In the new buildings that we have erected there are no wards. All of the rooms are private and each one is provided with a bath. The rooms—which are in groups of twenty-four—are all identical in size, in fittings, and in furnishings. There is no choice of rooms. It is planned that there shall be no choice of anything within the hospital. Every patient is on an equal footing with every other patient.
It is not at all certain whether hospitals as they are now managed exist for patients or for doctors. I am not unmindful of the large amount of time which a capable physician or surgeon gives to charity, but also I am not convinced that the fees of surgeons should be regulated according to the wealth of the patient, and I am entirely convinced that what is known as "professional etiquette" is a curse to mankind and to the development of medicine. Diagnosis is not very much developed. I should not care to be among the proprietors of a hospital in which every step had not been taken to insure that the patients were being treated for what actually was the matter with them, instead of for something that one doctor had decided they had. Professional etiquette makes it very difficult for a wrong diagnosis to be corrected. The consulting physician, unless he be a man of great tact, will not change a diagnosis or a treatment unless the physician who has called him in 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