DOCTORS AND ADVERTISING.
[To THE EDITOR OF THE " SPECTATOR."J SIR, —I should feel obliged if you would allow me space to correct certain statements in the article on "Doctors and Advertising" in your issue of June 10th. To begin with, I would say in general terms that instead of the medical pro- fession being indebted to the Medical Council, as you suggest,
for keeping up its morale and the honour of its members, it is mainly owing to the action of that same Medical Council in the past that the present unseemly wrangling between the doctors and the clubs is due; and, further, that what you regard as the chief virtue of the Council, viz., its refusing to protect the profession in its legitimate fees, is gradually leading to its ruin. For a professional fee is not, it is to be observed, of the same nature as a commercial transaction, which depends entirely on the supply and demand of the market at the time, but is rather of the nature of a charter, where the price of a service is guaranteed beforehand, and must remain a Axed and definite contract for every transaction that is made under it; as, for example, in the case of a railway company, where the penny a mile, or what not, must be guaranteed before mer can be found to embark on its construction, and where th( legal rate must be upheld in all courts against every infringe• ment. In other words, a professional fee is not a casual, irrelevant, or capricious element, but, on the contrary, is an integral and indefeasible one in every transaction between the profession and the public, and as such has not only been insisted on by the Incorporated Law Society and the Bar in the control of their members (on penalty of being struck oft the rolls), but has always been upheld by the Law Courts as well. It is the recognized law, the legitimate rule of the game.
But the Medical Council, although it has Crown members on its board representing the interests of the public, as well as other members representing the profession, and although it has exacted payment from practitioners on registration, in the faith that they would be protected in their legitimate fees, has from the outset maintained that it has no jurisdiction whatever over the undercutting of fees, by whatever means, of one member of the profession by another ; and that, in short, it was there for the protection of the public, and not of the profession at all And, accordingly, when about twenty years ago the medical aid societies, the friendly societies, and other clubs began sending their touts from door to door, and by the bait of lower fees induced the patients of esta- blished doctors to transfer themselves in batches to others of their own appointment (usually young men just beginning practice), the members of the Medical Council when appealed to to stop this disgrace calmly looked over their shoulders, like Mark Twain's coyote, and smiled—as if it were a matter of no concern ! Later on, when a medical man in Liverpool went so far as to sell himself to a local grocer, who gave his services gratis to every customer who should buy a pound of tea, although squirming and inclined to show its teeth, it ended by reiterating that it was none of its business. And when, later still, the profession in despair appealed to the Medical Council to pronounce at least a moral condemnation on such conduct, even if they could not issue a legal mandate for its restraint, it again point-blank refused.
But things in the meantime, from this inaction of the Council, had begun to prove serious for the profession. Most of the practices in working-class neighbourhoods had already fallen one-half and some two-thirds in value; and many medical men of middle age, with good practices and with families depending on them, were obliged to break up their homes and take positions as assistants or locum tenens to other medical men. A considerable number throughout the country committed suicide ; and, as was inevitable, the profession became thoroughly demoralized.
I can speak with authority on the matter, for at that time (some fifteen years ago) I had been doing a safe practice- of some 2700 a year for at least twelve years, but in the course of three or four years, under the domination of the clubs, whose touting the Medical Council had encouraged, it had fallen to £150 a year, and my friends were obliged to make application to the Civil List Pension for funds to enable me to carry on my series of literary works. In the meantime the Council, daunted and bewildered by its own action, either discovered that it actually had the legal power to remedy those very abuses which it had hitherto allowed to grow unheeded or it usurped it—for no fresh powers had been given it by the Legislature. It began by making it infamous conduct, and striking off the register any practitioner who should take office under a society that touted for patients from door to door ; it did the same for those who advertised themselves in print; and at last, as we saw the other day, in a fit of righteous indignation it overtopped itself by striking off the register a medical man in the employ of Mr. Sandow. But it is all too late. By their strange idea that the services of a medical man can be put up to auction like a pound of tea without harm to the morale of the pro- fession, they have reduced the fees for advice in working-class neighbourhoods to nothing at all, and for medicine to less than the patients will cheerfully pay to the nearest chemist ! Indeed to such a pass has the profession come through the action of the Medical Council in the past that the Government can without a blush of shame actually propose to buy up the profession wholesale at the rate of Os. per head of patients a year !
But if they imagine that, like the king in " Hamlet," the profession will submit to have its beard pulled thus, and " think it jest," they are mistaken.
As for the interests of the public I should only like to add this—viz., that, so long as a professional man is protected in his legitimate legal fee, he has all his time free to increase, if lie can, his practice at the expense of his neighbouring practi- tioners by his superior skill, knowledge, and good faith. That is playing the game according to its accredited rules. But if supply and demand and "run as you please" are allowed to take the place of fixed definite legal fees, it will soon be dis- covered that it will pay a professional man better to overreach his rivals by undercutting them than by supplanting them by his superior knowledge and skill.—I am, Sir, &c.,
JOHN BEATTIE CROZIER, M.B., LL.D.
Athenwum. Club, S.W.
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