Selected writings of John M. Scudder.
Related entries: Medicine as a Business
Dr. Scudder believed it the greatest kindness to man to let him work out his own salvation. He believed in toil and that the laborer was worthy of his hire. He saw no reason why the doctor (the worker) should not be pecuniarily rewarded for his labor and had no patience with those who flaunted the charity plea, provided those who were benefited were at all able to recompense the doctor for his services. No man would more quickly step out of his way to do his fellow-man good than he, but be would not injure him by making him a dependent where it was at all possible to avoid such a course. He taught physicians that in taking care of themselves pecuniarily they were best able to render humane and necessary service to the physically distressed.—Ed. Gleaner.
MEDICINE IN A PECUNIARY POINT OF VIEW.—We hear much said of the Samaritan-like character of the physician, of ministrations to sick, smoothing the couch of the sufferer, standing between death and his victim and warding off the fearful shaft, of the care of the poor, needy and suffering, ad nauseum, but nothing of the mercantile character of the profession. Something of all this "fourth of July buncombe" is true, for physicians have like sympathies with other men, but to suppose that this is the mainspring of action, is a joke too broad for even very credulous people. In fact such statements would never be made but to gratify a puerile pride that physic is a great charity, and the sooner it is stripped of this false mantle the better it will be for the physician and the patient.
If the practice of medicine is a charity, of course the sick have no right of complaint. The man begging for bread should not stop to inquire if it was aerated, yeast, buttered, toasted, or what not; if given, it should be received in the humble spirit of a man getting more than his deserts. So it has been to some extent with the doctor. As a charity, he has not felt the common incentives to diligence in study and investigation, and in the improvement of his art. He follows the old routine, uses the old methods, keeps things at loose ends both in his head, his office, and his business, and meets with poorer success pecuniarily than he does in practice.
As years have passed, and I have been thrown in contact with hundreds of physicians of various schools, I have become more and more satisfied that physicians do not work for charity more than other men, and this mantle under which they are constantly trying to creep, blinds only themselves. The public regard the doctor as they do the shoemaker and grocer—as a man trying to make money, but with this difference, that there is doubt whether he should have it or not, seeing that physic is a work of love and not of money.
This statement of affairs will grate harshly on many a doctor's ear, and he will hardly be willing to admit the conclusions at first, but as they become familiar he will readily acknowledge them. For my part, I practice medicine for the same reasons that I would plant corn or build houses if I was in other positions. Of course other worldly motives creep in, pride of position, rivalry and desire to excel, the approbation and praise of patrons, etc. All of this, recollect, is natural, and does not stand in the way of any amount of good feeling, charity, and all the other virtues which the physician is supposed to have in excess.
I hold that the true view of medicine is, to regard it as a merchantable commodity, and have it governed by the usual laws of trade. Thus A and B have medical knowledge and skill to sell, C and D are consumers. In ordinary circumstances the latter would cultivate the faculty of examining the merchandise offered, and the first would find the demands upon them governed by their intrinsic value, and by any fictitious value they could put upon their services by suavity of manner and extra means of pleasing. If we examine into the history of physicians who have had more than ordinary success, we will find that in the majority they have adopted means similar to those that would guide the successful tradesman.
If I employ a mechanic, I always prefer one that looks thrifty, because thrift and good workmanship usually go together. If I were to call a physician I should select one that had the appearance of being well-to-do, dressed well, was cleanly, kept a nice office, and drove a good horse, for these are evidences of business. And as the idea of a good physician presupposes education, I should expect him to have the appearance and address of a gentleman. Almost every person looks at the matter in this light, and though we have examples of success with rough, uncouth physicians, they are very rare. On the contrary, we not infrequently hear how Dr. so and so rode into practice with a fine horse and carriage, and another of large abdominal proportions but small brain assumed the airs of wisdom, studied attitudes, and set phrases, and passed for genuine coin: all this is familiar, and serves to point the moral.
That physician who puts in practice the same rules that govern successful trade will always succeed. There is first the pleasing exterior, well-clad, cleanly, genial, kind, a recognition and pleasant word for every one, as has your merchant. There is next the cozy office, clean, everything in order, evidencing business, as has your storekeeper. Then there is the well-stored library, sufficiently used, medical periodicals, new books and apparatus, showing progress. The well-timed remarks, the careful husbanding of resources, the ready knowledge which manifests itself in cases of emergency, evidencing preparatory education. This is a live man; he makes a business of his profession, he is always up to the times, he treats his patients well, gives them pleasant medicine, cures them quickly, presents his bills promptly, and gets his money. He does it all as a matter of business, and yet receives all the extra compensation of kind words and thoughts, and has just as kindly feelings, and is far happier in the end than if he were persuading himself that he acted from some other motive.—SCUDDER, Eclectic Medical Journal, 1866.
The Biographies of King, Howe, and Scudder, 1912, was written by Harvey Wickes Felter, M. D.