Tuesday, September 30, 2014

Bringing the Housecall into the Twenty-First Century, Part 2


My July 2 post concerned Medicast, a service that arrived in Los Angeles with the goal of bringing the housecall into the internet age. Anyone can download the Medicast app. Clicking connects you to a dispatcher who records your credit card information and sends a text message to the doctor on-call who arrives at your “home, office, or hotel” within two hours. You can Google Medicast.

Its fees are less than those of traditional hotel doctors (who don’t advertise) and much less than the entrepreneurial concierge doctors who do.

Always alert to competition, I contacted Medicast whose directors expressed delight at my experience and welcomed me aboard. I attended an orientation where doctors learned to deal with their software. We left carrying an iPad.

Over thirty years, a dozen national housecall services have come to Los Angeles and, mostly, gone. Size is their great obstacle. When I collect a fee, I keep it all. After paying the doctor, a service has other people to pay. Success requires either a high patient volume or high fees.

My maximum volume has been about 2,000 calls per year, and I have never grossed more than $130,000 – a great deal to most of you but peanuts for a doctor. It’s unlikely any organization can match my volume.

One national housecall service has operated since the 1990s. Its site emphasizes the quality of its doctors, and this was certainly true when I was one. It called 26 times between 2000 and 2002 when I stopped working for them. I collected my usual fee. The service charged more, but dispatchers often failed to tell guests how much. As a result, when I handed over my invoice they expressed surprise. Worse, they blamed me for the fee and did not hesitate to express their displeasure to the hotel. This cause me some difficulty. I'm sorry not to mention its name, but I'm as paranoid about being sued as the average doctor.

Over the next two months, I received 16 calls from Medicast, the last in mid-July. Last week a director phoned to explain that calls were increasing but not to the extent they expected, so they were adopting a different business plan. Two days later, a courier arrived to reclaim the iPad.

Friday, September 26, 2014

Hotel Visits I Don't Make


I don’t make housecalls for certain symptoms: shortness of breath, chest pain, loss of consciousness, and severe abdominal pain.

Treating asthma, the leading cause of breathlessness in the young, takes hours. Giving a shot and then leaving before the guest improves is risky.

Breathless in older people usually means heart or lung disease. No doctor in his right mind treats this with a prescription, but possessing a mind is not a legal requirement for practicing medicine.

No one ignores an elderly person who faints, but this doesn’t happen often. The young seem to faint regularly. They collapse, wake up, and call me, frightened. I’m happy to make a housecall, check blood pressure, do an exam, and ask questions. By this time he or she has recovered, and I’ve never discovered something alarming in otherwise healthy young people. “Everyone is entitled to one faint,” a wise old doctor told me. If it keeps happening, a doctor should investigate.

Chest pain is a serious sign, but serious chest pain is not subtle. Niggling discomfort does not qualify. Textbooks warn that heart attacks can occur with no symptoms although these are usually in people with other problems, especially diabetes. Since a doctor cannot diagnose a heart attack by listening with a stethoscope, a housecall isn’t helpful. If you phone because you’re worried, it’s unlikely the doctor will tell you not to worry because if he’s wrong, you’ll sue him.

As I’ve written before, when a guest suffers abdominal pain, I feel reassured when there’s diarrhea or vomiting. That usually indicates a stomach virus, miserable but short-lived, and I get the credit when he guest recovers. Pain alone can also be a stomach virus but plenty of serious conditions (gallstones, kidney stones, blood clots) come to mind.  

Medical science has no cure for drunkenness, but hope springs eternal, so hotel staff continue to call.

Monday, September 22, 2014

Listomania


I once made sixty to eighty visits per year to the Crowne Plaza at the airport. Now I make about five.

During my last visit I noticed a printed handout on the bedside table containing a long list of clinics and doctors. Given a list, guests tend to call the first number first and then work down. My name was sixth.

When consulted, hotel lawyers always forbid staff from recommending a doctor. Should a guest ask for help, an employee should silently hand over a list, the longer the better. In this way, when the guest sues the doctor, he or she won’t sue the hotel. Lawyers admit that this doesn’t work, but they can’t help themselves. 

Told to make the list, a clerk takes the easy route by consulting the phone book and the internet where she finds clinics, local practices, and entrepreneurial physicians who charge spectacular fees. She won’t find established hotel doctors including me, but I'm well-enough known to be included.

Having produced the list, management forgets about it. As time passes, employees become careless about handing it out, especially since it produces bad feedback. Some numbers no longer work; for others, guests who want to speak to a doctor end up speaking to an answering service or receptionist. Clinics and local doctors don't make housecalls or answer questions. Better to give out a specific number, preferably mine.

It might take years for calls to return to normal, but I am patient. 

Thursday, September 18, 2014

How Can I Break Into Hotel Doctoring?


My first response is always: read my blog. Begun in 2009, it contains everything you need to know about hotel doctoring including how I started.

While it’s entertaining, it might not help. I began in 1983 when there was little competition. I do no marketing except an occasional letter to general managers. I have no web site; this blog, as I chronically complain, has never attracted a customer. I don’t pay hotel employees when they refer a guest (illegal but a long tradition). Yet I do fine. My database, so old it’s a DOS program, contains nearly 18,000 visits. No one will ever match that.

The quickest way to break in is to buy another doctor’s practice. Buying an office practice is bad business because patients drift away, but a doctor selling a hotel practice simply transfers the phone number. As long as the buyer responds to calls, he’ll keep every client because hotels rarely pay close attention to their house doctor.

This is no idle theory because a veteran colleague will soon retire. Another physician has purchased his clientele, a dozen of Los Angeles' and Beverly Hills’ most luxurious hotels. I have heard only good things about the buyer, but he is not an established hotel physician or a friend, so I plan to benefit.

Despite collecting Social Security for ten years, I have no plans to retire, but it’s hard to imagine me working beyond a few more years. I might entertain an offer.

Monday, September 15, 2014

Good News, Usually


A flight attendant with diarrhea is usually good news. Airline crew are young, so they suffer uncomplicated medical problems, and diarrhea qualifies. Her hotel in Costa Mesa was 46 miles away, but it was Saturday morning, so traffic would be light, and I’m paid extra for the distance.

To my annoyance, this was one of those inexplicable weekends when the freeway was jammed although it wasn’t a holiday, and I never saw an accident.

After caring for the guest, always the easiest part, I got back on the freeway and its creeping traffic. Ten minutes later my phone rang. This was bad news because freeway driving is more tiring than practicing medicine, and I had had enough. The caller was a national housecall service, and, to my surprise, the patient was in Costa Mesa, a half mile from where I’d been.

The service agreed to my usual fee for a long drive, so I retraced my route, cared for the guest, and returned to the crowded freeway. I was weary when I finally arrived home, hours past lunch time, but it had been a lucrative day in the fascinating life of a Los Angeles hotel doctor.  

Saturday, September 6, 2014

The Old Man's Friend


A guest was coughing and feverish, and I heard crackling noises, a sign of fluid, when I listened to his lungs. I suspected pneumonia.

I prefer diagnosing pneumonia to an upper respiratory infection because I can prescribe an antibiotic and skip the stressful explanation of why I’m not prescribing an antibiotic.

Unfortunately, this guest was 85. Most victims of pneumonia don’t need to be hospitalized. Even without treatment, most recover. This is not the case with the elderly where, long ago, pneumonia was known as “the old man’s friend.” Dying of pneumonia when you’re already feeble is apparently not a bad way to go.

The son did not like hearing that his father must go to an emergency room, but they went. When I phoned the following morning, I learned that the diagnosis was pneumonia. The doctor had prescribed an antibiotic and sent them out.

I was shocked. Hospitals always admitted elderly patients with pneumonia. What incompetent was on duty?...  Answering my concerns, the son assured me that his father was resting comfortably and promised to return to the hospital if symptoms worsened. When I called that evening and the following day, he repeated his assurances that his father was resting comfortably. That afternoon they had checked out.

If something bad happens, he will sue the hospital, but he will also sue me. It takes a long time for a malpractice lawyer to organize a suit, so his letter wouldn’t arrive for about a year.

Tuesday, September 2, 2014

Preparing to Leave Town


I’ll take a vacation soon. When I leave, I call-forward my phone to a colleague. He’s covered for twenty years and does a fine job, but I have to prepare the ground.

I warn Virginia Mastey. When Frenchmen, tourists or residents, want a housecall in Los Angeles they call her, and she calls me. I have no idea how she built this business; it’s only a sideline, and she charges less than the going rate. The visits are easy, but no other hotel doctor will work for so little.

I warn Inn-House Doctor, a national housecall service that also cares for foreign airline crew laying over in Southern California. You might assume that airlines flying into Los Angeles board crew overnight at nearby hotels, but they often bus them twenty to fifty miles away to Long Beach or Orange County. I live eight miles in the opposite direction from the airport, but Inn-House pays generously for long drives, so I go. Sadly, my colleague lives fifteen miles even further, so Inn-House must make other arrangements.

I remind my colleague that if two international travel services (I won’t name them), call, he should not refuse them. I will mail him a check on my return and handle billing myself. These services take months to pay and require repeated, pestering phone calls. Other hotel doctors won’t work for them.