Tuesday, August 11, 2009

Caring for Airline Crew

Every night in every big city, several hundred commercial airline flight crew lay over. Lacking transportation, they have trouble finding medical care. Airlines in Los Angeles soon learned about me, and I’ve made 618 visits, mostly to flight attendants, and sent my bill to the airline. Flight crew are young and healthy with uncomplicated illnesses, so visits tend to be easy. On the other hand, airlines switch hotels when they obtain a better rate. Since I’m reluctant to give up business, I find myself traveling farther than I like.

As in other aspects of health care, foreign nations have a better system. When American crew need a doctor, they can go wherever they want and use their insurance. The combination of no transportation and huge deductibles mean they usually go nowhere. Since many call the front desk to ask if there is a doctor, I dealt with their pitiful calls. American pilots occasionally bit the bullet, but flight attendants couldn’t afford me unless I cut my fees. I give free advice and, if necessary, direct them to the nearest 24-hour clinic.

Then I have to decide if they’ll go. Once anyone calls me, I become his or her doctor. I think this is the law, but it’s certainly how some doctors feel, and it’s the reason lawyers (American lawyers) warn us never to give phone advice. If a patient disobeys my instructions, I’m still responsible, and I hate hanging up and worrying, so I occasionally make a housecall to an American flight attendant. My fee for a charity visit was $30 or $40. Afterward, I always feel virtuous, so there are compensations. Foreigners never required charity.

I’ve been the doctor for a dozen foreign airlines including Alitalia, El-Al, Virgin-Atlantic, Aer Lingus, Japan Airlines, and Cathay Pacific. Two provided a fascinating contrast. Conveniently (for this discussion) they laid over a few hundred yards apart: Virgin-Atlantic at the Torrance Hilton, Cathay Pacific across the street at the Torrance Marriott. These were seventeen miles from my house, over a half-hour drive when traffic moved smoothly.

If a guest at the Park Hyatt, a mile away, wants a housecall, I go, but I’m liberal at giving free advice over the phone. I don’t claim immunity from human nature, so my willingness to handle an illness over the phone grows with the driving time. A check of my computer reveals a visit on 56 percent of calls from the Park Hyatt. When the Warner Center Marriott in distant Woodland Hills phones, I make the trip 29 percent of the time. I also lean over backwards to avoid a visit if the guest might find the fee painful: 63 percent to the upscale Bel Air Summit versus 43 to the Airport Holiday Inn.

Foreign airline crew do not pay, but I have no objection to giving phone advice to guests in faraway Torrance. That’s when the English proved again why they’re the world’s best patients. If I explained that their illness didn’t require a visit, they understood. If I didn’t give a prescription, they didn’t point out the oversight.

Matters were different with Cathay-Pacific. Based in Taiwan, its flight attendants came mostly from Southeast Asia: Thailand, Malaysia, Singapore, Indonesia, the Philippines as well as Taiwan. These cultures have a different view of a doctor’s powers.

Although most Americans would deny it, they believe doctors – invariably doctors they like – possess healing powers that go beyond scientific medicine. It’s my impression southeast Asians take this more literally, and they also believe employing such powers require a doctor’s presence. When Cathay-Pacific crew called they rarely welcomed advice.

Hotel guests generally love to learn they suffer an ailment too minor to require a doctor, so I dispense a great deal of instructions on self-care. The common cold makes up fifteen percent of all human illnesses including those of Cathay-Pacific flight attendants, but my expertise seemed lost on them. I deliver an excellent explanation of stuffy nose treatment. Since foreigners need names of American over-the-counter medicine, I always asked them to get a pencil. Time and again, the phone remained silent for several seconds before I heard: “When you come?...”

Everyone who flies worries about ear damage when they have a cold, so I discussed it. Everything you’ve heard is either worthless or positively harmful. Never pinch your nose and blow. Over-the-counter decongestants aren’t strong enough. Everyone who flies with a cold should buy a nasal spray such as Afrin or Neo-synephrine. While you’re sitting in the plane before it takes off, spray each nostril thoroughly. Wait ten minutes for the spray to work, then repeat. That carries the spray far back into your nasopharynx to the exit of the eustachian tube, the only connection between your middle ear and the outside world. Even if your nose is clear, swelling of mucus membranes can block this opening. If the flight lasts more than a few hours, repeat this as the plane begins its descent, an hour before landing.

Too polite to interrupt, Cathay-Pacific crew waited until I finished before speaking words that made my heart sink.

“You come?... When you come?”

My database confirms what I always believed: that I made visits on about half my callers. Cathay-Pacific held first place among my clients with 82 percent.

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