Flashback... in Medical Economics

May 8, 2000

Flashing back in Medical Economics

 

Flashback in Medical Economics

25 years ago: April 14, 1975

Senior Editor Al Schutzer interviewed a 31-year-old professional basketball star named Bill Bradley, as part of a Medical Economics series: "See Yourself as VIPs See You."

At that time, Bradley's VIP status was confined to the basketball court. He had helped the New York Knicks win the NBA championship in 1970 and '73, and he would not enter the political arena until 1978, when he won election to the US Senate from New Jersey.

Reading those 1975 pages today, you'll find that a couple of key points jump out. One is Bradley's statement that "every year I visit a cardiac institute in Arizona to have a complete heart check." His heartbeat irregularities, of course, drew wide attention during his bid for the White House this year.

Most revealing, though, is the answer to Al's final question:

Schutzer: Not long ago, you delivered a commencement address at Saint Peter's College in Jersey City. In your speech, you exhorted the graduating class to go out and get involved in our complex society and leave "the comfortable room," a phrase you quoted from the Hermann Hesse novel Steppenwolf. How about you? Are you planning a move like that yourself in the next couple of years?

Bradley: I really don't consider myself right now as being any more in a "comfortable room" than other people. But if the question is, will I become more actively involved in public issues—national health insurance or the like—in the next few years, I hope so. I've always been interested in politics, but you just don't decide to get involved and then do it. There has to be the right moment, the right situation. Given those, yes, I would like to go into politics. If that doesn't occur, I'd still want to be in some form of public service. One of the things I'd most like to do would be to help improve the quality of life in this country.

Despite the failure of his run for the presidency, Bradley has every right to feel that he's helped "improve the quality of life in this country"—during his service in the Senate and in his public life afterward.

Who knows what's next for him? There's always 2004.

50 years ago: April, 1950

Our cover story lauded the "progressive spirit" of doctors in Colorado for a daring move: 20 of 26 local medical societies developed and publicized a list of average fees for about a dozen common services and procedures. The idea had come from a public relations expert (they wouldn't become known as "spin doctors" for another half century), who suggested that patients had no way of knowing whether they'd been charged a fair fee.

Here's what some of the numbers looked like:

 

Fees publicized in three Colorado areas

 

Procedure

Arapahoe CountySan Luis ValleyEastern District
Office visit$2$3$3 to $5
House call3.5045
Night call5810
Maternity, uncomplicated7575100
Tonsillectomy403560
Appendectomy125150175

 

Once the schedule was put together, doctors fretted over how to share the information discreetly with their patients. Some suggested printing the list in the local newspaper, while others advised placing mimeographed sheets in the waiting room. Still others favored "cards to be placed under the glass of the doctor's desk, near the patient's chair."

Doctors weren't obligated to follow the schedule, but that was easier said than done, as one local physician observed:

"An average fee tends to become a maximum fee. A husband is told that his wife's delivery will cost $150. He points to the fee table, which says $100 for an 'uncomplicated maternity' case. The doctor explains that this is a breech presentation, but he may as well save his breath. The husband simply does not understand, and the doctor can't take time out to give a short course in obstetrics. What the man remembers most of all is that line: maternity case—$100."

75 years ago: April, 1925

"In Union There is Strength," declared our editorial. We weren't talking about collective bargaining; rather, we were waxing rhapsodic over "the first time that physicians have cooperated in the purchase and ownership of a purely professional building in a community of moderate size."

The community was Hempstead, on New York's Long Island. Eleven of the 12 doctors in the town (pop. 8,000 back then) hired an architect and moved into an elegant, H-shaped building with a rotunda reception area, two-story ceilings, and a skylight. It was truly state-of-the-art; actually, it helped establish the art of building medical offices.

Previously, most doctors had been practicing in their homes. Our editorial contended that such offices, scattered around the community, made for an unseemly arrangement: "All too often the doctor's office is so unattractive that patients hesitate to enter except under consultation." Such offices "remind the casual observer of places for mere trade."

Once in their gleaming new quarters, the doctors didn't form a group or partnership, though "some of them are more or less associated," we reported. They covered for one another in emergencies and during vacations. Other building occupants included a dentist and a podiatrist, the latter to attend to the community's troublesome "corn crop."

A telephone switchboard was in operation 24 hours a day. Each doctor paid $60 a month in rent plus $50 for upkeep. They hired secretaries to keep the books and send out bills, a job previously handled by the doctors' wives.

An interior decorator took care of all the fine details, down to deciding which magazines to put in the waiting rooms. (He "quite logically barred all technical journals.") The cabinets were a pearl gray, "as both doctors and decorator felt that white has a glaring and often depressing effect."

We called upon the medical profession to copy this shining example, which itself was copied from Big Business. "In the opinion of Dr. H.M. Warner, one of the prime movers in the enterprise, the professional building has increased the respect of the community for the physicians, although their previous standing was very high, and it has placed the practice of medicine on an actual business basis, without in any way detracting from its dignity."

—Jeff Forster, Editor

 



Jeff Forster. Flashback... in Medical Economics. Medical Economics 2000;9:82.