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any account. He may send you a gift at Christmas as a mark of his gratitude, but this is by no means an invariable custom and you ought not to expect it. Besides this, most of the clergy are financially in difficulty owing to the smallness of their stipend and the lessened value of money. This rule of gratuitous attendance does not apply to clergymen of other churches who may be your patients, but where you know that they are not well-off you ought to render a modified account.
Then you would never expect to be paid for any attention you may have given to a brother practitioner or his family. It is, however, much more the custom for such patients to present you with a gift on recovery from their illness, and it would be most ungracious on your part to refuse it unless it took the form of money.
All other persons (unless by your own free will) are expected to pay for professional services, and, indeed, you ought to cut down your "free list " as much as possible. With the exceptions above indicated, you ought to present a bill to every patient; you may make it as small as you like, but it gives a feeling of independence to your patient to have paid your bill. It is not unusual for a patient to - tell you that unless you make a charge he will not be able to send for you again ; so we ought surely to oblige him and by so doing we enrich ourselves, confirm him as a patient and increase his own selfrespect. A young practitioner often finds a shyness in accepting payment from patients who consult him at his own house, and may even go the length of refusing it, thinking that he has done little or nothing to deserve a fee. One ought never under such circumstances to refuse a fee-it is a payment not only for skill, but for time occupied ; besides, to refuse it seems almost a slight to the person profferring it. Make no fuss about the fee, but take it as a matter of course unless you know that the person is too poor to afford it.
Rendering of Accounts.-Medical men are proverbially bad business men. They usually delay sending out their accounts, and time slips by for six, twelve, eighteen months, and so on. There can be no greater mistake than this negligence. The longer you delay the larger will your bills for attendance mount, with the result that you either hesitate to make so great a demand, and end by cutting it down very considerably, so losing money, or the patient, finding it much beyond what he anticipated (for the memory for past medical attention is astonishingly short), demurs to the sum you have asked, or delays paying it, or, and not infrequently, leaves the district without paying it at all. In other cases, where you have deferred long, the patients may have left the district soon after your attendance ceased, and may have forgotten to ask for your bill before removing. They may also have forgotten to leave their new address, so that you are unable to trace them. You will lose much money in every way by not rendering your accounts at short intervals.
Accounts should be sent out every six months. The sums charged are therefore not large, the memory for kind and prompt attention is still green, and as a rule they are paid almost at once. Accounts
should be presented, even although you are attending the patient at the time. Unless this is done it will give rise to much inconvenience and disorganisation of your books. At first you will feel diffident to be attending your patient whilst your bill has been presented, but this feeling soon wears off and you treat it as a business matter.
If your account is still unpaid after the lapse of six months, you make a second request, and if this remains unanswered, you may then hand the matter to your lawyer or to some debts recovery society in order to collect what is due to you.
When a medical man's practice is amongst the better classes, it is unusual for his accounts to remain unpaid for any length of time, and thus the necessity for drastic action is seldom resorted to. In certain cases a patient may come or write, explaining the reason for non-payment. You may then either wait for the full amount, remit it in part or even in whole.
Being a registered medical practitioner you have the privilege of suing for payment in courts of law. It is pleasing to know that this method of obtaining, payment of their accounts is seldom employed by doctors.
If your practice is in a shifting working-class population, you will be wise to present your account immediately or soon after you have ceased attendance on the patient. This may seem somewhat mercenary, but you will lose less money by following this advice.
Sickness, Accident and Life Insurance. There can be no better investment for the young prac
titioner than to insure himself against sickness, accident and death, and to do this at once after starting in practice for himself.
Even the most robust has no certainty of health ; at any time he may meet with an accident or be struck down by disease. As by far the largest proportion of doctors carry on their own practiceseach being what may be termed an individual business—when he is laid aside his income practically ceases. He may, of course, prevail on his colleagues to carry on his work, but this cannot be done for any length of time even in towns, and in the country it is not possible. Illness or accident, therefore, means much loss of income, and when a locum tenens has to be employed, a large outlay has, in addition, to be faced each week. Every wise doctor will, therefore, insure himself against such contingencies. One can insure against the risk of accident alone, and in that case the yearly premium is small,
It is much more advantageous, however, to insure oneself against both sickness and accident, as the first is much more probable than the second. One can insure against a limited number of the more common illnesses, and in such a restriction the premium is less than when we extend the insurance to cover all illnesses. I think it is more advisable, however, to pay the extra premium for a complete insurance, as Providence does not allow us the option of any certain illness.
The yearly premium to be paid will vary, of course, with the age of the insured person on joining, and with the amount of weekly compensation to be granted. Thus in one insurance society one can, at the age of twenty-five years, insure for a weekly payment of two guineas by paying a sum of £3 35. 6d. per year, or four guineas per week for £6 75. On joining at the age of forty-five years, these premiums would be £5 5s. and £10 Ios. respectively. A larger weekly compensation can be obtained by paying a proportionately higher premium. As a rule, full payment is continued for twenty-six weeks, then half payment for the remainder of the incapacity.
On first commencing practice we may be content with a small weekly compensation, but as we get older we can increase the yearly premium so as to obtain a larger weekly compensation when laid aside.
By making this comparatively small yearly payment we relieve our minds greatly, because we know that, even if we are unable to work through sickness, a certain definite sum of money will be paid to us each week, and money is never more precious than when there is sickness in a household.
In the case of fatal accident a lump sum (usually £1,000) is paid to one's representatives.
Life Insurance.—Though, fortunately, the average duration of a doctor's life is relatively high, yet “Heaven gives its favourites early death.” Much money has been expended on the medical education of the doctor, on the purchase of a practice, etc., and should untimely death be his fate, all this is lost. If the young man has dependants (mother, sister), or if he contemplates marriage, then most certainly ought he to insure his life on their behalf for as large a sum as he can afford to pay in yearly premium. In only too many cases young married doctors neglect