Tuesday, May 5, 2009

A Freebie

“This is Franklin De Forest. We’re staying at the Hilton. I wonder if you could help us.” There was a pause although the caller hadn’t asked a question. His voice quavered, so I knew he was elderly. American guests over sixty-five were awkward because Medicare paid a pittance for housecalls and forbade doctors from collecting the difference from the patient. I tried to avoid Medicare housecalls. Knowing the reason, many guests offered to paying the fee directly, promising not to send the bill on the Medicare. I think this is also illegal.

I heard muffled sounds, and then a female voice came on the line. Elderly men invariably handed the phone to their wives. “We just flew in from Chicago, and we leave for Tahiti in three hours. I feel so stupid... We went off without our medicine. Is there any way you could see us and write some prescriptions?”

Tourists regularly forgot their pills or lost them or packed them in luggage that disappeared. Authorities discourage doctors from prescribing without a thorough evaluation. Housecall agencies virtuously explained this, then sent a doctor who wrote prescriptions for heart pills, cholesterol pills, diabetes pills et al, then collected a few hundred dollars. I could not bring myself to charge for writing prescriptions.

“If they’re medications you take regularly, I’ll phone a pharmacy, and tell them to give you some more.”
“That’s so nice. My husband takes Lanoxin.”
“And what dose?”
“What dose, Frank…? He says the usual.”
“Point two five milligrams?”
“Point two five milligrams, Frank…? He says that’s probably right.”
“How many do you want?”
“Just enough till we get back.” The woman paused either to calculate or simply because she felt I was psychic. I repeated the question. “Say fifteen. He also needs Glyburide for his diabetes.”
“What’s the milligrams?”
“What milligrams, Frank…? He’s not sure, but it’s a little green pill.”

The man required three prescriptions, his wife four. Their recollections of dose and dosing schedule were vague. I determined several by consulting the Physician’s Desk Reference, but details of the wife’s “for my stomach” pill remained a puzzle, so I chose one that seemed harmless. I compromised on two other uncertainties by prescribing the lowest dose. The elderly take so many medicines there’s a good chance many are unnecessary. The call took fifteen minutes.

“We’re so grateful for your help, doctor. How can we pay?”
“No charge. But I’d like you to tell the manager how nice I was. This is a competitive business.”
The woman laughed. “I’ll do it first thing.”

Asked about payment after providing phone help, I always refused, then suggested the guest praise me to the hotel staff, and the guest always treated it as a joke. It was a joke, mostly, but I hoped a few would obey.

No comments:

Post a Comment