The Detroit times., 1910-02-18
DOCTORS STIRRED
OVER PRACTICE OF
SPLITTING FEES
"Divvy" Between Surgeon and Gen
eral Practitioner Who Sends Him
the Business" Denounced as
"Cloven- Footed Abuse"
Worst and Most Dangerous Form Of
Graft" Declares Bishop Will
Hams, Speaking For Laity.

Should the Skilled surgeon divide
his fee with the general practitioner
IN cases referred 10 him by the lat
ter?
This question Is made the subject
of an interesting discussion in toe
February issue Of the Detroit Medical
Journal, I'm which several OF Detroit :
leading physicians and surgeons eX
press their views on the subject
which has become n vital issue In the
profession The discussion appears
ia have been inspired by DR.. William
r. Metcaf's presidential address be
fore the Detroit Academy of Medicine
some time ago Oh The business end
of mediciae." ana his remarks at that
time on the question OF the division
OF fees are reprinted quite extern
sively.
The consensus OF opinion OF the
doctors taking part in the discussion
Is that the secret division OF fees he
tween surgeon and general practi'
toner Is abont the greatest evil the
profession has TO contend with. The
doctors agree that the family physi'
ian who refers IN. case, Is present AT
The operation and attends the patient
turing convalescence should be com
pensated for his services as well as
he specialist VINO invariably receives
4 big fee. This compensation, how
sver, should come from the patient.
{ Is contended, and II there is any
splitting OF fees 1t should be only
with the patients knowledge.
The country doctor who feels that
he is entitled TO compensation FOR
4 bringing a patient to the city for an
operation finds a champion in Dr..
Angus Mclean, who points out that
many doctors in the state have
ceased bringing patients to Detroit.
They Split in Chicago.
They take them 10 Chicago. where
they are usually able to secure a
satisfactory adjustment OF the ques-
ton OF fees he adds.
Here Is how DIR Mclean sizes up
the situation:
"A doctor from town some dis
4 lance. from Detroit, has patient.
b who in the doctors judgment, would
be benefited by surgery He makes
II the diagnosis aud advises operation.
"A The patient is somewhat timid and
81 wants his physician TO accompany
n him TO the city to remain with MIN
a comes out of the aresthetic.
The doctor leaves home. at noon,
say: he gets into Detroit at night.
The operation IS performed the next
Gay. The doctor waits around until
/ late In the afternoon and does not get
back to his WORK until late at night
or perhaps noon the following day
He has lost practically two days. and
his expenses, such as hotel bills and
carfare. What consideration does
/ he receive? Really nothing. The
law allows him the price OF visit.
He can make no extra charge, that
| the courts will recognize. for his dag
4 nosis OF cancer or gladstone disease
as the case may be, which every rea-
sonable person must admit, is worth
more than the fee OF an ordinary
visit.
II think it is perfectly Legitimate
that the physician should be allowed
a stated fee for his time, say $25 IL
this is collected by the surgeon II
should be so stated III the receipt
THE question OF division of fees,
so-called. ia not vexed problem so
far as the city is concerned The city
patient usually selects surgeon Tor
himself and the family physician, do
rule. does not concern himself IN
the situation. IL rs the country doe
tor who lives at distances varying
from ten to two hundred miles from
the CITY who feels that he should be
recommended for his loss OF time. Ills
claim upon the patient Is not recos
uized by the courts, SO what are you
TO do?"
Or, Metcalfs Strong Language.
DR. Metcalf. in HE address, referred
10 the division OF fees as the most
cloven-footed abuse that threatens
the integrity OF the medical practice
today
The people of this country have
supposed they Were rid OF the buying
and selling Of human beings coht'u-
ned the doctor. but what Is IL Wneh
man In general. family pracuce
Nv referring a patient TO one speclal-
ist. ID assured OF his velvet reward
while II he permits that same pauen'
to go TO an honest consultant the
graft game Is not possible Either
party TO this Kind OF compact VIII
naturally regard less and less any IN
terest but his own desire for immedl-
ate gain.
THE public ShOulu De NduBhO W
physicians to understand better what
constitutes the basis Of their charges.
II should be made plain that. IN tn"
choice or even the Endorsement OF a
specialist who is TO he called into IN
case. the family doctor Is rendering
a valuable service To his patient III
an operation is found necessary. he
should be the family representative
at the operating table, TO indorse. TO
criticize. or at least to understand
and bear witness 20 what Is done.
II this function Of the general prae'
titioner is made impossible by enis
being in the pay OF an INSCRIPTIONS
surgeon. what safeguard Is left TO the
patient against malpractice?
THE physicians reward for the re,
sponsibility here assumed should be
ample. and the specialist or consul
tant or surgeon should, In every way
possible. support this claim OF hiv
colleague. lie should not, however.
falsely assume to meet that claim