This problem has bedevilled all the years of my practice, and seems to have grown if anything more acute since my move first from my home practice to the SOFEA clinic in Camden Town, and finally on to Harley Street, of all places, to what is considered to be the pinnacle of medical practice, where I now work amongst those who are happy to charge the most exorbitant fees that I would be ashamed to charge anybody.
My arrival in
One of the reasons why the whole issue of fees has proved such a problem for me is because it has a lot to do with my assessment of my own worth, something I am unclear about. How do I value what I do, and do I put a monetary value on this, and, if so, at what level? What fee to charge therefore still remains a sensitive subject for me, particularly as a few days ago I happened to note from the web that a former student of mine is charging three times the rate I now charge. Is she right to do this, and am I therefore being unprofessional not to do the same? Or is there still some value in retaining the idea that the vocation I have chosen represents my desire to help others, rather than doing it for financial reward?
I realise I have ended up after all these years doing what a tutor during my original training told us not to do, which was to charge different levels of fees for different patients. He said that this only led to confusion, and he was right. “Stick to one fee and let the patients decide whether they can afford to pay it. Don’t make their financial circumstances your concern,” he told us. And this is what I have always found difficult.
I have come to the conclusion that my problem with working out how much to charge touches on my dislike of meanness, and its counterweight, my desire to be generous. I regard treating as a gift I am offering my patients. To ask them to pay for this is in some senses much like giving somebody a present and then holding out my hand for them to pay for it. Even though I recognise the need to make a living, to charge the high fees which some would definitely consider appropriate for my many years of practice and my level of expertise represents not the gift I would like to bestow on my patients, but smacks of meanness. For somebody who would always prefer to give than to receive, this inevitably causes problems, still unresolved within me to this day, after so many years of practice.