Saturday, December 18, 2010

"Do You Go To Ontario?"

“Do you go to Ontario?” asked the dispatcher for Expressdoc, an agency that sends doctors on housecalls. Travel insurers who don’t call me directly use Expressdoc. It’s a mystery why because it costs them extra, but I charge the same no matter who calls, so I don’t mind. Ontario is in San Bernardino County, fifty miles distant, but this is small potatoes. My record is ninety miles to Carpinteria. Freeway traffic, not distance, determines if I drive. I delay distant, late afternoon visits until the evening. Morning drives are acceptable; the hours between ten and noon are golden because traffic slows after the morning rush; it builds again after twelve, and there is no afternoon decline. The Ontario call arrived at 12:20, so I was not optimistic about the return. But it worked out fine. I took the Pomona freeway, bypassing downtown, and the hour’s drive passed with no significant slowing. I listened to Slaughterhouse Five on my CD; highly recommended.

The patient was a Brazilian lady visiting her son; her upset stomach presented no problem. Accompanying me to the elevator, the son he told me he was reevaluating his decision to remain in the US because the political atmosphere had grown so shrill and confrontational. I agreed. Did you ever think there’d come a time when South Americans considered their governments more stable than ours?

Wednesday, December 15, 2010

Another Easy Visit

Airport security confiscated a tourist’s glaucoma eye drops, so he called his insurance who called me. The drops come in a tiny 2½ cc bottle, so the seizure seemed puzzling. On the other hand, nearly ten years ago they took my tweezers, a beautiful needle-nosed instrument perfect for removing slivers. It cost $20. Later, I checked the Transportation Security Authority web site and learned that tweezers are specifically permitted. Naturally, I’m still fuming.

The visit was easy. Usually, I phone a refill to a pharmacy when a traveler needs a legitimate prescription, but December has been slow; no calls have arrived in a few days, so I’ve felt uneasy. Ironically, medical experts unanimously frown on giving prescriptions without an examination. They never explain how an examination in a hotel room can prove that a patient has, for example, glaucoma, osteoporosis, emphysema, acid reflux, or epilepsy. If he takes high blood pressure medication, and I find a normal pressure, must I refuse the refill?

Friday, November 19, 2010

Things I Don't Charge For

Quantas and other airlines recently canceled flights after an engine exploded, stranding a large number of passengers in hotel rooms. Within days I began receiving calls from guests running out of their heart or diabetes medication. They had brought only enough for their trip or the bottles were packed in luggage which the airlines refused to release. Aware of terrifying stories about America’s medical system, they were counting their money, hoping to have enough for the necessary king’s ransom. They were pleased to hear that I don’t charge for replacing legitimate prescriptions.

Most American drugs are available in other countries, but often in different formulations and with different names. Rather than try to figure things out, I tell guests to go to a drug store where the pharmacist will research the matter and phone. I’ll approve whatever he determines. Guests regularly forget to pack medication or find their trip unexpectedly extended, so I do this routinely. My record for replacing prescriptions occurred after 9/11 when all flights stopped, and hotels were packed. Some travelers also fell ill, so my paying business jumped for a few weeks. Then everyone returned home, and tourism plunged for almost a year. That was a bad time for hotel doctors, too.

I deliver plenty of free services. I don’t charge for anything I do over the phone. I don’t charge hotel staff. I’m happy when they consult; it’s a sign they know about me and, after the consultation, they might tell colleagues about the experience. As I’ve mentioned before, no hotel employs a house doctor. Even at my regulars, I don’t occupy an official position, so many employees have never heard of me. “Are you our doctor? I didn’t know we had a doctor” is something I hear even at hotels that have called for decades. This is not good because when guests ask for help, they usually accept the first answer.

Since I am the world’s most successful hotel doctor, you might assume I command respect in my profession. There is some truth in this, but it’s not unanimous. Delivering free care upsets many doctors. Those I know personally don’t mind, but I also belong to internet physician forums whose members feel differently. Although the forums exclude nonphysicians, any clever person can figure out how to join, but I advise against it because you don’t want to hear what doctors say when they believe you’re not listening. I enjoy their medical discussions but avoid threads on business and politics. As in most forums, contributors with strong opinions dominate. I find it unsettling that the longest, angriest discussions concern money. The most energetic participants tend to work in private practice where their income depends on patients or insurance. They detest not getting paid; they suspect most poor people are deadbeats; they hate insurance, the government, President Obama, and healthcare reform.

Recently I contributed a funny story. You may have read it earlier on this blog. An Israeli man at a Beverly Hills hotel needed a doctor’s signature on his request for a disabled parking pass but didn’t want to pay my fee. Since it was a trivial task, I told him I’d sign it gratis if he came to my home. After hanging up, I began to worry. Obtaining disabled parking permits is a scandal in California; eleven percent of drivers have one. If I didn’t believe this man was disabled, I planned to refuse to sign thereby risking an unpleasant scene. I passed an uncomfortable half hour until I heard the sound of someone approaching. Opening the door, I saw a man, one arm around a young woman (his daughter) hopping up the steps to my house. He had one leg. That was a relief.

I posted the story and awaited expressions of amusement. Almost immediately a doctor wrote angrily that I had prostituted my profession, undoubtedly to curry favor with the hotel. Doctors provide a service for which they deserve a fee, he added. Any Beverly Hills hotel guest could afford it; that I blithely gave him a free ride showed that, in my degraded state, I didn’t realize how this damaged hardworking physicians with bills to pay. Other responders agreed, and then, as happens on forums, they wandered off-topic and exchanged of anecdotes about being stiffed: by obnoxious patients, welfare patients, dissatisfied patients, insurance carriers, Medicaid, Medicare, the government. Doctors on doctor forums spend a good deal of time fuming over not getting paid.

Tuesday, June 22, 2010

A Relatively Easy Housecall

Before driving home, I answered a message from the Embassy Suites at the airport. The previous evening, a Canadair stewardess had phoned, confined to bed with a backache. Many foreign airlines call me to see sick crew members; I bill their central office. American air crew with their American insurance are out of luck. Billing an American insurance carrier – and for a housecall! – guarantees torment and aggravation, and I’ve long since given it up. Billing a foreign airline is no simple matter (“my manager says send your bill to the main office” never works), but once we’ve agreed on a formal arrangement, matters work smoothly. Sadly, I have no arrangement with Canadair. I explained this to the flight attendant, and she agreed to consult her supervisor. When I answered my message, I was delighted to hear her explain that Canadair had faxed an approval for my visit and its credit card number. Her backache had improved, and all she needed was a doctor’s note approving travel home as a passenger. I expected an easy visit.

After a short consultation and the note, I presented myself to the front desk where I discovered my optimism was premature. The number on the Canadair fax belonged to an American Express card. American Express charges more, so many credit card services, including mine, don’t cover them. I explained this to the desk clerk who summoned her manager who apologized, phoned Canadair, and learned that the airline did not have a Visa or Master card, a situation I’ve never encountered. No problem, the manager assured me. The hotel would mail me a check and bill Canadair. This seemed a bad idea because hotels don’t normally do that, and long experience has taught that expecting a hotel to do something it doesn’t normally do leads to frustration. But my rule is to never hassle a hotel, so I smiled and agreed. An hour later, the manager phoned to say that, rather than mail a check, the hotel would pay cash on my next visit. Naturally, I agreed.

Two days later, picking up my wife at the airport, I stopped by the Embassy Suites. I wouldn’t be writing this if matters went smoothly, but the desk clerks looked mystified when I explained my purpose. They phoned the manager who was tied up in an important meeting. I waited half an hour, but when my wife called. I departed after leaving a polite message on his cell phone. He was off duty when I returned the next day, and the desk clerks remained puzzled. There is no great lesson here, and I’ll eventually collect, although I suspect I’ll have to phone Canadair a few times, fax a few forms to Canada, and wait a few months.