MEDICAL EXAMINATIONS. 
[From The Spectator, December 22, 1887.] 
We print in other columns of this issue an interesting communica- 
tion from a practical worker in the field on the subject of the import- 
ance of careful medical examination in life insurance. His remarks are 
direct to the point, and will repay careful perusal. No company can 
do a safe business and be negligent or careless in the matter of selec- 
tion ; and to the end that only healthy lives should be introduced to 
the companies, medical examiners cannot be too careful or exacting in 
their examinations. All personal considerations should be laid aside, 
and a conscientious performance of well-defined duties alone permitted. 
Examinations for life insurance have come to be regarded as an import- 
ant and lucrative part of the practice of a very considerable army of 
medical practitioners. Some of the more prominent companies carry 
on their books the names of from 3000 to 5000 physicians who are 
duly accredited examiners for them, and there are probably at least 
20,000 of them in the country. While the numerous medical colleges 
are turning out new doctors by the hundreds every year, it is natural 
that many of these should seek appointments as medical examiners for 
old established life companies. It not only gives them a certain amount 
of income, but it helps to introduce them and build up their practice. 
Without casting any reproach upon their medical attainments, the testi- 
mony of experienced life underwriters goes to show that many of the 
examiners are either ignorant or careless of the requirements of the 
companies as regards examinations. Too often they regard the exam- 
ination of an applicant as a mere matter of form, not comprehending 
or appreciating the fact that it is not merely to ascertain the present 
physical condition of the applicant that the examination is made, but to 
determine his right to stand upon a platform of physical equality in the 
future with thousands of others who will have eventually to pay for any 
shortcomings of his in the matter of health, habits, heredity, etc. Many 
examiners, or would-be examiners, do not fully realize the responsibility 
that rests upon them in this respect, and it is to enlighten them as 
to what life companies require of their professional knowledge that 
The Spectator Company has undertaken the publication of a new 
work, entitled "The Medical Examiner in Life Insurance," by Charles F. Stillman, M. S., M. D., examiner at the New York offices of the 
Mutual Life and the Travelers Life insurance companies. Dr. Stillman 
is well known as a writer on professional subjects, and his extended 
experience as an examiner especially qualifies him for this undertaking. 
He does not pretend to teach practitioners of medicine their business, 
but to point out to them, in a thoroughly practical manner, how to 
apply their professional knowledge in the interests of the life insurance 
companies. He goes into all the details of the subject, explaining the 
relations that must exist between the successful examiner and the 
executive departments of the company, and what is expected of him in 
the examination of applicants for life insurance. This important work, 
now in press, will be issued next month, handsomely printed and bound. 
It will prove an invaluable guide to medical examiners. 
The following is the communication referred to above: 
[7b the Editor of The Spectator.] 
Not long since a prominent actuary remarked that he had found some diffi- 
culty in accounting for the high rate of mortality which his company had experi- 
enced during the past year. He had carried his investigations into several different 
quarters, but without arriving at any satisfactory explanation. Had it occurred 
to him to question the proficiency of his company's medical*staff, and to inquire 
into their method of conducting medical examinations, the excessive death rate 
would have remained no longer a mystery. 
One of the most important factors in the conduct of a safe insurance business 
is a staff of competent and reliable medical examiners. So much is proved by 
experience. The actuary may prepare his table of premiums with the greatest 
care and accuracy ; the board of directors may be most conservative, and may 
observe a high degree of caution and discernment in directing investments. But 
such efforts at the home office must prove of small avail if the medical examiners 
are not men of character and ability-conscientious in the performance of their 
duties to the company. 
The successful examiner must be at all times conscious of the importance of 
his position, and must recognize the fact that the future of his company depends 
in a great measure upon the manner in which he fulfills the trust reposed in him. 
He owes a duty not only to the company which he represents, but to each one of 
its policyholders, and if he indorses a risk as " first class " which is below the 
ordinary standard of health, he does an injustice to the other members, who must 
suffer indirectly by his error when the policy becomes a claim. 
It is further necessary that the examiner should not be embarrassed by any 
outside influences which might affect his action in deciding upon the value of a 
risk. It often happens that the medical examiner is placed in a peculiar and at 
the same time most unpleasant position. He may be called upon to examine a 
former patient or friend. He may, perhaps, hold intimate social relations with 
the agent who has secured the application. In such cases a conflict must ensue 
between duty on the one hand and friendship on the other. While he would not 
consciously mislead the company by passing a poor risk, the physician is often 
tempted to strain perhaps a single point, and his judgment is liable to be warped 
by the desire to submit a favorable report. The examiner is in all cases the 
representative of the company, and he must forget for the time that he is either 
the friend of the agent or the family physician of the applicant. If the circum- 
stances of the case are such that he feels he cannot throw aside all prejudice and give an unbiased opinion, the only safe way to emerge from the difficulty is to 
submit the true facts to the company or to refer the application to some other 
examiner. 
But while he is an employee of the company, and should be animated by a 
lively interest in its affairs, such interest should not cease with a faithful perform- 
ance of his duties strictly medical. His labors open up a broader field. To 
become a skillful examiner requires not only ability of a high order, but a certain 
tact and delicacy which is not, perhaps, essential in other branches of the profes- 
sion. Many important points, and some, no doubt, determining the value of the 
risk, will often be brought out by the examiner, which could not be discovered by 
any other means. It is not always sufficient to fill in mechanically the answers to 
the questions required in the application. These are merely submitted by the 
•company as memoranda of the most essential points, and there are sometimes cases 
where the examination has been favorable, and where every question has been 
answered satisfactorily, and yet where some almost latent evidence has led the 
doctor to suspect the existence of disease. The importance of the "remarks 
column " cannot be overestimated, and there are times when a simple suggestion 
inserted here is of more practical value to the company than all the questions and 
answers which may precede it. That doctor does not discharge his whole duty 
who confines himself to simply conducting the physical examination and comply- 
ing with all the requirements of the form. Many claims are paid in cases where, 
by the exercise of a b'ttle extra care and diligence, the examiner might have sus- 
pected and even discovered the symptoms of an incipient disease, and reported 
adversely upon the risk. 
The one important question for the physician to determine is whether the life 
under consideration is in all respects a safe risk, and in order to do this he must 
•demand a separate and distinct answer to each question in the application ; he 
must inquire into the family history ; he must carefully consider the probable 
influence of habits and occupation, and with special reference to any weakness or 
ailment. He should even be expected to follow up any particular line of inquiry 
which may be suggested by the amount or object of the insurance. In fine, the 
applicant is for the time on trial with reference to his physical condition, both 
present and prospective, and the examiner occupies the position of an acute and 
discriminating judge. 
There is a very large number of persons in this and other countries who con- 
sider life insurance companies as their legitimate prey. If they are applicants 
they do not think that they are doing a dishonest act if they prevaricate, or 
insert a misleading answer in the application for the insurance which they would 
procure for themselves or children. If they are agents they argue to themselves 
that they are dependent entirely upon their commissions ; that it is to their interest 
to write as much business as they can ; that they are not supposed to pass upon 
the applications, and that they are perpetrating no swindle when they foist upon 
the company a risk which they know to be bad. In such cases the company and 
the policyholder must rely almost entirely upon the medical examiner for protec- 
tion. If the application passes his scrutiny, it is more than likely to be approved 
at the home office, but his position is such that by the exercise of a little sagacity 
he may often be able to detect fraud and conspiracy on the part of the applicant, 
and to discover and frustrate the schemes of dishonest agents. 
In accepting the position of medical examiner the physician should first satisfy 
himself that the compensation is sufficient to enable him to give the time and 
attention necessary to a proper performance of the duties required. If his regular 
practice is too large to permit of his yielding the amount of time which the work 
demands, he should not accept the office, and the plea that the application is for a 
small amount, or that the compensation is inadequate, is not a valid excuse for a careless and hurried examination. Whatever is worth doing at all is worth doing 
well, and if the sum which the company can afford to pay is not large enough to 
reimburse the doctor for his time and trouble, he should either refuse the appoint- 
ment or demand a larger fee. 
I would not lay down a set of formal rules for the absolute guidance of the 
medical examiner. It is safe to assert, however, that the physician whose services 
must prove of the greatest value to the company which he represents, will be the 
one who thoroughly understands his own work, as well as the methods employed 
by his company in the transaction of its business ; who familiarizes himself with 
the special duties to be required ; who educates himself, if possible, in the princi- 
ples of forensic medicine ; who possesses tact and patience and is ever ready to 
sacrifice his time in order that he may better ascertain the truth. 
The duties which devolve upon the company in this connection are almost as 
numerous as those which pertain to the examiner, but they are far more clearly 
defined and better understood. I may refer, en passant, however, to the danger 
which attends the practice observed by certain compaines of leaving the selection 
of the medical examiner to the agent. He may nominate, perhaps, a friend or a 
physician, whose judgment he can twist and turn to suit his own convenience. 
The examiner should be under obligations to no one, except the company, and 
should be left entirely free and unconstrained in any action to which he may be 
moved. 
A plan has been proposed for a combination of the various companies, and 
the appointment of a staff of competent examiners in all the cities, who would be 
expected to devote their whole time to the work, and to conduct examinations at a 
certain stated fee. This scheme is open to objections, but it is worthy at least of 
some consideration. Meanwhile, a long step will be taken in the right direction 
when the fact becomes more fully recognized in insurance circles, that the pro- 
fession of the medical examiner is distinct from that of the physician, and when a 
special training for this office is guaranteed by the curriculum of our medical 
schools. F. L. Bedell. E 
Newark, N. J., December 15. 
THE 
Life Insurance Examiner, 
- BY - 
Charles T'. Stillman, NI. S., XI. U 
Price, - $3.00. 
Address, THE SPECTATOR COMPANY, 
No. 16 DEY STREET, NEW YORK.