All in the Family

Few expenses have risen more rapidly in recent years than the cost of illness. That may be a source of financial concern to patients and insurance companies, but not to physicians. They and their families generally get their doctoring free or at a discount from fellow physicians, who maintain a tradition known as professional courtesy. "It's just something you expect," says one doctor's wife. "It's like a Mafia --the family takes care of its own."

No one knows for sure how the practice of professional courtesy started. But it may well have begun with the 2,300-year-old Hippocratic oath, which exhorts physicians to regard other doctors as brothers. Modern standards reinforce the custom. The A.M.A.'s code of ethics, which urges physicians not to treat themselves or their families, holds that they should cheerfully provide care for other doctors and their dependents.

Compliment. Though interpretations of just how far professional courtesy should extend vary from one individual to another, most doctors willingly comply with the code. They treat other physicians, their wives and their immediate families for nothing, performing everything from routine examinations to major surgery. Some provide free care to medical students, nurses and hospital employees, and a few even offer discounts to clergymen.

But there is one branch of medicine in which professional courtesy is seldom offered: psychiatry. Because psychotherapy may take months or even years, most psychiatrists feel that they cannot afford to waive their fees. Some doctors tend to respond in kind by billing psychiatrists fully for any treatment provided.

Most doctors do not feel put upon by the demands of professional courtesy. Dr. Allen Charles, a Chicago obstetrician and gynecologist, delivers from three to six doctors' wives each month without charge. "I guess I should take it as a personal compliment when a doctor sends his wife to me," he says. Dr. Hugh Miller, a Newton, Mass., internist, feels that caring for colleagues is one of the things that sets doctors apart from others. "If you're a tradesman, then act like one," he says. "If you're a professional, then you should offer professional courtesy."

Despite the strong hold that the custom has in the medical community, a growing number of doctors would like to see it eliminated or at least curtailed. Some argue that receiving free medical care makes it awkward to be critical about the treatment if it is unsatisfactory. Others feel that friends may be unwilling to perform embarrassing but vital procedures. For example, in giving a doctor friend a general checkup, one physician failed to perform a rectal examination. The patient was later found to have inoperable cancer of the prostate.

Many doctors, reluctant to impose on other physicians, may avoid seeking treatment. "It leads to an uncomfortable sense of obligation," says an internist at North Shore Hospital in Manhasset, L.I. Others attempt to ease guilt feelings by sending expensive gifts to doctors who have treated them.

To avoid these situations, some doctors have begun to insist upon paying for any care provided by a colleague. "I tell them I will pay my own way or I won't come," says Dr. Donald Johnson, a Manhattan gynecologist. "That way I don't have to send a bottle of booze or something." Others are taking out policies to cover doctors' bills and demanding that those who treat them accept at least whatever the insurance companies allow. But their rebellion is not likely to spread very far. The majority of doctors seem more than willing to abide by the ancient advice of Hippocrates.

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