My Life and Work, Henry Ford [i want to read a book .txt] 📗

is in thorough agreement, and then if a change be made, it is usually without the knowledge of the patient. There seems to be a notion that a patient, and especially when in a hospital, becomes the property of the doctor. A conscientious practitioner does not exploit the patient. A less conscientious one does. Many physicians seem to regard the sustaining of their own diagnoses as of as great moment as the recovery of the patient.

 

It has been an aim of our hospital to cut away from all of these practices and to put the interest of the patient first. Therefore, it is what is known as a “closed” hospital. All of the physicians and all of the nurses are employed by the year and they can have no practice outside of the hospital. Including the interns, twenty-one physicians and surgeons are on the staff. These men have been selected with great care and they are paid salaries that amount to at least as much as they would ordinarily earn in successful private practice. They have, none of them, any financial interest whatsoever in any patient, and a patient may not be treated by a doctor from the outside. We gladly acknowledge the place and the use of the family physician. We do not seek to supplant him. We take the case where he leaves off, and return the patient as quickly as possible. Our system makes it undesirable for us to keep patients longer than necessary—we do not need that kind of business. And we will share with the family physician our knowledge of the case, but while the patient is in the hospital we assume full responsibility. It is “closed” to outside physicians’ practice, though it is not closed to our cooperation with any family physician who desires it.

 

The admission of a patient is interesting. The incoming patient is first examined by the senior physician and then is routed for examination through three, four, or whatever number of doctors seems necessary. This routing takes place regardless of what the patient came to the hospital for, because, as we are gradually learning, it is the complete health rather than a single ailment which is important. Each of the doctors makes a complete examination, and each sends in his written findings to the head physician without any opportunity whatsoever to consult with any of the other examining physicians. At least three, and sometimes six or seven, absolutely complete and absolutely independent diagnoses are thus in the hands of the head of the hospital. They constitute a complete record of the case. These precautions are taken in order to insure, within the limits of present-day knowledge, a correct diagnosis.

 

At the present time, there are about six hundred beds available. Every patient pays according to a fixed schedule that includes the hospital room, board, medical and surgical attendance, and nursing. There are no extras. There are no private nurses. If a case requires more attention than the nurses assigned to the wing can give, then another nurse is put on, but without any additional expense to the patient. This, however, is rarely necessary because the patients are grouped according to the amount of nursing that they will need. There may be one nurse for two patients, or one nurse for five patients, as the type of cases may require. No one nurse ever has more than seven patients to care for, and because of the arrangements it is easily possible for a nurse to care for seven patients who are not desperately ill. In the ordinary hospital the nurses must make many useless steps. More of their time is spent in walking than in caring for the patient. This hospital is designed to save steps. Each floor is complete in itself, and just as in the factories we have tried to eliminate the necessity for waste motion, so have we also tried to eliminate waste motion in the hospital. The charge to patients for a room, nursing, and medical attendance is $4.50 a day.

This will be lowered as the size of the hospital increases. The charge for a major operation is $125. The charge for minor operations is according to a fixed scale. All of the charges are tentative. The hospital has a cost system just like a factory. The charges will be regulated to make ends just meet.

 

There seems to be no good reason why the experiment should not be successful. Its success is purely a matter of management and mathematics. The same kind of management which permits a factory to give the fullest service will permit a hospital to give the fullest service, and at a price so low as to be within the reach of everyone. The only difference between hospital and factory accounting is that I do not expect the hospital to return a profit; we do expect it to cover depreciation. The investment in this hospital to date is about $9,000,000.

 

If we can get away from charity, the funds that now go into charitable enterprises can be turned to furthering production—to making goods cheaply and in great plenty. And then we shall not only be removing the burden of taxes from the community and freeing men but also we can be adding to the general wealth. We leave for private interest too many things we ought to do for ourselves as a collective interest. We need more constructive thinking in public service. We need a kind of “universal training” in economic facts. The over-reaching ambitions of speculative capital, as well as the unreasonable demands of irresponsible labour, are due to ignorance of the economic basis of life. Nobody can get more out of life than life can produce—yet nearly everybody thinks he can. Speculative capital wants more; labour wants more; the source of raw material wants more; and the purchasing public wants more. A family knows that it cannot live beyond its income; even the children know that. But the public never seems to learn that it cannot live beyond its income—have more than it produces.

 

In clearing out the need for charity we must keep in mind not only the economic facts of existence, but also that lack of knowledge of these facts encourages fear. Banish fear and we can have self-reliance.

Charity is not present where self-reliance dwells.

 

Fear is the offspring of a reliance placed on something outside—on a foreman’s good-will, perhaps, on a shop’s prosperity, on a market’s steadiness. That is just another way of saying that fear is the portion of the man who acknowledges his career to be in the keeping of earthly circumstances. Fear is the result of the body assuming ascendancy over the soul.

 

The habit of failure is purely mental and is the mother of fear. This habit gets itself fixed on men because they lack vision. They start out to do something that reaches from A to Z. At A they fail, at B they stumble, and at C they meet with what seems to be an insuperable difficulty. They then cry “Beaten” and throw the whole task down. They have not even given themselves a chance really to fail; they have not given their vision a chance to be proved or disproved. They have simply let themselves be beaten by the natural difficulties that attend every kind of effort.

 

More men are beaten than fail. It is not wisdom they need or money, or brilliance, or “pull,” but just plain gristle and bone. This rude, simple, primitive power which we call “stick-to-itiveness” is the uncrowned king of the world of endeavour. People are utterly wrong in their slant upon things. They see the successes that men have made and somehow they appear to be easy. But that is a world away from the facts.

It is failure that is easy. Success is always hard. A man can fail in ease; he can succeed only by paying out all that he has and is. It is this which makes success so pitiable a thing if it be in lines that are not useful and uplifting.

 

If a man is in constant fear of the industrial situation he ought to change his life so as not to be dependent upon it. There is always the land, and fewer people are on the land now than ever before. If a man lives in fear of an employer’s favor changing toward him, he ought to extricate himself from dependence on any employer. He can become his own boss. It may be that he will be a poorer boss than the one he leaves, and that his returns will be much less, but at least he will have rid himself of the shadow of his pet fear, and that is worth a great deal in money and position. Better still is for the man to come through himself and exceed himself by getting rid of his fears in the midst of the circumstances where his daily lot is cast. Become a freeman in the place where you first surrendered your freedom. Win your battle where you lost it. And you will come to see that, although there was much outside of you that was not right, there was more inside of you that was not right.

Thus you will learn that the wrong inside of you spoils even the right that is outside of you.

 

A man is still the superior being of the earth. Whatever happens, he is still a man. Business may slacken tomorrow—he is still a man. He goes through the changes of circumstances, as he goes through the variations of temperature—still a man. If he can only get this thought reborn in him, it opens new wells and mines in his own being. There is no security outside of himself. There is no wealth outside of himself. The elimination of fear is the bringing in of security and supply.

 

Let every American become steeled against coddling. Americans ought to resent coddling. It is a drug. Stand up and stand out; let weaklings take charity.