Mine is a fee for service kind of practice where after each consult the patient pays. There is no fixed fee and this was truer in the early years of my practice than in the later years. There were many patients who by intention or othewise succeeded in making me believe that they were of poor means and thus got away with out paying my fee or paying much less than my usual fee.
My main difficulty then and occassionally now was to find out the capacity of the patient to pay my fee.
Narayanappa was an infrequent visitor to my clinic. His asthma was mild and seasonal and like many of my patients, he self medicated, often using my old prescriptions and was none the worse for it. He was another of my many misjudgments. Whenever he came he could be found wrapped in an old torn kambal [blanket] with a dirty muffler around his neck, wearing his standard off white pajama and kurtha that had seen better days. He also came unaccompanied and I had not met his family members. I came to know that he very well off only by sheer accident. One can make out which part of the country a patient came from, by the way one dresses or by their accent or by their attitude but not their ability to pay. Sometimes I could make out by the questions they asked. For a Keralite his daily bath is important than any thing else in life, so he would ask me if he can have a bath, A Tamilian would ask me what should he eat and what he should avoid and a Kannadiga how much rest he should take off from work but this didnot help me in assessing their monetary status.
Narayanppa was an unusual Kannadiga, on one occasion when he was about to go he asked me whether he can drink kaach. This for a moment had me wondering, before it dawned on me that my poor indigent patient was asking me weather he can drink his usual tot of Scotch whiskey at night! When his doctor is struggling to have his weekly mug of beer, here is a patient who is asking him whether he can have his daily dose of Scotch whiskey. I did not grudge this travesty of justice and his whiskey but the many occasions that I took no money from him thinking that he is too poor to pay! I told him he can drink but refrained from asking for what ever he owed me, as I keep no track of the free service I do. But next time he came he paid double my usual fee and then on till he stopped coming, he paid more than others with out a whimper.