217 
history of the case? Does he know all the symptoms? 
Did he personally take note of them at the time? How 
much of this knowledge is objective, how much subjective? 
2. How much science and skill has the physician gener- 
ally and specifically? How much has he learned by per- 
sonal experience with this particular sort of case? How 
much of this knowledge is only theoretic? 
3. How long has he been in practice and what variety 
and extent in this practice does he have? 
4. Some shrewd attorneys look up unusual medical 
terms and request the expert to define them. If he is 
unable properly to define a term or give a reasonably clear 
definition, the attorney will at once voice his grave doubt 
as to the capability of the expert as a physician with the 
intent that the Court shall form the same opinion. 
5. The invariable question of a casualty expert in 
damage cases is: 
“Is it not true that it is the natural tendency of the 
body to get well from injury or illness?” 
If this is answered in the affirmative, the natural 
assumption of the attorney will be that the case at issue 
will ultimately completely recover, and hence no perma- 
nent injury ensue, and the damages, if any, will in conse- 
quence be nominal. 
If answered in the negative, the physician must be pre- 
pared to sustain his contention by the citation of perti- 
nent facts in this case or in cases of similar nature quoted 
by the authorities. In other words, this is a double 
question—one that might at one time be answered by 
“yes;” and at other times “no.” 
Flank or Indirect Attack.—The flank attack or indi- 
rect method is the one most commonly used. A criminal 
attorney of national reputation, when asked what 218 
THE SUCCESSFUL PHYSICIAN 
medical books he used to secure material to confuse the 
doctors, said, “ I use no medical books. Why should I use 
his ammunition? In dueling etiquette the challenged 
party has the choice of weapons—my natural selection 
will not be medical topics, but legal points with which I am 
familiar.” 
His efforts may be said to be based largely on a per- 
sonal study of the physician he is to examine, and include 
such points as credibility, mannerisms, temper, person- 
ality, dogmatic statements. Each witness is given careful 
scrutiny to find a possible hole in his armour. The weak- 
est point is chosen and the attack centered upon it. 
This attorney almost invariable awaits the chance open- 
ing—some side issue that may disclose a vulnerable point 
of attack during the course of the trial; some subject upon 
which the attorney feels he is better prepared than the 
doctor; some point that is not confined to the medical field, 
such as: 
How accurate are the physician’s records of day, date 
and circumstances? 
The personality and temperament of the physician are 
given the minutest scrutiny as he takes the stand and 
answers the first few questions. His veracity is first 
considered. 
Is he dogmatic or uncertain; theoretic or practical; 
calm or quick tempered; careless or careful in his state- 
ments? Taking advantage of any weakness in the form 
of peculiar mannerisms or temperament, the attorney 
fights his case out in court and directs his strategy to meet 
the circumstances as they arise. He aims to bring out 
the physician’s personality and render it ridiculous, or 
seeks to prove that his dogmatic assertions are erroneous, 
explode the theory, fool the memory, irritate the temper, THE PHYSICIAN AND THE LAW 
219 
trick the witness into a rage, and thus secure injudicious, 
harmful, or discrediting statements. 
To Illustrate the Flank Attack.—A certain well-known 
alienist for a great State, with thirty years’ experience, 
was testifying as to the competence of an aged, eccentric 
millionaire recluse. The physician had been present each 
day of the trial, and had taken extensive notes as the case 
progressed. He sat far back in the court room. 
The verdict hung on the question of the memory and 
import of two documents, contradictory in character, 
alleged to have been signed by the recluse within a few 
days of each other. 
This hypothetical question was put to the physician: 
Assuming, but not admitting, the allegations in this 
case to be correct, would you say that this man, who had 
seriously charged his memory with the keeping of two 
important dates in his mind and failed, would be insane? 
The doctor replied with a positive “Yes, Sir,” and con- 
tinued:—“A man who would sign two documents as 
described mentioning dates from his notes, is positively 
insane.” 
“Then, doctor, any man who would make this error, 
or a similar grave mistake, would be insane?” To which 
the doctor again gave a very positive, “Yes, Sir, he would 
be insane.” 
“Then, doctor, You must he insane, for the documents 
were not signed on the dates you have given” retorted the 
attorney. 
The physician flew into a rage, stormed and shouted at 
the attorney, was laughed out of court, and the case was 
lost. The physician was not prepared for an attack on 
his ability to set things down as he heard them. 220 
THE SUCCESSFUL PHYSICIAN 
Temper Should Be Guarded.—An ordinary witness or an 
expert should never try to strike back at the questioner; 
he should keep his temper at all times, and be extremely 
careful of his statements to an apparently friendly exam- 
iner, for such a one is more liable to devise some clever 
scheme for trapping the witness than is the blusterer. If 
a doctor does not know the facts, he should take time 
to consult the authorities before making any statement. 
The use of notes by the witness is generally allowed, 
These must be correct and must have been made at the 
time in question or shortly afterward when the memory 
is active. These writings do not constitute evidence, but 
are very valuable. Accurate data should be kept as to 
patients under the physician’s care, particularly where 
casualties are concerned. Careful record of conditions 
should be made when examining a patient for a client, the 
notes on the case being kept and filed with the doctor’s 
own records. And finally he can correct errors in his 
testimony after the examinations have been completed. 
He can then make a short clear statement of the case as he 
understands it and give his version in such a way that 
others may be made to see his point. 
Contracts: (A) Express. (B) Implied.—A contract 
is an agreement, upon sufficient consideration, to do or 
not to do a particular thing—Blackstone. 
(A) An express contract is made in distinct and 
explicit language. 
(B) An implied contract is one not created or evi- 
denced by the explicit agreement of the parties, but 
inferred by law, as a matter of reason and justice, from 
their acts or conduct. 
For a Contract To Be Enforceable in Law.—For this 
the parties must be capable of contracting, their minds THE PHYSICIAN AND THE LAW 
221 
must meet, there must be mutual consent, no mistake 
or fraud, and a valid consideration. 
Infants cannot contract, except occasionally for such 
necessities as meat, drink, apparel, physician and drugs. 
The minor’s contract is voidable until he becomes of 
age, when he can, within a reasonable time, render the 
same void or not. 
For a man to claim to be a physician and surgeon, 
the law charges him absolutely with the duty of possessing 
the requisite knowledge. The patient has a right to 
assume this to be a fact. 
The Physician's Implied Contract.—He contracts, by 
implication, that he will use that degree of learning and 
skill for his employer which is ordinarily possessed by 
other members of the profession in localities not dissimilar 
from that in which he is practising. 
When Not Bound.—A physician is not hound by his 
contract (it being assumed that he uses due care, skill 
and diligence): 
1. To accept employment from any one. This is at 
his own discretion. 
2. To place the patient in as good condition as he was 
before the accident or illness. 
3. To have the highest skill, nor to be thoroughly 
educated. 
4. To effect a recovery in every case. No presump- 
tion of lack of skill follows such a failure. 
5. To know the peculiar idiosyncrasies of patients to 
anesthetics or drugs of any kind. 
6. To have the same skill as the specialist. 
7. To make the correct diagnosis, provided the 
treatment he used was that indicated by the diagnosis. 
8. The amount of care and skill is modified by the 
complaint. 222 
THE SUCCESSFUL PHYSICIAN 
9. To make no mistakes of judgment in difficult cases. 
10. To show infallibility of judgment. 
11. To continue services after he has been discharged 
by the patient or by some one in authority, even if harm 
comes to his patient. 
12. To insure the successful result of treatment or 
operation. The fact that a patient grows progressively 
worse under his care and shows improvement when he 
ceases his attentions does not tend to prove liability. 
When He Is Bound.—A physician is hound by his 
contract: 
1. To use due care, skill and diligence and to keep 
abreast of the best usage of the profession; he must 
progress with his profession and avail himself of new 
appliances and treatments that are commonly adopted 
and sanctioned by the profession. 
2. To give the patient his best efforts, whether or not 
paid or whether he is to be paid by a third party—the 
obligation is the same. 
3. He must use his best judgment in all doubtful cases. 
4. To use the remedies or appliances that reason or 
experience dictate as being best to aid the patient to- 
ward a speedy recovery. 
5. To follow in a given case the established custom of 
the profession in similar cases. 
6. To use no experiment on the patient unless this is 
clearly explained and used with the patients consent. 
7. To give the proper directions for the patient’s care 
to the nurse, so that she would do for the patient what 
the physician would do if he were present. 
8. Give the proper instructions to the patient as well 
as to the nurse. 
9. Exercise every ordinary precaution, after visiting THE PHYSICIAN AND THE LAW 
223 
contagious cases to prevent the spread of contagious 
diseases to others. 
10. To advise against an operation that, in his best 
judgment, is needless or injudicious, whether or not this 
opinion is sought from him. If he does perform a needless 
or injudicious operation, he is responsible. 
Contributory Negligence of the Patient.—(1) The patient 
must cooperate with the physician and follow his 
instructions. 
2. If an improper diagnosis is made because of this 
neglect on the part of the patient to give the proper 
information, the physician is not liable. 
3. The patient is bound to follow the physician’s treat- 
ment and orders, provided the treatment is the same as a 
surgeon of ordinary skill would adopt or sanction, but not 
otherwise. 
4. A physician is not liable for the negligence of 
hospital or other attendants over whom he has no control 
unless the relation of agent exists. 
5. If a patient either wilfully or negligently fails to 
follow the physician’s instructions, he is barred from 
recovering damages in court. 
6. The inability of a patient to follow the physician’s 
instructions does not alter the condition if the instructions 
were correct. 
7. If a patient is told to visit the physician again and 
does not do so, the physician cannot be held liable. 
Malpractice: (A) Civil. (B) Criminal.—If one fails to 
do anything which a reasonable man, under like circum- 
stances with regard to those things which ordinarily 
regulate the affairs of men would do; or if he does some- 
thing which a reasonable or prudent man would not do, he 
is then, in a legal sense, negligent. 224 
THE SUCCESSFUL PHYSICIAN 
One who engages to undertake the fulfilment of any 
duty or trust, or to perform certain acts, agrees to do it 
honestly and with skill and assiduity. 
Negligence may be by—(1) Omission, or (2) Com- 
mission. Errors of omission are treated less severely 
than are those of commission. 
Physicians could obviate most damage cases if they 
would warn patients of any unfavorable possibilities, 
expressly stipulating that in the event of their occurrence 
they would not be responsible. To make one’s position 
secure this should be a written notice, a copy of which 
should be handed to the patient and the original kept to 
be filed with the records of the case. It is always best, 
in fracture cases, to inform patients that a perfect result is 
by no means certain. The one factor most responsible 
for damage cases is the failure on the part of the patient 
to follow instructions. 
Excerpt of Decisions in Civil Malpractice.—(1) For a 
patient to be able to sustain an action of malpractice 
he must be able to show that his own conduct was blame- 
less and did not materially contribute to the production of 
the injuries. 
2. If a physician’s lack of care, etc., is combined with 
negligence on the part of the patient, action may be 
brought, but the patient’s negligence would, or might, 
mitigate the amount of damages. 
3. Negligence on the part of the patient must be the 
direct cause of the injury and inseparable from, and 
contemporaneous with, the negligence of the defendant, 
in order to be used as a successful defense in malpractice. 
4. If the patient is aware of the danger accompanying 
a certain undertaking, he is by law deemed to have 
assumed the risk, and cannot complain if injury result. THE PHYSICIAN AND THE LAW 
225 
5. If a physician tells a patient that he is not an 
expert in certain forms of injury or ailments, and the 
patient sees fit to hire him, he cannot hold the physician to 
account for his lack of knowledge and skill. This will 
not excuse the physician from exercising such skill, care 
and diligence, as he may possess. 
6. A person is chargeable with the natural and 
probable consequences of his acts. 
7. The principal is liable for the torts of his agent 
committed in the course of his employment. 
8. If a third party is negligent and no business con- 
nection or agency exists, the physician is not liable. 
9. Patient’s consent to an operation is presumed if 
the patient submits without objection. The burden of 
proof to the contrary is on the patient. This pre- 
sumption applies only to the operation agreed upon. 
10. Physicians are liable for infecting their patients 
with unclean instruments, and for mistakes of diagnosis, if 
ordinary care and skill are not shown; and for a mistaken 
diagnosis if the treatment is incorrect for the diagnosis 
that was made; also if they deceive patients by bringing 
any one into a sick room under false representations, and 
performing an operation without the consent of the 
patient. 
11. The first and greatest right in law is the inviolabil- 
ity of the patient’s person—that is, one’s right to 
himself. 
Patient the Final Arbiter.—(12) The patient must be 
the final arbiter, as to whether or not to take a chance 
with an operation. 
13. The consent, or implied consent, to an operation 
must be given; under some circumstances implied unless 
the patient is deceived. The consent of the interested 226 
THE SUCCESSFUL PHYSICIAN 
parties must be had to each operation, whether for the 
same disease or for a new condition. 
14. The husband cannot prevent the wife from under- 
going an operation if she so desires. He must be given an 
opportunity to express his wish in the matter unless 
circumstances prevent. 
15. In emergencies, cases requiring quick action, 
injured, intoxicated, irrational, unconscious, or unidenti- 
fied, and where no opportunity or means exist for obtain- 
ing consent and an operation is imperative, the physician 
is justified in performing the operation, if this is, in his 
best judgment, necessary. He must do everything to 
protect himself, and where it is possible and expedient, he 
should have a consultation in each instance. 
16. The burden of proof of an unnecessary operation 
rests on the patient. 
17. Many States require that actions for civil mal- 
practice be brought within a specified time. Generally no 
such action will be possible after a year or after the doctor 
has brought suit for his fee. 
18. During the course of a consented operation new 
conditions may suddenly develop; in this event a sur- 
geon can perform an operation without the consent of the 
patient if this is necessary and expedient. 
19. A mistake of diagnosis or an unnecessary opera- 
tion is not actionable if the proper means was used to 
arrive at the diagnosis and the evidence shows it to be a 
mistake of judgment only; if a reasonable doubt could 
exist of the nature of the ailment after exercising due 
care, etc. 
20. A physician cannot be held liable for adjudging a 
person insane if he has made a careful examination. He 
is liable if no such careful examination was made. THE PHYSICIAN AND THE LAW 
227 
21. A physician, acting on his best judgment in an 
emergency, with due care, etc., but not acting judiciously, 
is not liable. 
22. A physician is liable if he delays too long in an 
emergency if he knows the consequences of unnecessary 
delay. 
23. If capable physicians disagree after a consultation 
on a procedure, following and acting on the decision 
of either group are justifiable and not actionable. 
24. The law will presume, until it is proved otherwise, 
that care and skill were used, and the burden of proof is on 
the patient to show that the doctor was negligent and 
unskilful, except where, from the acts or the failure to 
act, the negligence can be presumed from the injurious 
results. 
25. Usually actions for malpractice do not continue 
after the death of either the patient or the accused. In a 
partnership the surviving member is chargeable with the 
malpractice acts of the other. 
26. A person may secure damages only once for one 
and the same action, and this judgment is conclusive for 
all the injuries, direct or indirect, growing out of unscienti- 
fic or negligent conduct of the physician. 
27. When a physician is accused of negligence alone, 
his skill and competency cannot be considered. 
The Decisions in Autopsies.—(1) No autopsy can be 
held without the consent of the interested relatives, 
except in cases of crime, by sanction of law, sudden death, 
suspicious circumstances, reasons of public policy. 
2. With the exceptions noted in No. 1, the relatives 
have a right to the body in the same condition that it was 
in when death supervened. 
3. Permission to perform an autopsy must be secured THE SUCCESSFUL PHYSICIAN 
228 
from the relatives in the order of the nearness of relation: 
(A) surviving husband or wife; (B) children; (C) parents 
of the deceased, and so on to the next of kin. The nearer 
the relationship, the stronger the right of consent. 
Representations of a Physician to His Patient.—(1) A 
patient has a right to rely on the representations of the 
doctor as to his ailment, its curability, and the ability 
of his physician to effect a promised cure or relief. 
2. For the patient to have actionable grounds the 
opinion must have been communicated to the patient 
directly or indirectly by the physician; the opinion must 
have been false or erroneous, and known to have been 
false, or promulgated under such circumstances as would 
indicate a complete disregard for the best interests of the 
patient. Or there must have been intent to deceive 
the patient, the latter being justified under the circum- 
stances in believing the doctor and in relying on his 
opinion. His conduct must have been controlled by it. 
3. The opinion must have materially influenced the 
conduct of the patient, and it must appear that, without 
the influence of this opinion, the patient’s conduct would 
have been different. It does not need to be shown that it 
was the sole inducement. 
4. The patient must have been damaged by this 
reliance upon the representations made. 
Law in the Matter of Fees and Their Amount.—(1) 
When a regularly licensed and graduate physician treats a 
patient, the law in the United States implies a promise to 
pay a reasonable fee for the services. 
2. There is a presumption that a physician has com- 
plied with the law. 
3. Unauthorized practitioners cannot collect for their 
services. THE PHYSICIAN AND THE LAW 
229 
4. A physician need not show that his services either 
cured or benefitted the patient; he can collect for his 
services even if he makes a mistake in the diagnosis of 
the ailment if he has used due care, etc. 
5. He cannot recover if he was intoxicated and unable 
to give the proper treatment. 
6. The customary fees of the locality in which one 
may practise may be used as a guide in determining the 
value of one’s services. 
7. A physician is permitted to show how much the 
patient implied he would pay for the services rendered. 
8. It is customary to grade the fee according to the 
wealth of the patient, but when called in to treat an uncon- 
scious patient, the ordinary fee will prevail unless sanc- 
tioned otherwise by the patient. 
9. The measure of the worth of one’s services to a 
patient is not by the benefit he receives, and there is no 
presumption in law with regard to such value. 
10. The value to be proved is the ordinary and reason- 
able value for such service. The opinion of an expert is 
permissible to determine this value. 
The Liability of Other Persons for Fees.—(1) The phy- 
sician must show an express or implied contract to hold 
any one other than the patient liable for his fees. This 
promise to pay by one other than the patient must have 
been relied on by the doctor; the other antecedent acts of 
the parties to the contract determine the action. Legally, 
parties other than the patient can be held; in practice 
it is of little value to have this form of promise without 
friendly witnesses, otherwise it becomes the word of one 
person against that of another. 
2. Generally, in order to hold a third party liable and 
be able to recover, it is necessary to make this an express 230 
THE SUCCESSFUL PHYSICIAN 
contract in writing, as, for instance, on the bottom of your 
card or other paper. Have the third party sign the word 
“accepted” and sign your name. 
3. The relationship alone is not sufficient to establish 
the responsibility of a third party; the facts must show 
actual employment by the third person. 
4. A bill to an estate must usually be submitted 
within four months after the death of the patient, must be 
itemized in full, and presented to the executor. Suits 
may be filed against estates if the bill for services is 
not sanctioned by the executor, they are most difficult 
to collect, and unless their payment is sanctioned by 
competent legal advice, it is doubtful value to sue. 
Confidential Communications.—(1) To claim this privi- 
lege in court it must appear that the relations of physician 
and patient existed at the time the information was given. 
2. Privileged communications are permissible even if 
the physician is employed by a third party. They do not 
depend on the compensation, or if treated free or at a 
hospital, or in a private house. The partner of a physi- 
cian may not reveal communications brought to his 
notice. 
3. An examination, for securing information only, 
when conditions are mutually understood, is not confiden- 
tial or privileged. 
4. If a physician examines a patient for information 
alone, and later treats the person examined, the relation of 
doctor and patient is created, and the physician cannot 
testify. Nor can he do so on the termination of the 
relation of physician and patient or in case of death. 
5. The information considered confidential is that 
which is found necessary in prescribing for the patient’s 
ailment; this may be acquired by verbal communication, THE PHYSICIAN AND THE LAW 
231 
by looking at the patient, from other persons present, 
from signs of the patient or others, by writing, and by 
audible signs. 
6. Patients may waive the right, or if patient sues the 
doctor for malpractice or the doctor is testifying in behalf 
of the patient, this would constitute a waiver. 
7. A physician can be held for any damage suffered 
by reason of statements he has made about a patient’s 
condition. A woman patient was the close friend of 
the physician’s wife. The patient developed a venereal 
disease, and the doctor cautioned his wife about further 
association with the patient and was held for damages 
for divulging a privileged communication. 
For the law in the specialized forms of medicolegal 
practice the reader is referred to the works on these 
subjects.* 
*Hugh Emmet Culbertson. The Medical Man and the Law. Lea and Feb- 
iger, 1913. CHAPTER XII 
ETHICS 
From the beginning rules of conduct have been laid 
down for the general guidance of the community. In the 
individual occupations rules have been devised to govern 
those who choose a particular calling. In the majority 
of cases these rules have been altered from time to time 
to meet and to conform to changed conditions. Many 
of the rules and practices of the early representatives 
of the medical profession have fallen into disuse because 
they did not meet the approval of the men engaged in 
practice. 
One rule of conduct has not been improved upon by the 
lapse of time. This rule has withstood the test of use 
and applicability to every legitimate form of human 
endeavor. It has found expression in many forms from 
many different sources—the intent and general meaning 
have remained almost unchanged. It probably first 
appeared in written form in the Orient and is credited to 
Confucius—“Do not do to others what you would not 
have them do to you.” In another form this was given 
to the world by Jesus Christ, and in still other words by 
those who have followed these great teachers. 
This rule is the very embodiment of the conduct that 
should govern the actions of all men in all walks of life. 
It is the basis upon which most of the rules are formulated 
in the ethics of the medical profession. If this rule were 
followed literally, there would be little need for the other 
directions laid down by the various writers of ethics. 
232 ETHICS 
233 
The consistent following of this rule is the only 
method that will enable a man to hold up his head and 
be proud of his distinction. I would earnestly recom- 
mend it to each and every one who enters the practice of 
medicine. There is no rule that is superior to it, and I 
know of none that is its equal. 
All parents entertain the hope that their progeny may 
develop into wiser, more capable, greater, or more useful 
members of society than they succeeded in being. Each 
generation of doctors would seek to elevate the profession 
to a higher plane. Every year there enters the profession 
the output of the colleges, who also entertain this laudable 
ambition—to elevate the profession of which they are 
now a part. 
Fortunately, the great majority of people are honest, 
but there is always in the general public a minority that is 
neither honest nor honorable, and so we must have laws, 
jails, officers of the law and courts to interpret the laws, 
locks on our doors, burglary insurance, and other things 
to remind us that society, as it exists today, is not perfect. 
Just as there are unruly members in the general public, 
so also are there members in the medical profession who 
pay little heed to rules or ethics. They are self-seeking 
individuals who do not care how they get a thing so long 
as they get it. Against such persons and others of similar 
intent it is incumbent on the young man to be ever on 
guard. They plan their actions so that they stay within 
the law but fall far short of its intent. Their general 
line of thought appears to be to “Do unto others as they 
would do to you, but do it first.” 
This is the real condition that is likely to confront the 
young man soon after entering practice. On looking 
back to my early practice there is a certain similarity in 234 
THE SUCCESSFUL PHYSICIAN 
my experience to that of the young colt that first ventures 
far from the side of its mother, and approaches some 
other member of its species in perfect friendliness and 
good will, and receives a sharp nip in the neck or a good 
sound thump in the side for his temerity. These things 
are said reluctantly, for I am somewhat timid about dis- 
pelling the glamour that will at first surround the young 
physician. I have begun this work with the intention of 
presenting the facts as I see them, rather than as I hoped 
to find them, or as I still hope they may at some time 
become. 
Much has been written about the ideals of life and 
general conduct, but, unfortunately, these are not followed 
by a great majority of people. There are also long 
serious dissertations on the proper ethics for practitioners 
to follow, but one would never believe this by the actions 
of many whom he will meet. 
The fact that in every line of human endeavor some 
wander far from the tenets of their calling, does not, in 
any measure, excuse them for their digression. Though 
you read volumes on ethics, and follow the rules to the 
letter, and receive but little of this treatment in return, it 
will not serve as an excuse for you to resort to sharp 
tactics. 
Choice of Consultants.—In practice it will be found an 
excellent rule to follow the direction given by a capable 
coach for a football team—“ Play the game squarely and 
according to rule but you must protect yourself in the 
scrimmage.” In medical practice it will be found that 
the scrimmage is not so different from a football scrim- 
mage as it would at first appear. In view of the varying 
standards of probity one will meet, it will be quite evident 
that in your intercourse with the general public and with ETHICS 
235 
your fellow practitioners your words and actions must be 
a matter of serious thought and deliberate choice. The 
physicians you may be requested to meet in consultation 
must be looked upon and treated by you according to the 
standing and reputation of such consultants and their 
personal attitude toward you as an individual. To do 
otherwise may cause you the possible loss of a patient 
and, in addition, serious damage to your professional 
standing. The physician who will attempt to undermine 
the standing of a younger and less experienced doctor 
with a patient will not hesitate to divert another’s patient 
to his own practice. 
The extensive practice the consultant may be assumed 
to have, or his real or reputed wealth, does not serve as an 
indication of the treatment he will accord a younger 
man. This can be gauged only by a personal acquain- 
tance. In this respect, as in others, physicians are just 
ordinary mortals, and too many times the greater the 
practice, wealth or standing the more inordinate is the 
craving to enhance them. 
Were there fewer physicians and were competition less 
keen, the majority of men would be quite well satisfied 
with an assured competence and a large enough practice 
to keep them occupied. The number of physicians in any 
city who have all they can do and who receive all they 
care to take is indeed limited. In other words, there is 
always keen competition; in many of the most desirable 
places this progresses to the stage where it becomes 
desperately bitter. In the latter case it is evident that 
the dividing line which separates one man’s field from 
another’s becomes increasingly indistinct. This keen 
competition, with its overlapping interests, accounts for 
many of the bitter controversies among medical men. 236 
THE SUCCESSFUL PHYSICIAN 
This condition of affairs is bound to continue so long as 
two or more men strive to exist where there is not suffi- 
cient to support one. The greater the number of physi- 
cians to any given number of people, the more keen 
naturally will be the competition. With this competition 
will come more numerous infractions of the finer rules 
of ethics, just as the greater the poverty of individuals, 
the more frequent will be the violations of the law. 
Benefits and Dangers of Consultations.—How closely 
you must guard your own interests in consultations 
will depend upon your personal acquaintance with and 
friendliness between the consultant or consultants and 
you. Where the consultation is to be held with those in 
your own company or corporation, hospital or your 
associates, it would obviously be of little benefit to any 
one to be other than helpful and friendly to both the 
attendant and the patient. No added returns would come 
to any one concerned to introduce personal feeling into the 
case under consideration. Where there is no personal 
friendliness between the parties holding the consultation, 
and there is a possibility of personal benefit of any kind 
being derived, there exist all the elements necessary to the 
entrance of human passions. 
Personal advancement or money, or their equivalent, 
continue to be, as they have been, “the root of all evil.” 
These are the possibilities that are always present and 
should not be lost sight of by any one. It is true that 
these happenings are the exception, just as murder 
is the exception to the average person, but it does not 
follow that one should neglect to see that his own interests 
are conserved. Happily, the great majority of medical 
men are actuated by the highest motives and endeavor ETHICS 
237 
constantly to do the greatest good to the greatest number. 
In every consultation it is your duty to enter it with 
an open mind. If you have thoroughly prepared your- 
self in the matter of the history of the patient, made notes 
of the symptoms as they arose, recorded the reactions to 
the treatment given, etc., your views of the case in hand 
will in all likelihood be accepted by those called in to 
assist you on the case, and they will be pleased to compli- 
ment you personally for the able manner in which you 
have handled it. Besides this, they are apt to tell other 
medical men of your careful handling of cases. In other 
words, many of your consultations will be a sort of friendly 
examination of your ability as a doctor and an adviser of 
the ailing. Every avenue of possible criticism should be 
investigated and the objections removed before the 
consultation takes place. In this way the opportunities 
for saying unfavorable things about you to the patient will 
be eliminated. 
Following a consultation the attending physician is 
sometimes requested to take orders from the doctor who 
is called in to assist. This arrangement may not operate 
to the satisfaction of all concerned. Usually the young 
physician is gradually shifted to a subordinate position, 
which is humiliating. In such a case it is better for 
him to resign at once. 
Dr. Blanchard, in his “Letters to Dr. Betterman,” 
writes that, “most consultants seemed to make the most of 
their opportunity to create a good impression on the 
families to whom he took them. He mentions one case 
where the family seemed to lose faith in him and to prefer 
the consultant to continue the case. The refusal of the 
consultant to do so appears to have served as a very 238 
THE SUCCESSFUL PHYSICIAN 
unusual proceeding and came as a most pleasant 
surprise.”* 
To leave the pessimistic side of this subject one does 
derive a vast amount of good from these helpful workings 
of two or more minds centered on the main object in 
view—the good of the patient. This is the real point 
sought in most consultations, and the other remarks are 
included so that the young man may understand that 
his path may not always be strewn with roses. 
There is hardly anything in life that does not have its 
drawbacks, and we must take things as we find them. 
If the bitter must be taken, it is better to take it first, 
for the sweet will be relished all the more afterward. 
The “sweet” in this subject is the friendships that 
accrue from the meeting of good and true men who are 
working with you for a common purpose, and the knowl- 
edge that you are helping someone to better health. 
“A consultation is the best opportunity to show one’s 
real ability in medicine, one’s position as to honesty and 
one’s standing as a man,” in Blanchard’s estimation. 
Consultations may be classed as those having to do 
with—(1) The Patient; (2) Other Doctors; (3) Personal 
Matters. 
When a consultation has been held on one of your 
patients, it will be your duty to inform the relatives, 
the patient, or interested friends of its result. Urgent 
necessity may compel a sudden and decided change in the 
treatment, but unless this condition exists, it will be 
better to make whatever changes are suggested at a later 
visit. This will not tend to create in the mind of the 
patient the belief or suspicion that the former treatment 
was entirely wrong. 
* C. E. Blanchard, Letters to Dr. Betterman, (J. D. Albright, M. D., 
Publisher). ETHICS 
239 
Old and difficult cases that are not thoroughly under- 
stood by you should be an indication to call in some one 
in whom you have confidence and from whose knowledge 
you may derive benefit. 
In all doubtful cases, and in those in which death may 
be impending, or where there is any indication that this is 
a reasonable possibility, you should notify the interested 
persons of the conditions, so that they may express their 
personal preferences in the matter. The case may really 
be one in which a consultation would be valueless, but 
the friends of the patient often feel that everything 
was not done that might have been done, or that the 
calling in of some other physician would have relieved 
them from anxiety and saved them from possible condem- 
nation from relatives who are not present. 
Patients who are far from home are very prone to 
want consultations held for the most trivial ailments 
since they are apprehensive of the possible outcome. In 
these cases it is well to grant any reasonable request that 
will soothe their disturbed feelings and thus render the 
subsequent treatment less difficult. 
Any other necessity that may occur should be given 
similar consideration. In each and every instance you 
should meet the consultant more than half way, make him 
welcome, and show him that you appreciate his willing- 
ness to help. Make your intercourse and professional 
duties with him as agreeable as circumstances permit, and 
attend to the collection of his fee. 
Every conscientious doctor will encounter cases that 
puzzle him and that do not respond to the treatment 
given. In such cases the physician will call for the best 
consultant he knows, to get whatever assistance can be 
had. 240 
THE SUCCESSFUL PHYSICIAN 
To divide the responsibility for the treatment of one’s 
relatives with others or where some unforeseen and 
unfavorable turn in the affairs of your patient makes the 
responsibility greater than you care to assume, and in the 
rural districts, where everyone knows everyone else, it is 
often wise to call a consultation where some trivial or 
slight ailment has developed into a serious condition and 
where the death of the patient would seriously reflect on 
your ability. 
In all cases where there is a reasonable likelihood that 
legal action would be taken, either against you or another 
doctor or some common carrier or private concern, a 
consultation will establish the matter in case a suit results, 
and will also remove the reasonable possibility of the 
diagnosis being questioned. This is a most important 
matter, and it is becoming still more important since the 
compensation and other laws of similar nature have been 
enacted by the different states. In all these cases there 
should be accurate, written notes of the statements made, 
surrounding conditions, and all other matters bearing 
on the case. 
All fracture cases, injuries of whatever kind, damage 
by common carriers, etc., should follow the same course 
of careful note taking, careful diagnosis, etc. 
Threatened or self-induced abortions are a source of 
worry to almost every man in practice. Many states 
make it compulsory to report these cases to the police 
department before any treatment is undertaken. This is 
especially urgent when the patient is in a serious condition 
or near death. In those districts where there is no possi- 
bility of notifying the police department or other proper 
authority, it is especially to your interest to have some 
competent man see the case with you. This type of ETHICS 
241 
patient may, as you know, pass out quickly—one day she 
may be well and the next day she may be dead. The 
attendant circumstances may be thoroughly understood 
by close friends but not by the neighbors. When a patient 
who has been, to all intents and purposes, perfectly well, 
passes out in a small community, there are bound to be 
some who will talk, and what they will say will not be 
complimentary to you, the one who could defend your 
name being dead. Without some good reliable physician 
to stand by you in this matter, very grave damage to one’s 
reputation can and does result. 
I know of two physicians who had the greatest diffi- 
culty in keeping out of jail for a crime that they were not 
guilty of. It took them more than a year to defend the 
action in court and to clear themselves of the charges for 
a crime committed by a midwife who later on her dying 
bed confessed. 
Do not criticise the treatment or diagnosis of your 
colleagues. There is little doubt but that this stirs up 
more distrust in the mind of the general public and creates 
more hard feeling among medical men than any other 
single factor. 
Treat the cases that come to you in the same manner 
that you would if they had never called on a physician 
before. Many cases of mistaken diagnosis will come 
under your care, and mistaken diagnosis will be made by 
you in an equally large number of cases. The criticism 
that you make of the other doctor, will but furnish him 
the opportunity to revenge himself when one of your 
errors comes to his notice. 
No matter how angry a patient may be at another 
physician, it will not elevate you in his esteem for you 
to furnish him with further fuel to feed his flame. Let 242 
THE SUCCESSFUL PHYSICIAN 
other physicians build their own defense of their actions 
with their patients; if you can see nothing to be com- 
mended in what they have done, say nothing at all. The 
Medical Protective Company of Fort Wayne has found, 
after years of experience, that the majority of cases 
against physicians could never be sustained in court if 
other doctors did not assist them in their work. If you 
take the trouble to inquire about this from some one who 
has been in practice for many years, he will tell you that 
you will have enough to do to keep your own fences 
mended without tearing down those of others. There 
will be enough complaints, both real and imaginary, 
about your treatment, to keep you busy without bother- 
ing about those of some one else. 
There are few physicians who will not be called upon 
at one time or another to give testimony in court about the 
treatment of some other physician. The less dogmati- 
cally you respond to the questions asked, the better. 
And unless your colleague has shown the grossest negli- 
gence, the less you say the better it will be for you in 
the future. With the exception of testifying in the case of 
the criminally negligent, the irregular or other doctors 
who are trying to evade the law, it will be to your best 
interest to avoid every appearance in court if possible. 
It is the experience of the Medical Protective Company 
that of all those who bring suit against physicians, the 
majority are those who have no property of their own, 
hence they are able to sue you with malicious intent and 
you have no redress against them for they are usually 
judgment proof. It virtually amounts to an effort to 
secure recompense from the doctor often without any le- 
gitimate reason for their action other than that of the possi- 
bility of obtaining damages, and it is for this purpose, ETHICS 
243 
mainly, that suits are brought. For these and other 
patent reasons, the less often you appear in court the 
better it will be for your reputation and for that of your 
colleagues, as well as for the general reputation of 
physicians. 
The Object of the Practice of Medicine 
Some idealist has stated that a physician’s effort should 
be for the good of humanity in general, with the monetary 
return a secondary consideration. This theory is a relic 
of the custom of the middle ages, and can be applied only 
if it can be made to conform to the general practice of the 
profession of today. 
Some centuries ago it was the practice of the Egyptian 
and Grecian doctors (priests) to make no charges, but to 
receive from the grateful patients gratuities for the 
services they rendered. Because of their other sources of 
influence, and because they were recognized officials of the 
government and assured of the comforts and luxuries of 
life, no real need existed for them to receive more. 
What a profound difference from the conditions of the 
present day! They held their positions for life, while 
the modern physician is in practice only so long as he 
can maintain the race with the others in his community— 
when he falls behind, he must retire or seek some other 
field of endeavor. 
The early physician also received contributions for 
services other than medical, such as marriage fees and 
other similar ones, whereas the doctor of this age derives 
his whole livelihood from his personal efforts in the cure of 
the sick. Adam Smith, in his “Wealth of Nations,” 
clearly demonstrated that when an individual greatly 
benefited himself he, at the same time, benefited society 244 
THE SUCCESSFUL PHYSICIAN 
in general. This is the exact position of every physician 
of the present day. When he benefits himself greatly by 
his efforts, he at the same time greatly benefits society 
in general by improving the standards of health and 
decreasing disease. 
It is within my own memory when people scoffed at 
a minister for receiving a stipulated sum from his congre- 
gation for his ministrations in their behalf. This attitude 
has not entirely disappeared in this day. Caricaturists 
have made it the custom to depict the minister as of 
humble mien and in straitened circumstances. This 
attitude is changing. It is becoming clear to the people 
that the minister not only has a right to live, but to live 
on a basis of equality with those of his congregation; 
that his family has the same inherent right to the comforts 
of life as the congregation or public generally has, and that 
when the protecting head of the house is removed, his 
widow and children may be sure that they will not 
become mendicants. Society is gradually admitting 
that its professional servants have this right of support 
because of the services they render for the general good. 
Does any one believe that the physician does not also 
serve the society of which he is a part? It is because of 
this service that he is not in the same category as the early 
practitioner, who virtually lived upon gratuities. The 
very thought is repugnant to any self-respecting, independent 
man. He believes, and rightly so, that he is justly entitled 
to his fee for valuable services rendered. Courts and juries 
so look upon this matter, and if one sought to maintain 
that most men in medicine were practising for the love of 
humanity with their own interest only a secondary con- 
sideration, he would be laughed out of court. It is true 
that the interests of patient and doctor are mutual, but ETHICS 
245 
neither is paramount. When a physician helps a patient, 
he helps himself, but it is not for altruistic reasons nor 
purely for humanity’s sake—there is always the innate 
thought of self-support, which, however, works for the 
good of both parties. 
A physician cannot afford to be a charitable institu- 
tion. When he treats a patient gratuitously, he is forced 
by law to give him the same careful treatment that he 
would if he were being paid, but it is entirely optional 
with him whether or not he wants to treat a free patient. 
This is distinctly not the case with an institution that 
does charitable work for patients—it cannot be held 
liable for whatever errors may happen in the treatments 
given. It is recognized as a charitable institution, 
whereas the physician is not. 
I have spoken with many hundreds of physicians in 
widely scattered parts of the United States and only very 
few claimed that they were, first of all, working for the 
good of humanity. The few who did make such a state- 
ment or implied that this was their object in life, displayed 
nothing in their demeanor or their surroundings to indicate 
that they were sincere in their attitude. 
In my college days, and while teaching in other 
colleges, only very few students maintained that they 
were studying medicine for humanitarian reasons. They 
were quite frank in their statements that they intended to 
become physicians in order that they might make a 
living. Not that they were not intensely interested in 
their work, nor that they did not have visions of con- 
tributing toward the advancement of the race, for this 
was stated many times; but, after all, their principal 
concern was for themselves and for those who might come 
after them. 246 
THE SUCCESSFUL PHYSICIAN 
It is a rare thing to find a man who does not have some 
hope of excelling in a particular sphere, of creating or dis- 
covering something that may leave his name in stone and 
his deeds recorded in history. But the primary wish, in 
the meantime, is to better his own condition while he 
inhabits the earth. “A rose to the living is more than 
sumptuous wreaths to the dead.” 
Self-preservation is the first law of nature. This 
applies to the physician quite as truly as to every other 
mortal. The actuary of the New York Life Insurance 
Company finds that few doctors put aside a sufficient sum 
during their active years to give them a sufficient income 
in their old age. I insist that it is the legitimate duty that 
one owes to himself and a binding obligation to provide 
for those who are his dependents. 
The greatest danger that threatens the medical pro- 
fession is not the lust for the acquisition of wealth, for 
very few have this, but it is in not giving the people what 
they want. What they most desire is something that 
contributes to their well-being. No doctor demeans 
himself by catering to the patient’s wants—proper service 
to mankind is the highest function that he can exercise. 
Contract Practice.—Contract practice is held to be 
prejudicial to the best interests of the profession. Many 
medical societies deny membership to those physicians who 
engage in this variety of work. However, since member- 
ship in societies is composed of only about half of the 
practitioners, this rule is not generally rigidly enforced. 
Contract practice is on the increase rather than on 
the decrease. Every industrial accident company and 
most of the states that have included this form of insur- 
ance in their laws have naturally resorted to the contract 
method of taking care of their medical risks. This also ETHICS 
247 
applies to the states that have selected certain physicians 
to attend to their cases rather than let them go to any 
qualified man in the profession. The men who are thus 
selected often have no exceptional qualifications over 
others in the immediate vicinity, but this is found to be 
the most expedient way to handle these affairs. It is an 
injustice to the general practitioner or to the surgeon not 
favored, but none of these individuals are thus rendered 
ineligible to membership in the medical society. This is a 
form of practice more than any other, that is introducing 
commercialism into the profession. Every indication at 
the present time is that this method will increase rather 
than decrease. Whether or not it is agreeable the state- 
ment of a physician that he is in the practice for the sake 
of humanity is changing to that of permitting him to fill a 
contract position the same as any other man in commercial 
pursuits, where he contracts to do a certain thing for a 
stipulated sum. 
The same condition applies to railroad surgeons, 
physicians in state hospitals, private hospitals, sani- 
taria, municipal service, life insurance, etc. 
Contract practice is objectionable for several reasons, 
one of these being that the physician is compelled to 
attend to so many cases that he is not in a position to do 
either the patient or himself justice. This same objection 
is true of physicians who hold positions in city hospitals 
and other public institutions. These institutions are in 
theory maintained by and for the benefit of the entire 
public, not just a part of it. Moreover, they usually do 
not employ enough physicians, and for this reason each 
doctor is compelled to do so much that he is not able to 
give the patients the proper attention, or to do justice to 
himself. Moreover, it works a hardship on other physi- 248 
THE SUCCESSFUL PHYSICIAN 
cians, who lose this opportunity of gaining expertness by 
practice. 
These connections are often available only to those 
who are already connected with a college or teaching 
institution. In some states there are many restrictions 
which are often a part of the state or municipal laws. 
When they are not so determined, it is the custom to 
distribute these positions among a coterie of medical men 
who are politically well connected, all of which works to 
the detriment of the physician in general practice. 
The men who secure positions by political manipula- 
tion cling to them, in many instances, to the limit of 
their ability, generally for their personal benefit, and they 
use these public institutions to serve their own ends. 
The same applies to the positions of the emergency 
service at the heads of the departments of most colleges 
and staff hospitals. 
When there is any charitable work to be done in a 
city or town, my observation has been that people or 
doctors do not go to the trouble of using political pull or 
other influence for the honor of doing this service. The 
positions in the city and staff hospitals have a long waiting 
list of those who endeavor to secure positions that pay 
nothing directly. 
One of the reasons for the eagerness to secure these 
positions is the practice it gives along certain lines and 
also the special personal benefits that these positions 
made possible. 
Hospitals naturally divide men into narrow-minded 
cliques, each jealous of and hostile to the other. Every 
institution should be open to all reputable doctors and 
each should receive the same right of service. 
Those who locate in a strange city and take their ETHICS 
249 
patients to a staff hospital need not be surprised if their 
patients leave the institution with the names of one or 
more very capable doctors whom they did not know 
before going to the hospital. The nurses, instead of 
telling the patients that their doctor is an expert, will say 
that they had never even heard of him. 
Patients are quick to notice the difference in the way 
the nurse and the man who occupies a staff position in 
that hospital serve you. If all does not go well, it is 
just possible that you will be asked to yield the case in 
favor of one of these doctors. News travels rapidly in 
these hospitals. When some well known physician on 
the staff has many operations and you have only an 
occasional small one there, this fact will reach the ears 
of your patient and your reputation will suffer accordingly. 
For these and other apparent reasons you should take few 
cases to the staff hospital until you are on the staff. Then 
you occupy the same position of vantage as the other 
physicians and can meet them on their own ground. 
These are a few general conditions that you will 
invariably find when you go into practice in any large 
city. There are many other angles to the applied ethics 
of the profession that could be mentioned. The few 
points that I have brought out are not intended in any way 
to criticise the profession in general. They are not 
chargeable to the profession, but rather to the rapidly 
changing conditions of the times in which we live. A few 
legislators cannot give morality to a people. The wish 
of the majority of the common people makes our laws, 
and when laws do not conform to the wishes of the people, 
they are ignored or repealed and it seems to me that the Law 
of Ethics should be so revised that the practices of to-day 
should harmonize more closely. 250 
THE SUCCESSFUL PHYSICIAN 
PRINCIPLES OF MEDICAL ETHICS OF THE 
AMERICAN MEDICAL ASSOCIATION 
CHAPTER I 
THE DUTIES OF PHYSICIANS TO THEIR PATIENTS 
The Physician’s Responsibility 
Section 1.—A profession has for its prime object the service it 
can render to humanity; reward or financial gain should be a sub- 
ordinate consideration. The practice of medicine is a profession. 
In choosing this profession an individual assumes an obligation to 
conduct himself in accord with its ideals. 
Patience, Delicacy and Secrecy 
Section 2.—Patience and delicacy should characterize all the acts 
of a physician. The confidences concerning individual or domestic 
life entrusted by a patient to a physician and the defects of dis- 
position or flaws of character observed in patients during medical 
attendance should be held as a trust and should never be revealed 
except when imperatively required by the laws of the state. There 
are occasions, however, when a physician must determine whether 
or not his duty to society requires him to take definite action to 
protect a healthy individual from becoming infected, because 
the physician has knowledge, obtained through the confidences 
entrusted to him as a physician, of a communicable disease to which 
the healthy individual is about to be exposed. In such a case, 
the physician should act as he would desire another to act toward 
one of his own family under like circumstances. Before he deter- 
mines his course, the physician should know the civil law of his 
commonwealth concerning privileged communications. 
Prognosis 
Section 3.—A physician should give timely notice of dangerous 
manifestations of the disease to the friends of the patient. He 
should neither exaggerate nor minimize the gravity of the patient’s 
condition. He should assure himself that the patient or his friends 
From Directory of the American Medical Association—1921. ETHICS 
251 
have such knowledge of the patient’s condition as will serve the 
best interests of the patient and the family. 
Patients Must Not Re Neglected 
Section 4.—A physician is free to choose whom he will serve. 
He should, however, always respond to any request for his assistance 
in an emergency or whenever temperate public opinion expects the 
service. Once having undertaken a case, a physician should not 
abandon or neglect the patient because the disease is deemed incur- 
able; nor should he withdraw from the case for any reason until a 
sufficient notice of a desire to be released has been given the patient 
or his friends to make it possible for them to secure another medical 
attendant. 
CHAPTER II 
THE DUTIES OF PHYSICIANS TO EACH OTHER AND TO THE 
PROFESSION AT LARGE 
Article I.—Duties to the Profession 
Uphold Honor of Profession 
Section 1.—The obligation assumed on entering the profession 
requires the physician to comport himself as a gentleman and 
demands that he use every honorable means to uphold the dignity 
and honor of his vocation, to exalt its standards and to extend its 
sphere of usefulness. A physician should not base his practice on 
an exclusive dogma or sectarian system, for “sects are implacable 
despots; to accept their thraldom is to take away all liberty from 
one’s action and thought.” (Nicon, father of Galen.) 
Duty of Medical Societies 
Section 2.—In order that the dignity and honor of the medical 
profession may be upheld, its standard exalted, its sphere of useful- 
ness extended, and the advancement of medical science promoted, 
a physician should associate himself with medical societies and 
contribute his time, energy and means in order that these societies 
may represent the ideals of the profession. 
Deportment 
Section 3.—A physician should be “an upright man, instructed 
in the art of healing.” Consequently, he must keep himself pure 252 
THE SUCCESSFUL PHYSICIAN 
in character and conform to a high standard of morals, and must 
be diligent and conscientious in his studies. “He should also be 
modest, sober, patient, prompt to do his whole duty without anxiety; 
pious without going so far as superstition, conducting himself with 
propriety in his profession and in all the actions of his life.” 
(Hippocrates.) 
Advertising 
Section 4.—Solicitation of patients by circulars or advertise- 
ments, or by personal communications or interviews, not warranted 
by personal relations, is unprofessional. It is equally unprofessional 
to procure patients by indirection through solicitors or agents of 
any kind, or by indirect advertisement, or by furnishing or inspiring 
newspaper or magazine comments concerning cases in which the 
physician has been or is concerned. All others like self-laudable, 
defy the traditions and lower the tone of any profession and so are 
intolerable. The most worthy and effective advertisement possible, 
even for a young physician, and especially with his brother physi- 
cians, is the establishment of a well-merited reputation for profes- 
sional ability and fidelity. This cannot be forced, but must be the 
outcome of character and conduct. The publication or circulation 
of ordinary simple business cards, being a matter of personal taste 
or local custom, and sometimes of convenience, is not per se improper. 
As implied, it is unprofessional to disregard local customs and 
offend recognized ideals in publishing or circulating such cards. 
It is unprofessional to promise radical cures; to boast of cures 
and secret methods of treatment or remedies; to exhibit certificates 
of skill or of success in the treatment of diseases; or to employ any 
methods to gain the attention of the public for the purpose of 
obtaining patients. 
Patients and Perquisites 
Section 5.—It is unprofessional to receive remuneration from 
patients for surgical instruments or medicines; to accept rebates on 
prescriptions or surgical appliances, or perquisites from attendants 
who aid in the care of patients. 
Medical Laws—Secret Remedies 
Section 6.—It is unprofessional for a physician to assist unquali- 
fied persons to evade legal restrictions governing the practice of ETHICS 
253 
medicine; it is equally unethical to prescribe or dispense secret 
medicines or other secret remedial agents, or manufacture or 
promote their use in any way. 
Section 7.—Physicians should expose without fear or favor, 
before the proper medical or legal tribunals, corrupt or dishonest 
conduct of members of the profession. Every physician should aid 
in safeguarding the profession against the admission to its ranks of 
those who are unfit or unqualified because deficient either in moral 
character or education. 
Safeguarding the Profession 
Article II.—Professional Services of Physicians to Each Other 
Physicians Dependent on Each Other 
Section 1.—Experience teaches that it is unwise for a physician 
to treat members of his own family or himself. Consequently, a 
physician should always cheerfully and gratuitously respond with 
his professional services to the call of any physician practicing in 
his vicinity, or of the immediate family dependents of physicians. 
Compensation for Expenses 
Section 2.—When a physician from a distance is called on to 
advise another physician or one of his family dependents, and the 
physician to whom the service is rendered is in easy financial 
circumstances, a compensation that will at least meet the traveling 
expenses of the visiting physician should be proffered. When such 
a service requires an absence from the accustomed field of profes- 
sional work of the visitor that might reasonably be expected to 
entail a pecuniary loss, such loss should, in part at least, be provided 
for in the compensation offered. 
One Physician to Take Charge 
Section 3.—When a physician or a member of his dependent 
family is seriously ill, he or his family should select a physician from 
among his neighboring colleagues to take charge of the case. Other 
physicians may be associated in the care of the patient as 
consultants. 254 
THE SUCCESSFUL PHYSICIAN 
Article III.—Duties of Physician in Consultations 
Consultations Should Be Required 
Section 1.—In serious illness, especially in doubtful or difficult 
conditions, the physician should request consultations. 
Consultation for Patient’s Benefit 
Section 2.—In every consultation the benefit to be derived by the 
patient is of first importance. All the physicians interested in the 
case should be frank and candid with the patient and his family. 
There never is occasion for insincerity, rivalry or envy and these 
should never be permitted between consultants. 
Punctuality 
Section 3.—It is the duty of a physician, particularly in the 
instance of a consultation, to be punctual in attendance. When, 
however, the consultant or the physician in charge is unavoidably 
delayed, the one who first arrives should wait for the other for a 
reasonable time, after which the consultation should be considered 
postponed. When the consultant has come from a distance, 
or when for any reason it will be difficult to meet the physician in 
charge at another time, or if the case is urgent, or if it be the desire 
of the patient, he may examine the patient and mail his written 
opinion, or see that it is delivered under seal, to the physician in 
charge. Under these conditions the consultant’s conduct must 
be especially tactful; he must remember that he is framing an 
opinion without the aid of the physician who has observed the 
course of the disease. 
Patient Referred to Specialist 
Section 4.—When a patient is sent to one specially skilled in the 
care of the condition from which he is thought to be suffering, and 
for any reason it is impracticable for the physician in charge of the 
case to accompany the patient, the physician in charge should send 
to the consultant by mail, or in the care of the patient under seal, 
a history of the case, together with the physician’s opinion and an 
outline of the treatment, or so much of this as may possibly be of 
service to the consultant; and as soon as possible after the case has 
been seen and studied, the consultant should address the physician ETHICS 
255 
in charge and advise him of the results of the consultant’s investi- 
gation of the case. Both these opinions are confidential and must 
be so regarded by the consultant and by the physician in charge. 
Discussions in Consultation 
Section 5.—After the physicians called in consultation have 
completed their investigations of the case, they may meet by them- 
selves to discuss conditions and determine the course to be followed 
in the treatment of the patient. No statement or discussion of 
the case should take place before the patient or friends, except in 
the presence of all the physicians attending, or by their common 
consent, and no opinions or prognostications should be delivered as 
a result of the deliberations of the consultants, which have not 
been concurred in by the consultants at their conference. 
Attending Physician Responsible 
Section 6.—The physician in attendance is in charge of the case 
and is responsible for the treatment of the patient. Consequently 
he may prescribe for the patient at any time and is privileged to 
vary the mode of treatment outlined and agreed on at a consultation 
whenever, in his opinion, such a change is warranted. However, 
at the next consultation, he should state his reasons for departing 
from the course decided on at the previous conference. When an 
emergency occurs during the absence of the attending physician, a 
consultant may provide for the emergency and the subsequent 
care of the patient until the arrival of the physician in charge, but 
should do no more than this without the consent of the physician 
in charge. 
Conflict of Opinion 
Section 7.—Should the attending physician and the consultant 
find it impossible to agree in their views of a case, another consultant 
should be called into the conference or the first consultant should 
withdraw. However, since the consultant was employed by the 
patient in order that his opinion might be obtained, he should be 
permitted to state the result of his study of the case to the patient, 
or his next friend in the presence of the physician in charge. 256 
THE SUCCESSFUL PHYSICIAN 
Consultant and Attendant 
Section 8.—When a physician has attended a case as a consultant, 
he should not become the attendant of the patient during that illness 
except with the consent of the physician who was in charge at the 
time of the consultation. 
Article IV.—Duties of Physicians in Cases of Interference 
Criticism to Be Avoided 
Section 1.—The physician, in his intercourse with a patient under 
the care of another physician, should observe the strictest caution 
and reserve; should give no disingenuous hints relative to the 
nature and treatment of the patient’s disorder; nor should the 
course of conduct of the physician, directly or indirectly, tend to 
diminish the trust reposed in the attending physician. 
Social Calls on Patient of Another Physician 
Section 2.—A physician should avoid making social calls on 
those who are under the professional care of other physicians with- 
out the knowledge and consent of the attendant. Should such a 
friendly visit be made, there should be no inquiry relative to the 
nature of the disease or comment upon the treatment of the case, 
but the conversation should be on subjects other than the physical 
condition of the patient. 
Services to Patient of Another Physician 
Section 3.—A physician should never take charge of or prescribe 
for a patient who is under the care of another physician, except in 
an emergency, until after the other physician has relinquished the 
case or has been properly dismissed. 
Criticism to Be Avoided 
Section 4.—When a physician does succeed another physician 
in the charge of a case, he should not make comments or insinuations 
regarding the practice of the one who preceded him. Such com- 
ments or insinuations tend to lower the esteem of the patient for 
the medical profession and so react against the critic. 
Emergency Cases 
Section 5.—When a physician is called in an emergency and finds 
that he has been sent for because the family attendant is not at ETHICS 
257 
hand, or when a physician is asked to see another physician’s 
patient because of an aggravation of the disease, he should provide 
only for the patient’s immediate need and should withdraw from 
the case on the arrival of the family physician after he has reported 
the condition found and the treatment administered. 
Section 6.—When several physicians have been summoned in a 
case of sudden illness or of accident, the first to arrive should be 
considered the physician in charge. However, as soon as the exi- 
gencies of the case permit, or on the arrival of the acknowledged 
family attendant or the physician the patient desires to serve him, 
the first physician should withdraw in favor of the chosen attendant. 
Should the patient or his family wish some one other than the 
physician known to be the family physician to take charge of the 
case, the patient should advise the family physician of his desire. 
When, because of sudden illness or accident, a patient is taken to a 
hospital, the patient should be returned to the care of his known 
family physician as soon as the condition of the patient and the 
circumstances of the case warrant this transfer. 
When Several Physicians Are Summoned 
Section 7.—When a physician is requested by a colleague to 
care for a patient during his temporary absence, or when, because 
of an emergency, he is asked to see a patient of a colleague, the 
physician should treat the patient in the same manner and with the 
same delicacy as he would have one of his own patients cared for 
under similar circumstances. The patient should be returned to 
the care of the attending physician as soon as possible. 
A Colleague’s Patient 
Section 8.—When a physician is called to the patient of another 
physician during the enforced absence of that physician, the patient 
should be relinquished on the return of the latter. 
Relinquishing Patient to Regular Attendant 
Substituting in Obstetric Work 
Section 9.—When a physician attends a woman in labor in the 
absence of another who has been engaged to attend, such physician 
should resign the patient to the one first engaged, upon his arrival; 258 
THE SUCCESSFUL PHYSICIAN 
the physician is entitled to compensation for the professional services 
he may have rendered. 
Article V.—Differences Between Physicians 
Arbitration 
Section 1.—Whenever there arises between physicians a grave 
difference of opinion which cannot be promptly adjusted, the 
dispute should be referred for arbitration to a committee of impartial 
physicians, preferably the board of censors of a component county 
society of the American Medical Association. 
Article VI.—Compensation—Limits of Gratuitous Service 
Section 1.—The poverty of a patient and the mutual professional 
obligation of physicians should command the gratuitous services 
of a physician. But institutions endowed by societies, and organi- 
zations for mutual benefit, or for accident, sickness and life insur- 
ance, or for analogous purposes, should be accorded no such privileges. 
Contract Practice 
Section 2.—It is unprofessional for a physician to dispose of his 
services under conditions that make it impossible to render adequate 
service to his patient or which interfere with reasonable competition 
among the physicians of a community. To do this is detrimental 
to the public and to the individual physician, and lowers the dignity 
of the profession. 
Secret Division of Fees Condemned 
Section 3.—It is detrimental to the public good and degrading 
to the profession, and therefore unprofessional, to give or to receive 
a commission. It is also unprofessional to divide a fee for medical 
advice or surgical treatment, unless the patient or his next friend 
is fully informed as to the terms of the transaction. The patient 
should be made to realize that a proper fee should be paid the 
family physician for the service he renders in determining the sur- 
gical or medical treatment suited to the condition, and in advising 
concerning those best qualified to render any special service that 
may be required by the patient. ETHICS 
259 
CHAPTER III 
THE DUTIES OF THE PROFESSION TO THE PUBLIC 
Physicians as Citizens 
Section 1.—Physicians, as good citizens and because their 
professional training specially qualified them to render this service, 
should give advice concerning the public health of the community. 
They should bear their full part in enforcing its laws and sustaining 
the institutions that advance the interests of humanity. They 
should cooperate especially with the proper authorities in the 
administration of sanitary laws and regulations. They should 
be ready to counsel the public on subjects relating to sanitary 
police, public hygiene and legal medicine. 
Physicians Should Enlighten Public—Duties in Epidemics 
Section 2.—Physicians, especially those engaged in public health 
work, should enlighten the public regarding quarantine regulations; 
on the location, arrangement and dietaries of hospitals, asylums, 
schools, prisons and similar institutions, and concerning measures 
for the prevention of epidemic and contagious diseases. When an 
epidemic prevails, a physician must continue his labors for the 
alleviation of suffering people, without regard to the risk of his own 
health or life or to financial return. At all times, it is the duty of 
the physician to notify the properly constituted public health 
authorities of every case of communicable disease under his care, 
in accordance with the laws, rules and regulations of the health 
authorities of the locality in which the patient is. 
Public Warned 
Section 3.—Physicians should warn the public against the devices 
practiced and the false pretensions made by charlatans which may 
cause injury to health and loss of life. 
Section 4.—By legitimate patronage, physicians should recognize 
and promote the profession of pharmacy; but any pharmacist, 
unless he be qualified as a physician, who assumes to prescribe for 
Pharmacists 260 
THE SUCCESSFUL PHYSICIAN 
the sick, should be denied such countenance and support. More- 
over, whenever a druggist or pharmacist dispenses deteriorated or 
adulterated drugs, or substitutes one remedy for another designated 
in a prescription, he thereby forfeits all claims to the favorable 
consideration of the public and physicians. 
Conclusion 
While the foregoing statements express in a general way the duty 
of the physician to his patients, to other members of the profession 
and to the profession at large, as well as of the profession to the 
public, it is not to be supposed that they cover the whole field of 
medical ethics, or that the physician is not under many duties and 
obligations besides these herein set forth. In a word, it is incum- 
bent on the physician that under all conditions, his bearing toward 
patients, the public and fellow practitioners should be characterized 
by a gentlemanly deportment and that he should constantly behave 
toward others as he desires them to deal with him. Finally these 
principles are primarily for the good of the public, and their enforce- 
ment should be conducted in such a manner as shall deserve and 
receive the endorsement of the community. CHAPTER XIII 
DEMEANOR IN CRITICAL CASES. STATING 
THE PROGNOSIS 
Diagnosis 
1. To Go About Your Diagnosis Correctly.—The first 
as well as the most important point in diagnosis is to know 
what you are doing, and go about it in a direct-workman- 
like manner. This means that everything except the 
patient and the pertinent factors relative to his ailment 
should be completely excluded. His story of his com- 
plaint and all related things are to be considered and 
weighed. Center your conversation, attention and effort 
on the point to be determined. Allow nothing to lead the 
conversation into other channels until the question at 
issue is settled in your mind and all your patient’s ques- 
tions have been answered in a way that you have every 
reason to believe will set his mind at rest; concentrate 
all your faculties on the problem confronting you, and 
listen attentively to all your patient has to say. Do not 
interrupt him in his story unless it is to gain some essential 
fact he has not made clear to you. Make these interrup- 
tions as rarely as possible. Most patients have a pre- 
formed theory as to the way in which their disorder began, 
or what caused it. If they are not allowed to describe 
the condition as they see it, they will retain a fixed notion 
in their own minds that you can not arrive at the proper 
conclusion because you did not hear all the pertinent facts. 
They will feel that the part of their untold story was of 
vital importance in arriving at the proper conclusion. 
261 262 
THE SUCCESSFUL PHYSICIAN 
The simple act of listening to their story attentively 
serves two ends. Both of these are important. The 
patient has had that for which he craved: an oppor- 
tunity to be completely heard. You have had an oppor- 
tunity to study your patient while he was telling his story. 
This study of the individual and the disease will also 
have included the peculiarities of the patient. What 
method could give you a more correct measure of a man 
than listening to his ordinary conversation? He will be 
too interested in the detailing of his ailment to disguise 
his language. 
Now that you have listened carefully to his story, is 
the time for your questions. These should be directed 
exclusively to determine precisely what you desire to 
learn. In the first place, patients expect you to know 
certain things without having to ask all about them. 
In the second place, the time of those interested as well 
as your own is too valuable to waste. More than this, 
the patient will readily conclude that you do not know 
much if you wander too far afield. Most of them, for 
example, will not consider that the age of their grand- 
parents has anything to do with a constipated bowel. 
The questions that are asked should disclose the needed 
information, and when all is available to make certain of 
your patient’s history, further questions are useless. 
The patient has a right to assume that your whole atten- 
tion is given to his case. This being true, there will be 
no need to repeat a question. If your methods for deter- 
mining what afflicts your patient are carried out as they 
should be, this will lead him to believe that you know 
what you are doing. 
In this way you will learn what is wrong with 
your patient, instead of making the error that many DEMEANOR IN CRITICAL CASES 
263 
indolent minded physicians do by “asking” the patient 
what ails him. That is what you are engaged to find out. 
To conform to time-honored custom, you will ask to see his 
tongue, take his temperature and pulse, and inquire about 
his sleep, bowels and appetite. “The tongue tells a story 
of its own, even when silent,” some of the later teachings to 
the contrary—a story the laboratory does not always 
disclose. 
Learn what is the matter with your patient. Do this 
by observation of the patient, asking questions of him 
or of those caring for him. To do otherwise will shortly 
teach your patient to cease referring to his symptoms. 
No matter what the ailment may be, patients do not 
believe that they have been properly cared for unless they 
have been examined. Every patient should have some 
form of examination, no matter how trivial the complaint, 
unless it is self-evident to you that he already knows what 
the trouble is and wishes treatment only. Old or new, 
seen frequently or seldom, examine and find out how your 
patients are and what troubles them. 
Every effort should be made to have your talks with 
your patients alone. There are always some questions 
that patients hesitate to answer when others are present. 
This is especially true when intimate personal matters 
are under consideration. All the facts will not be brought 
out if others are present, in many instances, and the omis- 
sion of any one of them may be sufficient to lead you 
into error in forming your conclusions. This is particu- 
larly true of certain personal perversions and habits. 
Certain conditions of mismated couples can be elicited 
only by the fullest confidence and strictest privacy. 
If your practice is to include many women patients, this 
truth will shortly be brought home to you. 264 
THE SUCCESSFUL PHYSICIAN 
In the sexual way there is present in women an under- 
development and urge of one in ten, and in married couples 
there is an unbalance one way or another in one in five. 
There is no more aggravated case of nervousness of women 
than in one of these mismated couples. You will not 
secure this information if others are present at your 
examination—husband or other relatives not excepted. 
S. Weir Mitchell contends that “you cannot properly 
diagnose the peculiar nervous ailments of women unless 
you know something of their sexual fife, for their whole 
nervous mechanism is connected with it.” 
Patients often deny any venereal history for the reason 
that they do not consider that it is any of your business, 
for to them their past venereal history has no connection 
with their present trouble. To those who show any 
hesitation in answering these questions it is well to explain 
the possible connection between an old forgotten ailment 
and their present complaint. A case in point may be 
cited: A man had stomach trouble. Stomach tests, 
z-ray and other examinations showed a simple chronic 
gastritis with generally lessened secretions. A short 
treatment failed to benefit and the case disappeared. 
Two years later a call to this man showed paralysis of one 
side, and he was only 35 years old. He had denied having 
any sore or venereal ailment because he saw no connection 
between this old infection and his present affliction. 
All the symptoms cleared up with syphilitic treatment. 
A woman was treated for six months before the reason 
for her periodic neuralgias of the head was learned. It 
was improper balance between the husband and wife. 
If you want the whole truth, you will need to interview 
husband and wife separately. There will be times when 
you must obtain your final answer by giving expression DEMEANOR IN CRITICAL CASES 
265 
to a suspicion of the existence of a certain condition. 
Often you will never obtain the whole story. 
Another important matter is the manner in which you 
make your diagnosis known to your patient. This will 
have a decided bearing on your success. 
Let it be understood that patients are not so keen to 
know the minutiae of the diagnosis as they are to learn how 
long they are to be sick. They will insist on knowing 
when they will be well and “how much it will cost.” 
Patients will be more skeptical of you in the beginning 
than later on, because they will then have more faith in 
you. 
The man who believes he can make his diagnosis and 
give his findings to patients and friends in a cold, unfeeling 
manner need feel no surprise when the patient goes else- 
where for treatment. You cannot give a diagnosis and 
make a friend by adopting the attitude of—“this is my 
diagnosis—you can take it or leave it.” People will not 
tolerate such an attitude. 
A patient who will come to you and be given a correct 
diagnosis, may be lost if you do not also calculate his 
mental capacity. 
The longer you go about in the fixed belief that the 
medical fraternity is a thing apart from the general com- 
munity, and that a medical man is a superior being, just 
so long will you be failing to serve the community as 
you should. If you carry this belief very far, you will not 
even have a chance to serve the community, for people 
will seek some one more human to whom they can tell 
their troubles. As I have stated before, the prominent 
business man is often more readily seen than the snobbish 
upstart, and the real medical man is the most human and 
approachable of physicians. This brings us to the diagno- 266 
THE SUCCESSFUL PHYSICIAN 
sis problem, viewed from the angle that attention must be 
given to the character of the individual before you. Your 
demeanor must correspond his with conception of what an 
efficient physician should be and do. 
You can make a rapid, correct diagnosis on some 
patients and lose them as a result. You have traveled 
too fast for him to follow you. You may ask many ques- 
tions of another, find out all his family history, make a 
slow diagnosis, which is also correct, and still lose this 
patient. Your mind did not travel fast enough. This 
man is not interested in fine details—he is after the main 
point and the results. 
The American public is temperamental, emotional and 
critical. These mental traits are just as much to be 
considered in the manner of making and giving your 
diagnosis as is the symptom complex of their ailments. 
The method you adopt for the quick, nervous, ener- 
getic man is obviously not applicable to the slowmoving, 
analytical mind of the phlegmatic person. Your method 
of diagnosis must take the individual into consideration. 
To every patient you must show that you understand 
your profession and act in a manner that will convince 
him of this fact. The method of doing this will be 
determined to a large extent by the individual tempera- 
ment of the patient . 
When you first begin to practise, patients will be more 
skeptical and ask more questions than they will in later 
years, when you are better known. 
Every medical man will agree that a full and correct 
diagnosis frequently cannot be made at once. Some 
cases may be treated for weeks and months and the 
real character of the ailment still be uncertain. In other 
cases the diagnosis is never fully made or known. An DEMEANOR IN CRITICAL CASES 
267 
extreme instance of this is that of a woman who has had 
periodic attacks of intense pains in the abdomen, vomited, 
bile, and had diarrhea for more than thirty years. She 
had consulted, been treated by, and been operated on, 
by many specialists. The cause of the vomiting, pain and 
diarrhea had been removed, according to the various 
diagnoses that had been made, and the vomiting, pains 
and diarrhea still continued. The stomach had an ulcer 
and she was kept on a milk diet for months. At her first 
operation it was found that no ulcer had ever existed, and 
the various other organs that were blamed for and 
operated on produced no effect or change in the character 
or frequency of the attacks. 
It follows then that in an old chronic case no imme- 
diate diagnosis should be attempted, no treatment given 
except to relieve some distressing complaint. The patient 
will know, and the doctor should frankly admit, that 
time must be taken to study the case thoroughly before 
any conclusion can be made. 
2. To Decide Upon Your Diagnosis.—There will be 
times when the physician must side-step facing the issue 
with a definite conclusion. This will be patent to all. 
It is not so evident to all that a definite decision must 
ultimately be met. The patients who have been ailing a 
long time will have past experience to judge by. They 
will know that an immediate diagnosis could not be made 
correctly and would certainly refuse to accept a hasty de- 
cision. This will aid the doctor, because it agrees with 
what he knows to be true. It does not follow that a con- 
clusion will not soon be asked for. It will be requested 
and it must be met or the physician in charge will have to 
make way for some one who will give the patient his can- 
did definite conclusion. 268 
THE SUCCESSFUL PHYSICIAN 
In acute and chronic, old and new cases, a decision 
must be made sooner or later. The man who tries to 
evade the question continually, or very often, is liable to 
be left in the long run. 
When the time arrives that a diagnosis can be made, 
i.e., when sufficient time has elapsed for the observation 
of the case to permit a correct diagnosis, it is distinctly 
the duty of the physician to give it, and he should do so 
in a convincing manner and without any reservation. 
Any indecision, under the circumstances, must be care- 
fully avoided. More cases are lost and more doctors fail to 
convince the patient by indecision than by any other method. 
This faculty of solving a problem and arriving at a definite 
decision is very often a personal quality of mind. 
The doctor giving the diagnosis thinks he is right. If 
the physician’s mind holds a doubt as to the correctness of 
his own conclusion, he will often fail to convince either 
himself or his patient. 
To convince a patient you should have no reservations 
in your mind. You must be sure that you are right. 
When you feel that you are right, you could pass on and 
should pass something on to your patient that will make 
him agree with your belief. He will act on your opinion 
and advice when he has been fully influenced by your 
demeanor and has accepted your decision as a true fact. 
There is only one certain way to arrive at this desired 
frame of mind. You must understand your profession 
generally, know your case thoroughly, study it carefully, 
eliminate the possibilities and settle on the probabilities. 
Whatever thinking must be done, do it in the proper 
place—at home or in your office. Forget that there ever 
was such a word as think. Eliminate it completely from 
your vocabulary. As soon as you say “think,” there DEMEANOR IN CRITICAL CASES 
269 
arises in the patient’s mind that great doubt: “My 
doctor does not know.” The patient is placing his very 
life in your hands and he expects you to know. He 
is paying you to know. It is your business to see that 
you do know all the pertinent things about him before 
you attempt to make a diagnosis. Your patient has 
every right to expect this from you or to be told that it 
cannot positively be known. 
Once you have made your diagnosis and know it to be 
correct, adhere to it. A positive, decided diagnosis will 
win more cases than any other single factor. 
In this connection I would remind you that most 
people have more than one ailment. It has become 
almost an obsession with the general public to lay their 
troubles to some one disease. They have been abetted 
in this by their doctors and teachers. If you will recall 
the simple diagnoses that came to the postmortem room 
and compare them with the findings of that examination 
the disparity the two becomes apparent. The first 
appears as a simple item, whereas the latter resembles 
a complete bill of lading. Keeping this fact in your mind 
you can, with perfect truth, say that most patients’have 
more than one disease. 
In those cases, then, in which a definite diagnosis 
cannot properly be made, formulate a diagnosis of the 
apparent diseases until the case progresses sufficiently 
to permit you to choose the correct one. 
The Patient Must Understand the Diagnosis.—Under 
no circumstances allow your patient to be uncertain as 
to the meaning of your remarks. See to it that the patient 
understands what you say and comprehends what you 
mean. Persist in the explanation until it is quite evident 
that he grasps it and understands what has been told THE SUCCESSFUL PHYSICIAN 
270 
him. No matter what station in life your patient may 
occupy, take particular pains to use the simplest language 
possible. Anything approaching the mysterious should 
be, and most often is, construed as an insult to the intelli- 
gence of the patient. 
As soon as the patient shows that he fully understands 
what you have told him, “ any reasonable suggestions that 
you may then make will be readily followed. If they are 
not followed, it shows that your mind has traveled too 
fast for him and you must ascertain from him what it is he 
does not understand. Approach the explanation from 
some new angle until this becomes clear.” 
Strange and inexplicable things happen to doctors 
every day. Unusual and unforeseen terminations of 
cases frequently occur. Therefore one should be pre- 
pared, when making his diagnosis, to leave room for a 
change. Even though you feel that you know positively 
all that afflicts your patient, the unexpected may happen. 
It is always well therefore to add, “ barring the unknown.” 
To have some very grave condition develop suddenly 
and without apparent reason is a most trying ordeal for 
the physician. The patient may have been getting along 
ever so smoothly, when all at once, without warning, 
comes this sudden change, like a bolt from a clear sky. 
This is the possibility that accompanies every case— 
and it is for such possible contingencies that you must be 
prepared. Patients are prone to expect more of their 
physician that it is humanly possible to give. They will 
expect you to warn them of these dangers. If you have 
left no way out, for yourself, you may suffer undeserved 
blame and censure. 
This uncertainty is also a reason why no ailment 
should be regarded lightly. Certainly you should be DEMEANOR IN CRITICAL CASES 
271 
good-natured, desire for an early recovery, spread cheer 
wherever you can. A sudden change may easily occur, 
when you will regret having given your patient an open- 
ing to censure you for not telling him of the approach of 
danger. 
Prognosis 
There are about thirty thousand Christian “Science- 
less” healers in the States—one to every three thousand 
inhabitants. These people are making a comfortable 
living out of the patients who were incorrectly diagnosed or 
gloomily prognosed, or both, by regular physicians. 
A famous Chicago alienist was noted among the pro- 
fession for his facility in giving a favorable prognosis. 
He gave a favorable prognosis when most of the other 
consultants pronounced the outlook partially or complete- 
ly unfavorable. 
Be most careful and cautious in stating that a patient 
can live but a few weeks, days or hours. It is a risky 
business. It requires a wiser man than any doctor I 
know to venture such a statement and be correct. 
Almost every physician has former patients who are 
alive and well whom he has mentally or openly consigned 
to an untimely grave. 
I have met dozens of people who have derisively 
boasted of foresight superior to that of the physician 
who had made this sort of error in his prognosis. 
The safest plan is to give no certain prognosis. We 
have no insight into the future. It is very poor judgment 
to guarantee anything, and should never, under any cir- 
cumstances, be given. 
It is not practical to avoid giving the patients some 
conception of our opinion of the duration of their illness. 272 
THE SUCCESSFUL PHYSICIAN 
Patients are often more interested in this question than 
in any other concerning themselves. An answer that is 
truthful and, if possible, satisfying to the patient and 
friends is often insisted upon. One should avoid giving 
any prognosis unless it is demanded by the patient or by 
some interested person. 
You can state with absolute frankness that the dura- 
tion of sickness is uncertain: that much depends on the 
vitality of the patient as well as on his responsiveness to 
the treatment. In simple ailments, however, where the 
outcome is apparent, be outspoken. Be always cheerful 
in demeanor except where hope is gone. 
Where the patient shows constant improvement, 
and there is no doubt as to the result, encourage him as 
much as possible. You may, in appropriate instances, 
hazard a guess as to the time of his ultimate recovery. 
Flint states that “a happy face is often of more value 
than drugs.” Coleridge says that “the one who is the 
best physician is the one who can inspire the most hope.” 
It costs you nothing to be hopeful, encouraging and cheer- 
ful and to have a pleasant greeting for your patient. 
Good cheer is a wonderful aid to those who are in 
distress. We know that many men have died purely of 
homesickness—a craving, in reality, for the sight of his 
friends—of someone who has a sincere interest in his 
welfare. If a physician is all he should be, a friend 
and kind counsellor of the sick, he can bring good cheer 
that will be a distinct aid at all times, and in many 
instances will tide the sufferer over some critical period. 
This trait will make your patients look forward to your 
arrival, enjoy your visit, and speed you on your way 
until the time of your next call. An instance will illus- 
trate this: A well known physician worked for a number DEMEANOR IN CRITICAL CASES 
273 
of years as a regular graduate male nurse, and later, with 
the help gained by nursing, completed his study and 
became a doctor. He was a wonderful success. He is 
well liked personally by his friends, respected by other 
physicians for his marked ability, and almost worshipped 
by his patients. Why? These are his own words: “I 
nursed patients so long that I feel how they are getting 
on when I enter the room. I see how they feel by their 
facial expression and posture in bed. I know they cannot 
feel well if the room is untidy and the bed and pillows 
neglected.” This doctor does not consider it beneath 
his dignity to arrange the pillows, sheets or bandages, 
or supervise the sponge or alcohol rub and the making 
of the bed. He attends to the details, as experience 
has taught him that it pays to make his patients 
comfortable. 
It is rarely that a physician is called upon to do any 
of the things that custom relegates to the province of the 
nurse. It is his duty to the patient and to himself to see 
that those functions ordinarily performed by the nurse are 
accomplished. This should be a matter of regular routine 
observation on the doctor’s part. Almost every patient 
will feel better satisfied if the doctor applies the bandages 
and the dressings. In severe critical cases it is his duty 
to do everything that may assist in even the slightest 
degree in adding to the comfort of the patient or the 
possibility of prolonging his life or speeding his recovery. 
Instead of giving up when things look darkest, he will 
earn the undying gratitude of all concerned by remaining 
with the patient until the last breath. Though he may 
lose his patient, the very persistency with which he tried 
to save him will live long in the memory of those who were 
near and dear to him. 274 
THE SUCCESSFUL PHYSICIAN 
Death.—When it is manifest that death is approaching, 
lose no time in apprising the relatives and friends, so that 
they may be prepared for the inevitable. Having done 
this, it is well to request a consultation. 
The physician you call in should be well known to you 
and to the community, and should be one you know to be 
reliable, capable and friendly. 
When you have held your conference, it is quite proper 
to tell the worst immediately. Let it be known that all 
hope is gone, that everything possible has been done, and 
then depart quietly. Before leaving, however, be sure 
your instructions are written plainly on the chart for the 
nurse, in case any new developments may arise. 
Meet the interested friends courteously; explain the 
patient’s condition, and inform them when you are to see 
your patient again. To tarry too long with these friends 
may subject you to many embarrassing questions and 
have the burden of their grief added to your own. 
Prognosis in Incurable Diseases.—The diagnosis in 
such cases is usually certain, and if the patient asks 
about the possibilities of a cure, he is entitled to know the 
truth. Policy, tact and the interest of the patient may 
require that you do not tell the entire truth. Every 
physician meets conditions where it would be harmful to 
do so. This does not alter the fact that whatever you do 
tell the patient must be accurate. 
Bearing in mind the paradoxes that are presented in 
disease, it is permissible to point out any favorable 
features that are present, and also to say that certain 
unexpected conditions might bring about improvement. 
One does no harm by looking for and pointing out the 
most hopeful possibilities that could occur. But it is a 
crime to raise a hope where you believe none exists. DEMEANOR IN CRITICAL CASES 
275 
When permissible, place a mild construction on the general 
aspect of the case and select your words so that the informa- 
tion you give may be least distressing. Show sympathy 
and interest in the condition by all means. To use the 
blunt, cold, direct word “incurable,” alone and unmodi- 
fied, is cruel. Whatever is said, let conditions be what 
they may, give your candid opinion. 
The Value of Religion to the Afflicted.—There is 
scarcely a person who does not have some form of belief 
regarding the soul. Each sect and creed has certain 
peculiar doctrines, and most of them have rites that are 
customarily performed for those who are about to die. 
A devout belief in almost any sect or creed is com- 
forting, and the person who is threatened with death is 
often relieved by receiving that spiritual guidance for 
which he craves. 
Every consideration for the mental and physical 
welfare of the patient will prompt the physician to grant 
readily the administrations of such rites as the patient’s 
church demands. 
I do not believe it the province of the physician to 
perform religious rites unless he is of the same faith as 
the one he is attending. It will rarely be necessary for 
him to do so. Some one of this faith who is authorized 
to perform these rites is usually available. There are 
other reasons that should urge you to take this course of 
promptly notifying relatives and friends of the danger of 
impending or approaching death. The everlasting enmi- 
ty of the patients’ relatives and friends may be incurred 
if you do not. 
Should the beliefs of the patient and the physician be 
the same, it is permissible, in certain instances, for the 
physician to administer the rites himself, although this is 276 
THE SUCCESSFUL PHYSICIAN 
seldom necessary or advisable. Each man to his profes- 
sion is a better rule to follow. 
Due notice should be given to all parties concerned of 
the possibility or probability of impending death. This 
will permit the friends or relatives to have their own 
rites performed in their own way. 
Another reason, that is purely medical, is that the 
worry and anxiety over the possibility of death occurring 
without these rites having been performed having been 
removed, tends to calm and satisfy the patient so that a 
crisis in his affliction may be passed and he proceed to 
a recovery. 
It happens sometimes that when your patient recovers 
because of your own untiring intelligent efforts, after you 
have labored with him for days and weeks, his friends will 
calmly inform you, in a matter-of-fact way, that “it was 
the religious administration that cured him.” But it is 
the proper and right thing to do, nevertheless, and you 
can find consolation in the thought that you did for the 
patient as you would choose to be done by. CHAPTER XIV 
INSURANCE 
A physician must carry life insurance. Life insurance 
is the only method ever devised whereby a doctor—or 
any other professional man—can capitalize his chief as- 
set—his brain. A physician is essentially a student—he 
is not a business man. He does not store up assets in the 
form of “plant,” machinery, material, manufactured 
goods, stocks of merchandise, etc., which may be indem- 
nified against loss by theft and fire and converted into cash 
at his death. His skill, his knowledge, his trained mind, 
these are his capital and they vanish at his death. This 
skilled mind of his is often worth many times the mer- 
chant’s stock of goods, and the only way to capitalize it 
to provide for his own old age or for his family, is to carry 
an adequate amount of life insurance. 
A doctor must have credit—moral credit—before 
any one will consult him. And since business and moral 
credit are not only often interwoven, but also much alike, 
he should understand what constitutes the basis of credit. 
Credit is, or should be, based on three things: Character, 
ability, and emergency assets. Without character there 
is nothing, but character alone is not enough. With 
both character and ability, a man is entitled to credit, 
even though he has no assets—he can produce property. 
If he has character, which includes a willingness, a 
determination to pay, and conservative forethought 
which prepares for emergencies, and ability, which 
277 278 
THE SUCCESSFUL PHYSICIAN 
assumes that he can manage his affairs, finance his under- 
taking, look after its details, and sell his product or 
services so that there will be something to be managed and 
financed, and emergency assets which are large enough, 
and quickly convertible into cash, to pay the obliga- 
tion should his character and ability be lost by death— 
then he is entitled to full credit. 
The only emergency asset available at low cost is life 
insurance. This is as true of the banker and the business 
man as it is of the physician. Life values are, in the last 
analysis, the only true values. Goods, material, and 
good will are the outcome of life value. Life values are 
lost by death, which is certain to occur; material values 
are lost by fire, yet there may be no fire. 
Accordingly, it shows a keener insight into actual con- 
ditions to insure life values—skill and brain power— 
against certain ultimate loss than to insure property 
against a loss that may never occur. This realization is 
causing business and professional men to take on increas- 
ingly large policies of life insurance. 
When a man dies there is a loss. Losses must be paid, 
blow? By the insurance company, if there is a policy in 
force; by the man’s family, if there is none. How will the 
family pay the loss? By being reduced to a lower stan- 
dard of living, by denial of educational advantages to 
children, by unaccustomed toil by wife and children; 
possibly by charity, or by want and privation driv- 
ing children to steal food, and thus leading to a criminal 
career. 
But value of emergency assets is not confined to 
paying a man’s debts and providing for his family at his 
death. He may not die during his productive years. Of 
course, if he does not die, he will become an old man and INSURANCE 
279 
need protection himself. Statistics show that, starting 
with one hundred healthy men at age twenty-five, there 
will be sixty-four still alive at age of sixty-five—sixty-one 
have lost all their property; fifty-four are dependent 
for support on their children or other relative or on 
charity; seven are still able to work and will be able to 
support themselves for another year at least, and only three 
are able to live on the savings of their productive years. 
With this unimpeachable evidence confronting you, 
the way should be clear. You need help. You need a 
plan by which an estate for your old age can be created 
with absolute certainty. The sixty-one dependent men 
earned enough money during their productive years to 
have provided for their own old age—but they had no 
plan. 
Working alone, a man’s chances of ultimate financial 
independence are small. The fear, therefore, of the 
average man and wife that they may in old age, be prac- 
tically penniless and dependent on their children, friends, 
or the state, is well founded. If you could know, beyond 
any doubt, that a bank as strong as the Federal Reserve 
Bank would put you on its monthly payroll, without 
work, at age sixty, sixty-five or seventy, and continue to 
pay you the same amount every month as long as you live, 
your financial worries would be over. Well, one of the 
strongest financial institutions in America will do that 
very thing—and much more. It is all included in the new 
service of the Optional Endowment contracts maturing 
at age sixty, sixty-five or seventy, offered by some of the 
leading life insurance companies. These contracts anti- 
cipate a man’s intentions and enable him to do easily and 
quickly all that he may aim for in a financial way, no 
matter how hard he works. 280 
THE SUCCESSFUL PHYSICIAN 
This service presents the only method known to 
finance whereby a man can create, with absolute certainty, 
an estate for both himself and his family. If he could 
be certain that he would live, that he would not become 
disabled by sickness or accident, that some one or some 
force, would compel him to deposit a stipulated amount 
regularly, that business reverses or mistakes of judgment 
would not cause him to lose everything before he reaches 
age sixty-five—if he could know these things he could 
create an estate for his old age without the aid of any one. 
He does not, and cannot, know one of these things, and 
they are the ones on which the creation of an estate 
depends. Should he die without insurance, he leaves only 
the few deposits he has made, not the estate he intended to 
create; if he is disabled, his earning cease, and he will be 
compelled to exhaust the deposits already made. If he 
makes regular deposits in a bank for twenty years, or 
more, he will be virtually the only man who has ever done 
so without the compelling force of obligation; if he has not 
lost everything by age sixty-five, he will be one of the 
three out of a hundred. 
Therefore, when a way is presented to him by which 
he can create an estate, no matter which of these things 
may happen, he is the most reckless gambler to attempt 
doggedly a practical impossibility. 
We believe that the Optional Endowment policy ma- 
turing as a life monthly income, to begin not earlier than 
age sixty nor later than age seventy, is the best form of in- 
surance for a physician or other professional man. There 
may be times or circumstances, however, when another 
form of policy may be a better temporary protection. 
For example: A young doctor just beginning his practice, 
in order to carry as large a volume of insurance as his INSURANCE 
281 
limited means will permit, should start with an ordinary 
life policy. The premium on this plan is the lowest 
of any form of permanent insurance. As his finances 
improve he should take on new policies on the ordinary 
fife plan until he carries a fair volume of insurance, and 
then, as his finances continue to improve, he should 
begin to convert these Ordinary Life policies into Optional 
Endowments. This he can do merely by paying the 
difference in the reserves (cash values) of the two forms 
for the years carried. For example, an Ordinary Life 
taken at age twenty-five and carried five years has a 
reserve cash value of $45.76 for each $1000; an Optional 
Endowment at age sixty taken at age twenty-five and 
carried five years has a reserve value of $80.25. By pay- 
ing the difference of $34.49 the Ordinary Life can be con- 
verted into an Optional Endowment at sixty. In the 
same way the Ordinary Life can be converted into a 
Twenty-Payment Life, or any other form with a higher 
premium rate, without any question of insurability. 
We strongly recommend the Ordinary Life to the 
young doctor provided he keeps in mind the plan of 
converting it when his volume of insurance is substantially 
all he desires. 
If a doctor finds himself temporarily in financial 
straits, or if he borrows money, or assumes an obligation 
such as a mortgage on a property he intends to buy, 
etc., he may take term insurance. Term insurance 
should never be taken as permanent insurance because 
it carries no reserve or cash value, and therefore does 
not provide for one’s old age. Term insurance is written 
for a limited number of years, at the end of which time it 
expires, the same as fire insurance, the premium covering 
the actual risk of death only during the term period. 282 
THE SUCCESSFUL PHYSICIAN 
A term policy, however, may be converted, on medical 
examination, into any form of permanent insurance during 
the conversion period specified in the policy. Term 
insurance rates are very low. 
In addition to fife insurance, a physician should 
carry total and permanent disability insurance, which 
most of the reliable fife insurance companies now combine 
with their life policies. He should also carry an accident 
and health policy, such as is now issued by the better 
class accident insurance companies. He should like- 
wise carry a physician’s liability policy as a protection 
against suits for malpractice. Such a policy should be 
obtained from a responsible surety or liability company. 
This matter is treated more explicitly in the chapter on 
“The Doctor and the Law.” CHAPTER XV 
VACATIONS AND HOBBIES 
Hobbies and Health.—The first as well as the last, and 
most important, thing in the practice of medicine is to 
retain your health. 
It is a sort of paradox to speak of health in writing a 
book to and for doctors. It appears presumptive on 
first thought. But observations, personal experiences, 
and investigations of health records show that many 
physicians are slow to follow hygienic principles and that 
many of them become insane from overwork. The doctor 
who knows the ways of health and disease often neglects 
himself. 
There is no calling that makes so strong a demand for 
good health, and but few compel their followers to break 
so many of the rules that go to make for health. 
The practice of medicine requires that the successful 
man must be mentally, physically, and morally strong. 
The race for success in this day as in those past goes to the 
strong. What profession draws harder on mental, physi- 
cal or moral strength than does the practice of medicine? 
The hours are long, the work of medicine or surgery is 
difficult and exacting, and the temptations are many. To 
meet those exacting requirements, one must have health 
and strength. 
The human organism has not yet completely adapted 
itself to the tension of modern fife, according to the New 
York Conservation Commission, and this “constitutes 
283 284 
THE SUCCESSFUL PHYSICIAN 
one of the greatest social and physical menaces of the 
day.” We see many people whose ailments are directly 
traceable to overwork. Dr. Brady, of the N. Y. Con- 
servation Commission, has well put it—“the struggle in 
business life today is a long-drawn-out fight against 
fatigue. You dare not rest for fear of being left behind.’’ 
If physicians would only apply their knowledge to 
themselves, there would not be so many wrecks. All 
have watched the man who has run for miles in a race— 
at its close the contestants are each running as hard as 
when they first started. But how fast are they going? 
Each one is putting forth his maximum effort—but his 
speed is only a fraction of that of the fresh runner. This 
comparison applies to the doctor who works continuously 
and the one who takes an occasional rest. 
The physician who works all day and part of the night 
may believe he is making speed. He is certainly putting 
forth all the effort he has, but neither his mind nor his 
body is capable of expert judgment or quick action. He 
is poisoned by the toxins of fatigue. It can be shown that 
the great bulk of accidents happen early in the beginning 
of the day’s work or near its close. In the morning the 
faculties have not become completely focused on the job 
in hand; at the close of the day they have wandered 
because of fatigue. The wonder is that more gross 
mistakes are not made because of these very things. 
If a physician is to get the greatest service out of his 
mind and body, he must make provision for play hours as 
well as for working ones, for when one works continually 
there will come a time when he will not know how to play. 
Like the mender of shoes, who is usually imperfectly shod, 
and the tailor, who is improperly clad, and the carpenter, 
who is poorly housed, so is the doctor poor in health. VACATIONS AND HOBBIES 
285 
Every medical man should consider taking his vaca- 
tion when his cares begin to keep him from sleeping at 
night. It does not take many hours of sleep to effect 
repair when the sleep is sound, but when it is only a 
partial sleep, one wakens and feels quite as bad as when he 
went to bed. The best thing to do in such a condition is 
to cultivate a hobby, if you do not already have one. 
If your health is poor, all your attainments will be 
worthless. With all your getting, get health. For 
the man who does not have a moderate amount of health 
will find that when his health is gone, his practice has 
gone with it. 
How can a man have a cheerful face and a pleasant 
smile and give a hearty hand grasp if he is sick? Just 
recall the sickly smile that the convalescent tries to wear 
when you call. That is about how you look when you 
call on a patient and try to make him think you are happy. 
The world is not going to stop revolving if you go away for 
a time. People will continue to get sick after you return. 
If you build a thriving practice from nothing, your reputa- 
tion will certainly survive a few days, absence from your 
work, and the added energy you have on your return 
will more than compensate for the little you will lose. 
Physicians deprive themselves of more than they can 
conceive by being sparing in the matter of vacations. 
“Economize on everything else rather.than on this. On 
this the very well-spring of your being depends. Health 
is the pearl of great price, for which, if need be, we should 
be willing to exchange all our possessions. Without it all 
else is powerless to make us happy. Many a man has 
bartered his health for millions and sighs for what wealth 
cannot restore.”* Doctors see this everyday. In spite 
* Orison Sweet Marden—Success Magazine, Jan., 1921. 286 
THE SUCCESSFUL PHYSICIAN 
of this, they go on working and slowly abuse their most 
valuable possession, heedless of the misery all about 
them, each one chasing some particular phantom, which, 
once gained, they believe will make them happy. Should 
they gain the coveted prize, it but serves as a pinnacle 
from which they can see other great vistas spread out 
before them that must be reached, and another plunge is 
taken. In this chase that essential thing—health—is lost. 
With its loss all other things become valueless—with all 
your getting, get health. 
It is a wise saying that it is better to wear out than to 
rust out. Good judgment doesn’t warrant one in doing 
either. The finest steel will crystallize with constant use 
and decompose with idleness. Its greatest use is de- 
veloped only by alternate periods of use and rest. 
The finest minds can be and often are driven to exhaus- 
tion. They can and do become useless through indolence. 
To obtain the maximum of their efficiency, there must be 
alternate periods of work and rest. 
The greatest thing to relieve the mind, to give it rest, 
is to pursue some hobby. The farther this hobby is 
from the surroundings and conditions of your profession, 
the greater good will the change accomplish. 
The special object one may be attracted to does not 
matter, just so it affords interest and pleasure. Actually 
one might go through a certain course daily of his own 
volition and keep in fine physical and mental condition. 
In practice this does not work out because the great 
majority simply will not adhere to it. Physical culture ex- 
perts recognize this failing of their clientele and aim to instil 
friendly competition into the pastime. One must have 
company when one plays, and for this reason should seek 
that pastime that would attract congenial companions. VACATIONS AND HOBBIES 
287 
Local conditions and personal inclinations will govern 
the choice. To many hunting is the sport supreme. It 
combines all the elements of exercise and in addition calls 
in use all the mental faculties. Any bird hunter will 
testify to the scheming and planning required to match 
the instinct of self-preservation possessed by all the 
feathered tribe. The hunter of deer knows full well 
that only if fortune favors him can he expect to outwit 
his game. 
It is obviously impossible for me even to suggest to 
others the particular form of recreation that would suit 
them. The point is that each and every one should have 
something to break the monotony, fatigue and worries; 
change is the important thing. The particular vehicle 
by which this is accomplished is the least important 
factor. The newly rich father was told to take his 
daughter out of the special school, and in answer to his 
inquiry for the reason was told that his daughter did not 
appear to have the proper comprehension; he said: “I 
will buy her one.” If you do not find a hobby convenient, 
go out and hunt one. At all events, acquire one, and 
ride it to the point that you find that relaxation that all 
must have. 
Tennis, golf, hiking, horseback riding, hand ball— 
anything will do for a hobby so long as it takes your 
mind off your work and gives you mental and physical 
recreation. 
Locality and inclination will influence you in the 
choice of your hobby—but get one and ride it. CHAPTER XVI 
GRIST FROM THE MILL OF EXPERIENCE 
The following quotations and adaptations are from 
the works of noted medical and other authors and their 
advice may well be heeded by the young physician. 
Learn early and remember well that every patient that 
comes into your office comes from and is a loss to some 
other doctor, so—treat them all and get all the patients to 
come that you can, for your competitors are doing the 
same. 
“Do your new patients return? If not, find out why. 
If you make NO mistakes, you are the only one known 
in the practice of medicine who does so—but, having 
made them, do not show your poor judgment by getting 
angry when told of them. It will be of immensely more 
value to you to be told of your failures with patients than 
of your successes. The successes you know; the mistakes 
you did not know, or they would not have been made.” 
Keep your own counsel regarding the details of your 
patient’s affairs. If there is to be any talking, let them 
do it. Your friendly patient of to-day may be your 
bitterest enemy to-morrow. So be careful what you 
say to him. 
Do not preach morals to patients! You are hired to 
treat ailments—not to expound on theological topics. 
Let others who have been trained for this work do this. 
Keep your religious views to yourself. Your patient 
has just as positive opinions on these topics as you have. 
288 GRIST FROM THE MILL OF EXPERIENCE 
289 
To get into a controversy with him will only tend to make 
him drift to some one else. 
“Never explain—you will not need to explain to your 
friends and your enemies will not believe you.”3 
Endeavor to determine when patients are becoming 
dissatisfied and ask for a consultation or withdraw from 
the case before they ask for a consultation and dismiss 
you. 
What lies in store for your patient behind the veil of 
to-morrow is unknown. You can, therefore, guarantee 
them nothing. 
Modify your treatment at all times when it is possible 
to suit the desires of your patient. 
Remember what you say to your patients and see that 
your later statements agree with your first. You will 
have many to remember and he has only his own case 
to keep track of—and will remember all you tell him. 
Be sure that your statements are the same each time. 
Only notes made at the time of your conversation, and 
covering the substance of the same, can be relied upon. 
“ It requires the same amount of medical skill, sterling 
virtue, and expenditure of time to treat the indigent as the 
well-to-do or rich. Apply your efforts in the direction of 
eliminating the no pay or poor pay patients. 
“The disparity that exists between the income of the 
medium to poor city doctor and the one in great demand 
is not so much in the number of patients visited each 
day but in the amount each one pays. 
“Patients seldom put any great value on the services 
of a doctor when they get them for nothing. We appre- 
ciate those things most that are the hardest to obtain, and 
that cost us the greatest personal privation.”2 
Patients will argue, complain and object to paying a 290 
THE SUCCESSFUL PHYSICIAN 
legitimate fee for a difficult operation, and yet if they are 
really satisfied will boast to their neighbor about paying 
this large bill. 
“ Keep a list of your old patients. Look up this list in 
one or two years and see how many are coming back to 
you. This will give you food for serious thought.”2 
When a patient calls you because he could not locate 
his own doctor, do not act as if you were doing him a 
favor—this will not make him call you again. 
“Never neglect your present patient for the supposedly 
promising one in your reception room or elsewhere. 
Your present patient is Your Opportunity. A patient 
in your consultation room is worth more than a dozen 
prospective ones.”2 
Make it an unfailing rule to learn how and why each 
patient comes to you. In each case send a letter of 
appreciation to the one who recommended him to you. 
“You will need to be popular. This will require you 
to be patient with many a tedious complaint, old chronic 
grumbler, and other nuisances. Every business has in it 
many unpleasant features and ours is no exception. 
“Some patients growl and grumble from force of 
habit. Try to discern the growlings of an old chronic 
from a real complaint. 
“When you can make the strange patient feel that you 
are not only friendly but his friend, he is no longer a 
stranger. 
“You may be too close fisted with your patients and 
friends or too absent minded to hand out a cigar occasion- 
ally. The results, in either case, are identical. 
“Being pleasant to your grouchy patient will not 
change his temperament, but it will change his estimate 
of your character and good will flow to you from this 
changed attitude. GRIST FROM THE MILL OF EXPERIENCE 
291 
“When occasion demands that you change from the 
established rule of treating patients in their turn, see that 
the reasons for the change are good ones and that it is 
agreeable to those who are made to wait.”2 
It is costly for the physician to indulge himself in the 
privilege of saying what he thinks—and his popularity 
will be affected inversely to the amount he indulges in 
this practice. 
“If a patient gets angry and raises his voice, don’t be 
foolish and do the same thing. A fight with a patient 
in your office will help your practice about as much as a 
scandal.” 
“The way to head off competition in practice is to keep 
working. If this will not bring out your best qualities, 
you are not made of the right stuff. Tell your patients 
what you can do: they will find out about the other 
doctor themselves.”5 
“ If a patient cannot pay a small bill, be sure that it will 
not be any easier for him to do so when it gets larger. ”2 If a 
man cannot pay one week’s board, how can he pay two? 
Is the question a large hotel owner always asks. 
Do not endorse papers—you are a doctor and not a 
banker. If you must do something, lend your patient 
the cash or refer him to someone who is in that line of 
business. 
Pay your bills when they are due, or see that those 
to whom you owe money are informed of your inability 
before the promised date of payment. 
“You can set medicine up on a pedestal if you want to 
and delude yourself into the idea that you are of the Lord’s 
anointed, and as such entitled to special privileges. But 
when you get right down to brass tacks, it is just as well 
to mingle vaingloriously with the multitude and gather 
in the cash the same as other folks.”6 292 
THE SUCCESSFUL PHYSICIAN 
“Because you did well in your practice this year, do 
not get the old hammock ready for the coming year and 
think it will keep coming. The only way you can keep 
it coming is to work at your practice all the time. 
Patients are not going to come after you—you must go 
more than halfway to meet whatever practice you get. 
What preparation have you made to find out the names of 
the people who have moved into your neighborhood P”2 
“You must treat the children right if you intend to 
stay in practice. They grow up quickly. They will go 
to the doctor that they feel friendly toward.”2 
“Necessity, pressure, excitement, crowd contagion, are 
things which bring out our full energies—while worry, 
despair and fear are the ones that hold us back.”4 
“The best rule to follow is to do the best you can and 
not worry.” 
“To say ‘No’ requires the highest power of the mind 
and requires the most energy.” 
“Have something to give your patient that he wants. 
Your work must be appreciated. Make it a point to 
please patients. No one lowers himself in pleasing his 
clientele. 
“Be determined to serve your patients better than 
they were ever served before. Know that whatever has 
been done by other doctors can be done by you, if you will 
properly prepare yourself to do it. Know that whatever 
has been done by doctors can be done better by you if you 
go about it with sufficient preparation. Nothing gives 
one greater satisfaction than to note professional progress. 
“If the doctor looks common, he will think common. 
So both mind and body should be well dressed. ”5 
Telephone your convalescents and inquire of their 
progress. If they are going on a long journey, ask them 
to write you of their condition. GRIST FROM THE MILL OF EXPERIENCE 
293 
“Be tolerant of the whims of the sick—and never 
accuse of malingering unless you are certain.”1 
“It is well to cater to high class patients—do not for- 
get that the masses are more numerous. The plain 
patients require the same courteous treatment as the 
exclusive set. Be impartial in your politeness to all 
patients. 
“You gain nothing by arguing with a patient—go on 
the policy of some of the great department stores and 
hotels—‘The patient is always right.” To argue with 
your patients may win arguments for you and lose 
patients at the same time. To even intimate that the 
patient is a liar is to invite him to go to some other doctor 
—and this is just what he will do. 
“Try to find the points that you and your patients 
agree upon.”2 
When a patient begins to argue about the size of your 
proposed fee, do not become impatient—this patient is 
calculating how he can meet the obligation. The man 
to be afraid of is the one who says, “Go ahead, I do not 
care what it costs.” 
“ It is the quality of the service you give a patient, not 
the price, that he will remember and that will make him 
come back or stay away. 
“Whatever price you make to a patient, do not say it 
as if you were ashamed. If this patient should argue 
about the price, it is your duty to show him the reason- 
ableness of the same in view of the difficulties of the case 
and the amount of work that the treatment entails. 
Except from force of habit, a man will not argue about the 
price if you have shown that you are giving him full 
value for his money.”2 
“It will be difficult to satisfy patients if you get them 294 
THE SUCCESSFUL PHYSICIAN 
in the habit of expecting too much for their money. The 
hardest show-crowd to please is the one that gained admis- 
sion on passes. People appreciate what it requires effort 
or expense to obtain. 
“Politeness to patients begins at the telephone. It 
will be difficult to get patients to come to your office if 
you are short or gruff with them on the phone.”2 
Tell patients who need further attention and who do 
not seem inclined to seek it that you will return the follow- 
ing day unless you hear from them to the contrary. 
“Never compel, force or make a patient do anything. 
You can usually win a patient to do anything if he has 
any reasoning mind left. 
“Never allow yourself to be angry with a patient under 
any circumstances whatever. You may be very strong, 
firm in argument, unbending in urging your claim and 
insistent on obedience as you please—but never more than 
this. 
“Always take a patient’s word without questioning, 
unless you have the best of reasons to doubt—and then 
give your reasons. 
“ Direct your best mind to the making of your patients 
well. If you take a case because you think you can suc- 
ceed—put every other consideration aside save your deter- 
mination to bring the patient to his normal self. 
“The spirit that prompts getting the best results in 
every case undertaken will also profit better than any 
other in the end. 
“When you benefit others, you benefit yourself. 
Teach this truth to your patients—patients that may 
have become selfish, self-centered or self tearful—to be 
carried out with success with the patient, your desire to 
benefit him must be the whole truth. GRIST FROM THE MILL OF EXPERIENCE 
295 
“Arguments with the reasoning mind are much less 
effective than reason directed to the subconscious. To 
carry this out, gather your patient’s ideas in simple con- 
versation, making notes of the important features. Then 
talk to those conditions. When you find them giving the 
right answer, the subconscious mind will retain and enter- 
tain the right idea. This will ultimately correct the 
conscious mind.”1 
Though there are millions of people in the world, there 
are no two individuals who are identical in all respects, 
in appearance, mentally, morally, in their reaction to 
disease, food or medicine. One will do well to inquire 
of the chronic or periodic sufferers if there is any drug or 
food they cannot take. In this way one will avoid some 
embarrassing reactions of drugs and respect the informa- 
tion the patient may give in regard to this idiosyncrasy. 
No case comes to mind where the patient misled the doctor 
in this regard. I have frequently had patients who have 
endeavored to explain to me this peculiarity of theirs to 
some drug. If the information is not heeded serious 
trouble may come to the patient as a result. Two cases 
illustrate this peculiarity to a drug, both in the hospital for 
pernicious vomiting, both giving similar indeterminate 
histories, both objecting to the stomach-pump for the test- 
meal. They were given apo-morphin. One almost died, 
the other was relieved temporarily. 
“The more you educate your patients to pay cash the 
more they will do it.” 
“If you can say a word that will induce your patients 
to pay cash, say that word. 
“No patient’s word is as good as cash right in hand.”2 
“ When a patient asks for a statement so as to pay his 
bill, have it ready. To ask him to wait or to come at some 296 
THE SUCCESSFUL PHYSICIAN 
other time is the common and unpardonable sin of many 
physicians. 
“ The most important patient you will ever have is the 
one who will pay cash for the services you render. Know 
this man and all about him. This patient and others like 
him will pay your bills and make you comfortable.”2 “He 
that sells on trust, loses many friends and always wants 
money. ’ ’—Franklin. 
“You must know which patient to trust or begin look- 
ing for a good collector—one who makes this his whole 
business.”2 
The doctor, who loses his suits for valuable services 
rendered; who is made ridiculous in court in cases of injury 
and is forced to pay damages for alleged malpractice, is 
the one who has no accurate record of his visits, no notes 
or observations about the case, and the business attached 
to it. 
“If you are to grow you must have system in your 
office. This system must fit your business. Adopt this 
system when you first start in practice, for a good system 
will make a better doctor and a more successful practi- 
tioner. See that the medical system you adopt facilitates 
your practice and is accurate. 
“ The filing of records of cases will take some time, but 
when you do need the record of a case you will need it 
acutely. See that these records are placed so that you 
can find and use them. 
“A bill for services rendered is certainly uncollectable 
when you quit trying. 
“Have your bills to patients correct and you will not 
need to apologize or correct mistakes.”2 
“ If a patient cannot pay for his first visit and does not 
return because you asked him for your fee, you are only GRIST FROM THE MILL OF EXPERIENCE 
297 
out one call—had he treated for months the result would 
have been identical so far as payment was concerned— 
you lose in both instances—in the first only one call, in 
the other, months of effort. 
“A verbal understanding with a patient becomes a 
legal misunderstanding if one of the parties dies, forgets 
or changes his mind.”2 
Authorities referred to: 
1. Hayden Brown. Advanced Suggestions. Wm. Wood and Co. 
1919. 
-\Z. Modified from Frank Farrington. Selling Suggestions. The 
Ronald Press Co., 1913. 
3. Elbert Hubbard. The Roycrofters. 
4. Wm. H. James. The Energies of Men and The Gospel of 
Relaxation. H. Holt and Co., 1911. 
5. Christian D. Larson. Business Psychology, Thomas Y. 
Crowell Co., 1912. 
6. Fred I. Lackenbach. Town Topics, San Francisco, July, 1920. INDEX 
Ability, changing of, into income, 98 
Accounts, old, collection of, 165 
Advertising, 107 
by means of apartments, 109 
of civic organizations, 108 
of clinics, 112 
of colleges, 112 
of commercial clubs, 108 
of hospitals, 112 
of hotels, 109 
of newspapers, 110 
of papers, 110 
of public generally, 109 
of societies, 107 
of telephone book, 110 
Alcohol, use of, 39 
American Medical Association, prin- 
ciples of medical ethics of, 250-260 
Anesthetist in hospital, 132 
Apartments, advertising by means of, 
109 
practice in, 115 
Appearance, personal, 34 
Assistant to another doctor, 136 
Attendant, office, 148 
Automobile, 150 
Autopsies, consent to, 227 
Bag, Chicago, 153 
medical, 153 
of city use, 154 
obstetrical, for country use, 155 
surgical, for country use, 155 
Banks, care of employees, 126 
Beneficial societies, care of members, 
135 
Bills, 206 
Blanchard, 237, 238 
Brady, 284 
Broadmindedness, 35 
Burbank, 26 
Brown (Hayden), 297 
Business side of profession, 98 
stationery, 146 
Card system, 159 
Cards, personal, 145 
Carlyle, 13 
Carnegie, 114, 171 
Chart method, special daily, 159 
Cheer, good, 21 
Cheerfulness, 2C5 
Chicago bag, 153 
Choice of location, 65 
how to make, 70 
Christian, 297 
Chronic case, faith in, 49 
Civic organizations, advertising by 
means of, 108 
Civil malpractice, 223, 224 
Cleanliness, 34 
Clinics, advertising by means of, 112 
Clubs, commercial, advertising by 
means of, 108 
Coleridge, 272 
Collection of old accounts, 165 
Colleges, advertising by means of, 112 
Commercial clubs, advertising by 
means of, 108 
houses, care of employees, 125, 126 
Communications, confidential, 230 
Confidence, 23 
of patient, 42 
Confidential communications, 230 
Consultants, choice of, 234 
Consultation room, 140 
299 300 
INDEX 
Consultations, benefits and dangers, 
236 
Contract practice, 246 
Contracts, 220 
enforceable in law, 220 
express, 220 
of physician, 221 
when bound, 222 
when not bound, 221 
implied, 220 
Contributory negligence of patient, 
223 
Court, physician in, 215 
discrediting testimony, 216 
Criminal malpractice, 223 
Critical cases, demeanor in, 261 
Culbertson, 231 
Daily office journal, 157 
Death, 274 
Decisions, quick, 38 
Declarations, dying, 215 
Demeanor in critical cases, 261 
toward nurses, 193 
Demosthenes, 34 
Department stores, care of employees, 
125 
Diagnosis, 261 
deciding upon, 267 
method of making, 261 
understanding of, by patient, 269 
Disability insurance, 282 
Discoveries, new, 37 
Dishonesty, 15 
Dress, proper, 34, 35 
Drug habit, 38 
Drugs, office dispensing of, 144 
Dunglison’s definition of tempera- 
ment, 28 
Dying declarations, 215 
Employees of banks, care of, 126 
of department stores, care of, 125 
of factories, care of, 127 
of mines, care of, 133 
of railroads, care of, 128 
of street car companies, care of, 130 
Energy, 104 
English, use of, 32, 33 
Environment, 25 
and heredity, 26 
Ethics, 232 
of American Medical Association 
principles of, 250-260 
Examination of patients, 47 
Experience, mill of, grist from, 288 
Expert, essentials of, in malpractice 
suit, 214 
witnesses, 216 
Express contract, 220 
Factories, care of employees, 127 
Faith, 48 
in chronic case, 49 
Farrington, 297 
Fees, 53 
law in regard to, 228 
liability of other persons for, 229 
Flattery, 59, 60 
Flint, 272 
Fraternal societies, 108 
Friends, loyalty to, 18 
Goe, 114 
Good cheer, 21 
fellow habit, 39 
nature, 21 
Graduate nurse in hospital practice, 
197 
in private practice, 197 
Gratitude, 54 
Greeley, 70 
Grist from the mill of experience, 288 
Habits, 37 
drug, 38 
good fellow, 39 
of regularity, 38 
Health and hobbies, 283 
Helps, 114 
Heredity and environment, 26 
Hobbies, 283 
and health, 283 INDEX 
301 
Honesty, 15 
Hospital, advertising by means of, 112 
and physician, 183 
anesthetist in, 132 
practice, graduate nurse in, 197 
Hotels, advertising by means of, 109 
practice in, 115 
Houses, commercial, care of em- 
ployees, 125, 126 
Hubbard, 26, 69, 100, 297 
Implied contract, 220 
of physician, 221 
when bound, 222 
when not bound, 221 
Impressions created by office, 43 
Income, changing ability into, 98 
Incurable diseases, prognosis in, 274 
Industrial accident insurance com- 
panies, care of patients for, 121 
Insincerity, 14 
Instruments for office use, 143, 144 
Insurance, disability, 282 
liability, 282 
life, 277 
malpractice, 210, 213 
Integrity, 15 
Investments, 169 
first, 171 
method of making, 173 
James, 105, 297 
Journals, medical, 152 
Knowledge other than medicine, 105 
Laboratories, position in, 131 
Lackenbach, 297 
Language, 32 
Law and physician, 210 
Learn from life, 63 
Liability insurance, 282 
Liar, 14 
Library, 151 
Life insurance, 277 
companies, examination of 
patients for, 124 
learn from, 63 
Liquor, use of, 39 
Location, choice of, 65 
how to make, 70 
Loyalty, 17 
as asset, 18 
to friends, 18 
Malpractice, civil, 223, 224 
criminal, 223 
insurance, 210, 213 
suit, essentials of expert, 214 
how to avoid, 210 
to prepare defense in, 213 
Management of office, 138 
Marden, 285 
Mark Twain, 29 
McCaskey’s practical office system, 
161, 163 
Medical bag, 153 
of city use, 154 
journals, 152 
Society, 88 
Medicine, knowledge other than, 105 
practice of, object of, 243 
Meeting people, 89 
Memory, 30 
aid to, 32 
development of, 30 
Mens sana in corpore sano, 28 
Mill of experience, grist from, 288 
Mind, open, 37 
Mines, employees of, care of, 133 
Mitchell, (E.V.), 33, 215 
Mitchell (S. Weir), 264 
Money, investment of, 169 
Miinsterberg, 12 
Narrowmindedness, 35 
Nature, good, 21 
Neatness, 34 
Negligence, 223, 224 
contributory, of patient, 223 
New patients, method of handling, 45 
strangeness of, 45 
Newspapers, advertising by means of, 
110 302 
INDEX 
Nurse and physician, 193 
demeanor toward, 193 
graduate, in hospital practice, 197 
in private practice, 197 
office, 148 
practical, 199 
visiting, 198 
working, 198 
Nurses, 206 
Obstetrical bag for country use, 155 
Office attendant, 148 
dispensing of drugs, 144 
equipment, 138 
attendant, 148 
automobile, 150 
consultation room, 140 
dispensing of drugs, 144 
instruments, 143, 144 
library, 151 
medical bag, 153 
journals, 152 
nurse, 148 
operating room, 141 
periodicals for reception room, 
152 
personal cards, 145 
reception room, 139 
signs, 145 
stationery, 146 
telephone, 146 
treatment room, 141 
impressions created by, 43 
management, 138 
nurse, 148 
stationery, 146 
systems and accounts, 156 
card system and special daily 
chart method, 157 
daily office journal, 157 
McCaskey’s, 161, 163 
pocket visiting list, 156 
Operating room in private practice, 
141 
Osier, 69 
Overdress, 35 
Papers, advertising by means of, 
110 
Patients and physicians, 204 
classes of, 42 
confidence of, 42 
contributory negligence, 223 
duty of physician to, 210 
examinations of, 47 
how to attract, 41 
to hold, 41 
new, method of handling, 45 
strangeness of, 45 
representations of physicians to, 
228 
Periodicals for reception room, 152 
Personal appearance, 34 
cards, 145 
Personality, 11 
and' temperament, difference 
between, 12 
definition of, 11, 12 
development of, 12 
essential to success, 11 
Pharmacist and physician, 183 
Physician and hospital, 183 
and law, 210 
and nurse, 193 
and patient, 204 
and pharmacist, 183 
duty of, to patient, 210 
implied contract of, 221 
when bound, 222 
not bound, 221 
in court, 215 
discrediting testimony, 216 
representations of, to patient, 228 
Pocket visiting list, 156 
Practical nurse, 199 
Practice, contract, 246 
of medicine, object of, 243 
various forms, 115 
Precedent, 35 
Prescriptions, writing of, 187 
Principles of medical ethics of Ameri- 
can Medical Association, 250-260 
Professional salesmanship, 57 INDEX 
303 
Prognosis, 271 
in incurable diseases, 274 
stating of, 261 
Psychology, 63 
Railroads, care of employees, 128 
Reception room, 139 
periodicals for, 152 
Reliability, 40 
Religion, value of, to afflicted, 275 
Rest, 39 
Rockefeller, 171 
Room, consultation, 140 
operating, in private practice, 141 
reception, 139 
periodicals for, 152 
treatment, 141 
Roosevelt, 13 
Rounder, 49 
Sage, 171 
Salesmanship, professional, 57 
Self-confidence, 23 
Selling yourself, 57 
Ships, practice on, 134 
Signs on office, 145 
Sincerity, 13 
Sleep, 39 
Smiling, 21 
Smith (Adam), 243 
Societies, advertising by means of, 
107 
beneficial, care of members, 135 
fraternal, 108 
Stationery, office or business, 146 
Stores, department, care of employees, 
125 
Street car companies, care of em- 
ployees, 130 
Success, personality essential to, 11 
Surgical bag for country use, 155 
Telephone, 146 
book, advertising by means of, 110 
Temper of witness or expert, 220 
Temperament, 28 
and personality, difference between, 
12 
Dunglison’s definition, 28 
Temptations, 37 
Testimony, discrediting of, of physi- 
cian in court, 216 
Thrift, 169 
Tillotson, 14 
Tradition, 35 
Transient patients, 150 
Treatment room, 141 
Trust, 48 
Truth, 205 
Vacations, 283 
Vices, 37 
Visiting nurse, 198 
Webster’s definition of personality, 
11 
Whitehead, 98 
Witnesses, expert, 216 
Woolworth, 171 
Working nurse, 198 
Writing of prescriptions, 187