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UNDER CHARGE OF WILLIAM E. BUTLER, B.S., M.D., JUR. D., Member of the New York Bar; Professor of Medical Jurisprudence at Dartmouth.

The Legal Status of Fees.

The practice of medicine has ever been an exalted profession. In former days the physician received no stipulated remuneration, but an honorarium. In the present materialistic age, the "bread and butter" problem is decidedly important and it is important for the practitioner to know to whom he must look for compensation.

The busy doctor is usually a poor business man. A few hints may not be amiss to keep him clear of the shoals on which many patients and others liable for his fees would land him.

for the wealthy and another for the poor, but the fact is that the big fee is regarded as the regular one and the small one is merely a reduction to accommodate the poor man's pocket book. Thus we see that the medical man is most of the time doing partial charity.

It is also perfectly proper to charge more for the treatment of a case requiring special care and skill but it is well to remember that, where a doctor has given service to a patient and has treated him over a long period at a certain definite fee per visit, he must advise the patient of the increase in his rate before he is entitled to the larger


Where an express contract exists, the problem is simple; but on account of the nature of the physician's calling most of the contracts are implied. The contract having been entered into, the practitioner is entitled to his compensation. This right exists where the physician is called and responds promptly only to find that another doctor is in attendance or that the need of his services has past. Again, as the acceptance of his services by the patient binds the contract, the right to compensation continues thru the subsequent visits. If an assistant is required his services must be paid for.

The amount of one's fee varies with the locality and the personal standing of the physician and, it might be added, the financial ability of the patient to pay. This might appear to indicate the existence of one set of fees

Where a consultant is called in without the consent or request of the patient, or of one competent to act for him, no right to compensation exists. When such consent is expressly or impliedly given, the patient is obligated to pay the fee even tho there is an agreement between patient and attending physician, unless the consultant has knowledge of the agreement.

Where an attending physician calls in a consultant and several consultations result, the patient cannot be charged at the rate of two consultation fees. This would make the services of the doctor a luxury and not, as the law now holds, a necessity.

To whom must the doctor look for his fee? The general proposition is,

that the person for whom the services are actually rendered is liable, if he is capable of making a binding contract. If the patient be incapable of making a binding contract the person, who is, under the law, responsible for his necessaries, is responsible for the payment of the medical charges.

As a corollary to this, no person calling in a physician to attend another person is obligated, therefore, unless he has made himself expressly liable, or unless he would be obligated even if he did not himself call in the physi

cian or surgeon.

Where called in to attend an infant, a married woman, or an insane person the doctor may assume that the parent or guardian, the husband, or the committee of the lunatic or his estate will be held accountable for his bill. To this rule there are some exceptions, as

where an infant or a wife has voluntarily left the home of the parent or husband and has, by living apart, given the world to understand that he or she is able and willing to provide for his or her own necessaries. If a

child or wife is forced, thru fear of violence to leave the home, the father or husband is impliedly bound to provide for their necessaries. Should the father die the mother is responsible unless the child have a separate estate.

If a man live with a woman as his wife he is responsible to the practitioner who believes them to be husband and wife.

A master is not liable for services to his servant unless he calls the doctor in to attend the servant. The master's wife cannot bind the husband even by an express agreement as the

husband is only bound by contracts for necessaries furnished to her or to her children.

Where the third party engaging the physician is a stranger, the Statutes of Frauds comes in and provides that the defendant shall not be charged upon "any special promise to answer for the debt, default or miscarriage of another person unless there be an agree

ment or some memorandum or note in writing signed by the party charged." It will be seen that this fault in payment by the patient, the promise is conditional upon the dethird party saying "Attend the patient and if he does not pay you I will." To be binding this must be in writing and signed. and signed. But if the stranger says, "Attend the patient and I will pay you" it becomes a binding agreement and holds the third party, with the proviso, however, that the promise must be made at the time of rendering the services and not after the render

ing as the subsequent promise is with

out consideration and is therefore void.

If the physician, after continuing his treatment for a certain period thinks he will not be paid and insists as a condition precedent to his continuing treatment of the case that the third party guarantee him for past and future services, the continuation of the services is sufficient consideration and will bind the third party.

To render a corporation liable for the services of a physician called to attend an injured man the physician must show that the servant or officer employing him was within the scope of his authority or that there was a ratification of such employment by one having the authority to act.

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A Review of Our January Issue by Prof. H. C. Farrar.

I have read your splendid MEDICAL "Vasomotor Ataxia" by Dr. Cohen REVIEW OF REVIEWS thru with pleas- is strong and shows his mastery of the ure and profit. theme. His full description of it and diagnosis and essential explanations are exceptionally satisfactory. Let us hear from him again.

Medical books and journals have ever appealed to me. It is a great science and, for the better part, most worthily manned and worked. Yet there are old fogies in it, as in all departments of human endeavor. However, progress is the spirit of the age, and will move grandly on, in spite of the old moss-backs. Your REVIEW strikes out on new, needed and vigorous paths. It certainly has a great field before it, but the coast is clear for intelligent and indomitable enterprise.

"Tuberculosis in Children," by Dr. Kerr, is at present a live subject and demands the best thinking we can give it. I enjoyed its clear comprehensiveness and statements, and especially his ease and force of diction.

Your REVIEW has a decidedly firm business look, and makes its own appeal. Along its new lines and others that it will open it surely will win. Its thought is clear and positive and needed. It will catch the eye of the progressive part of the great fraternity.

There is ever a positive need of careful and radical revision of old matters and usages. The good may be made better.

As I read your Magazine, these thoughts occur to me: The editorial department is alive with practical suggestions and looks difficulties squarely in the face and resolves on solution and extermination.

The Tuberculosis Question by Dr. Beverley Robinson is wisely and sincerely discussed, as it needs to be.

The appreciative article on Dr. Louis Pasteur, by Dr. Warbasse, is a great credit to your REVIEW. Your frontispiece portrait is beautiful. The article is so full of information, so practical and valuable. Pasteur's early experiences of failure and success are handled effectively. What a beautiful character is his!

"Paracelsus" is breezy and bracing, plump down from the high hills where dwell the gods!

There is such a royal swing of thought and such terse epigrammatic puttings, it makes one sit up and take notice.

Iconoclasm is a vigorous weapon and dangerous as well; there is a joy in its swing and a bit of relish in its destruction. But in a public journal one who wields it must be wise of head and sure of aim! Victor Robinson wields it well; he hits and keeps hitting, as at a Donnybrook Fair. That gift should be rarely exercised. In this case it answers, for the dear old Paracelsus was puffed up, and had reason to be, because he knew so much in an ignorant age. Oh, but there was so much information in it; so many sidelights flashing and lighting up whole realms of rich achievement and revealing by-products! I read the article at white heat; and fairly glowed when thru, only regretting it was not half a dozen pages more.

Your Index Medicus is a literary benediction, so helpful to the reading progressive physicians. It is worth the price of your journal twice over and more. The plan is admirable and could easily be used in all professions, tabulating books, as well as magazines, etc.

January 24th, 1912.

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