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.

Saturday, October 2, 2010

Hitting the Jackpot

This week the Adventure called. An inexpensive motel two miles from the airport, it's a collection of single rooms and dormitories with an outdoor restaurant on the premises. Guests are mostly colorful, raffish, college-age, and from around the world. Many are traveling so cheaply they have no insurance, so I spend a great deal of time giving phone advice and making visits at a discount.

Conventional tourists also stay, and this was one. The guest called at 8:30 as I was preparing breakfast, and I told her I’d arrive between 9:30 and 10. Later, as I was preparing to leave, the phone rang again. The caller was the Miami office of Coris USA, a travel insurance agency that mostly serves Latin Americans. Half my calls from hotels require only phone advice, but insurance calls are 100 percent paying visits, so I answered in a happy frame of mind, almost certain that I could skip the gym. I don’t search for reasons to avoid my daily workout, but I like to exercise before the noon rush, and two morning housecalls make that impossible. This doesn’t happen often, so I reward myself without guilt. Keeping fit is essential, but an hour of exercise is as exciting as an hour brushing your teeth, and I’m deeply suspicious of anyone who claims to enjoy it.

It’s not rare to drive thirty miles between hotels, so I awaited the location of my second visit with anticipation. My jaw dropped to hear that it was the Adventure. Two visits at the same hotel, a rare treat!

A downside was that both patients seemed to be suffering the most difficult medical problem I encounter. You might guess that this is heart disease or cancer but it’s the common viral upper respiratory infection – cough, congestion, sore throat, fever. These make up twenty percent of a family doctor’s traffic and mine as well. The source of my difficulty is that (a) patients yearn for a cure and (b) doctors yearn to cure, but we can’t cure these. Doctors everywhere in the world solve this problem by prescribing antibiotics. It works perfectly. Patients believe they're being cured, and the doctor doesn't contradict them. Prescribing antibiotics for viral infections is too common to be the sign of bad medicine; good doctors do it, too. Experts denounce this avalanche of useless drugs as a massive environment pollutant, responsible for the epidemic of nasty infections resistant to all antibiotics which are killing more and more people. This argument does not impress doctors; all agree that environment pollution is deplorable, but it happens outside the office. A patient in the office must never leave disappointed; given antibiotics, he never does.

Having gotten this off my chest, I’ll admit that neither of those patients turned out to have a virus. When I arrived, I discovered the first, a young Australian with a severe cough and high fever, probably had pneumonia because I heard abnormal noises on listening to his chest. In an otherwise healthy person, pneumonia is the only common respiratory infection that medical science can cure. So I cured him.

Walking upstairs, I examined the Coris patient, a middle-aged man from Brazil who explained that he had bronchiectasis. This is an uncommon disease in which a small area of the lung becomes obstructed with frequent infections. He was suffering an exacerbation, so I gave him antibiotics in good conscience.

These were satisfying encounters. That both patients were guests at the same hotel was a delightful bonus although there was a downside. With no travel between visits, I finished at 11 o’clock, too early for me to skip the gym without guilt.

Thursday, September 2, 2010

Caring for Guests at Cheap Lodgings

Calls arrive regularly from the Banana Bungalows, a youth hostel bordering the freeway north of Hollywood.

A Dutch woman was suffering a bad cold. Hearing the fee, she assured me she had insurance. I reminded her that most European travel insurance (unlike South American and Asian) requires clients to pay up front and then file a claim. Hearing this, she decided to wait. I told her she probably didn’t need a doctor, gave advice, and phoned a pharmacy to prescribe a cough medicine. Prescription cough medicines are not superior to those sold over the counter, but patients believe they are.

A German explained that he had broken out in pimples, adding the pleasant information that he had “very good insurance,” so he would pay for the housecall. This is my favorite scenario. The phone call provided diagnosis: chicken pox. It was simply a matter of driving, informing the patient, giving the usual advice, and collecting his money.

The Banana Bungalows are probably a converted motel: cabins strung out along several narrow alleys off the Hollywood Freeway. I parked near the largest bungalow. Reaching the front desk required passing through a room containing several battered couches on which sat a handful of guests watching a movie on TV. Although they come from around the world, hostel guests resemble American college students. Perhaps the men look scruffier, the women more stylish. Also, like college students, there were fewer black faces but an impressive number of Asians.

The desk clerk directed me toward a cabin a hundred yards up the alley. When I knocked, an unhappy voice invited me in. The shabby interior contained four double-decked bunk beds, all unmade. Papers, food cartons, luggage, and clothes littered the floor, and there was no other furniture, not even a table where I could write. The air smelled of unwashed bodies: a typical hostel.

I sat on a vacant bed and introduced myself. One glance confirmed the diagnosis. A minor illness in children, chicken pox can be serious in an adult. Fortunately, this was a mild case. That was the good news, I informed him. The bad news was that he was contagious for a week after the rash appeared.

“I must fly home Friday.” In three days.

“The airline doesn’t want you on board with chicken pox,” I said. I added that the man’s insurance might pay for the change of itinerary. Whether or not it paid, I suspected he would board the plane on schedule. Everyone yearns to get home.

Walking down the hill, I puzzled over the appeal of youth hostels. This one charged thirty-five dollars a night, a bargain. But cheap motels begin at fifty dollars and offer privacy as well as an unshared bathroom. Rental cars surrounded each bungalow, essential for solo travel in the U.S., and the cheapest cost a hundred dollars a week. Perhaps young foreigners like to clump together. Back at the front desk, I stood on tiptoes to peer over and examine the reverse side. I counted four vivid red stickers displaying the name and phone number of other housecall doctors. Years ago, I gave in and paid ninety-five dollars for a thousand stickers of my own design, a more dignified blue on a white background. I still haven’t solved the problem of getting them posted.

I caught the eye of the desk clerk, a youth with a shaved head, tank top, and jeans. The quality of front desk personnel varies directly with the quality of the hotel. Since hostels are a nonprofit enterprise, their employees fall below the bottom of the scale.

“Could I speak to the front desk manager?” I asked.

“I guess that’s me.”

“I’m Doctor Oppenheim. I just took care of the man in bungalow ten.” He shifted impatiently. “Did you call a doctor?”

The clerk shook his head.

“Maybe one of your colleagues?”

“I’m the only one on duty.” It’s a mystery how often I find no one who admits to referring a guest. I began my sales pitch.

“Who do you call when a guest wants a doctor?”

The clerk shrugged. “Nobody gets sick much. We send them to an ER.”

“Someone called me. And look at those stickers.” I reached forward to tap the far side of the counter. The clerk looked, but his expression remained blank. I pressed on. “All hotels use me. Your guests can call any time. I’m happy to talk to them. That doesn’t cost anything, and half the time I solve their problem.”

At chain hotels, employees maintain eye contact as I speak. I often sense their lack of interest, but at least they remember their manners. The Banana Bungalow’s clerk kept nodding to encourage me to get to the point. He flicked an impatient glance at a guest standing nearby.

“I notice others have their numbers posted. Would you mind adding mine?”

“No problem.” The clerk snatched the sticker I held out and then turned to the waiting guest. I decided not to hang around to make sure he posted it.

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.