Under My Skin

Put the cash in the shoebox


 

Even when I was training back in the Pleistocene era, old Doc Greenberg was a throwback. During my pediatric residency, I accompanied him for a day to his office in the Parkchester neighborhood of the Bronx. With no secretary or office staff, Greenberg just processed patients himself. After he examined their kids, each mother handed him a $10 bill, which he stuffed into a box in his desk drawer. No records, no accountability, no payroll taxes ... Those were the days, bygone even then.

A doctor's bag pterwort/iStock/Getty Images Plus

What prompted this reverie was recollecting a conversation I had quite some time ago with Stan, a retired drug rep of the old school: terrible combover, rumpled suit, beat-up briefcase. Stan regaled me with tales of derms he had called on many years before.

“Ed Gillooly down in Scituate used to charge $7 a visit,” Stan told me. “I asked him why so little – this was back in the ’60s – and he said, ‘Phil Gluckstern charges 20 bucks a visit in his fancy downtown office, but he has to spend half an hour with a patient. I just see ’em, diagnose ’em, prescribe for ’em, and they’re out the door.’

“Dermatology wasn’t the high-class deal it’s gotten to be,” said Stan. “It was sort of out there. Every doctor had his own special lotion or concoction, his calling card. The local pharmacist knew how to mix it up, but of course would never share the secret formula.

“Nobody referred anybody to another doctor if they could help it. They were terrified they’d never see the patient back.

“It was all cash. There was no Medicare, no third parties. The money would get put into a shoebox, which would go into the doctor’s closet. A lot of offices were in the doc’s house. Sometimes a babysitter would go through the closet, and wouldn’t you know, but the next time the doc’s wife looked, last week’s receipts were gone.

“Secretaries? Doctors wouldn’t bother with them. Sometimes their mothers or wives, who knew as little about office management as they did, would come in and mess things up.”

This observation resonated. Almost 40 years ago, I took over what was left of Al Shipman’s practice when the old-timer (as he seemed to me then) retired to Florida.

Al’s office was a converted garage. Rummaging through a closet, he offered me ancient samples of sulfur-resorcinol acne lotions. Then he pulled out a well-thumbed Merck Manual from the 1930s, with the front cover missing. “I always found this useful,” he said. “You can have it if you want.” I politely declined.

“You young fellas spend money like it’s going out of style,” said Al. “You all think you need secretaries. Never had one!”

My reverie done, I focused back on Stan, who was saying, “Doctors in those days did pretty much everything themselves.

“For instance, Jack Vallis had about thirty chairs in his waiting room. Whenever Jack came out to call the next patient, everybody got up and moved over one chair.

“Once – I swear this actually happened – a patient came in with a severe laceration on his wrist; his damned arm was dangling half-off. But he had to sit down in the last chair and take his turn, same as anybody else.

“I used to call on non-derms too. We carried cortisone creams and antifungal creams, and they used to stop and ask me, ‘Now Stan, I put this fungus cream on the fungus and the cortisone cream on the eczema, am I right?’”

Some things indeed don’t change.

Dr. Alan Rockoff, a dermatologist in Brookline, Mass.

Dr. Alan Rockoff

I guess it’s just human nature to pine for the good old days, when one imagines things were slower and simpler: no HMOs, no EHRs, no on-line eligibility checks, no prior authorization madness. When patients (or their biopsy specimens) could go to any lab you sent them to.

Ah, wasn’t that the life? When patients paid you 10 bucks in cash and you stuffed it in your shoebox? When if they didn’t have cash, they sent you a roast turkey on Thanksgiving, or a dozen eggs, or maybe nothing at all?

If you’re the sentimental sort, you can wax nostalgic about those good old days if you want. But you’ll forgive me if I don’t join you.

Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@mdedge.com.

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