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Wednesday, September 28, 2011

Suitophobia

“I’m Doctor Oppenheim….”

“Welcome to the Intercontinental, Doctor Oppenheim. Are you checking in?”

Damn. Another employee who doesn’t recognize me. This happens in hotels that have called for decades. Who knows what she’ll tell a guest who asks for help?

No American hotel employs a “house doctor.” Some general managers designate a local practitioner. Some (under the impression that it protects them from liability) make up a list of physicians, but many pay no attention, leaving it up to guest service personnel. This gives the advantage to entrepreneurial doctors who tour hotels and extol their services to the staff, perhaps with the hint of material gain for a referral.

I can’t stomach delivering a sales pitch, but years ago I decided to hand a copy of my latest book to each general manager and explain modestly that writing allowed me free time to serve their guests. The managers listened politely, made flattering comments, and went back to work. It was clear many had no idea who I was. My tenth visit, to the downtown Hilton, was my last. “What do you mean ‘serve our guests?’” snapped the GM. “We don’t have a hotel doctor. We don’t want a hotel doctor. You’re going to get a letter from our lawyer!” He snatched my book and marched off. I was a familiar figure to Hilton staff, having made over 100 visits, but I never made another.

That was my first encounter with the epidemic of suitophobia that rages among hotel managers, compelling them to forbid staff from helping sick guests except by getting them off the premises. At any given time, about ten percent are affected. Most recover after a few years. I made over 600 visits to the J.W. Marriott in Century City before calls abruptly stopped. I learned the reason from concierges who swore me to secrecy when they snuck me in to see a particularly demanding guest.

Here’s a scenario that should give these managers pause. A guest asks for a doctor. The employee explains that, for liability reasons, he cannot comply but will happily provide directions to the nearest hospital. The guest declines to go. The employee offers to call paramedics. The guest refuses, returns to his room, and dies. Lawyers will fall over themselves to take this case: the guest asked for help and didn’t get it. I’ve dealt with similar cases, often over the phone. Most sick guests don’t need an emergency room or the paramedics, but when they do I don’t take no for an answer. I’ve delivered this argument to half a dozen general managers and persuaded none. The disease must run its course.

Friday, September 16, 2011

Guests Who Drop Hints

Every patient is unique, but it’s amazing how many repeat phrases that I’ve heard hundreds of times. These are invariably hints which painful experience teaches me not to ignore. Here are some.

Guest: “You’re the doctor.”
Like “You’re the boss,” this means “You’re wrong.” Other hints that I’m off base include:
“I wonder if I need something stronger…”
“My regular doctor always gives me...”
“My husband had the same thing, and the doctor said it was...”
Hearing these, I go back to square one and explain my thoughts.

Guest: “If I don’t get something it turns into (...bronchitis, strep, walking pneumonia, a sinus infection...).”
This guest is saying: “I want an antibiotic.”
Patients often work hard to convince me that their cough, congestion, or sore throat has a special feature that requires an antibiotic. They tell me that -
“I have an important meeting, and I can’t afford to be sick.”
“I have a tendency to strep.”
“It’s not a cold. It’s bronchitis!”
“If I don’t catch it quick, it goes to my chest.”
Plus the old favorite: “My regular doctor always gives me...”
This is one hint doctors rarely ignore. Prescribing useless antibiotics is almost the standard of practice; even good doctors do it.

Guest: “I try not to.”
This means “Yes” in answer to questions like: “Do you cheat on your diet, stick Q-tips in your ears, consume large amounts of alcohol, tranquilizers, salt, laxatives, or high cholesterol food?”

Guest: “I try.”
This means “No” when I ask if someone has obeyed instructions that are almost impossible to obey (take a pill every four hours, stick to an exercise program, ignore a crying baby)...

Guest: “Are you sure I need this?”
This means zero compliance unless I work hard to convince him to go along. Similar hints include:
“I don’t like to take medicine unless it’s absolutely necessary.”
“I’m sure it’s not broken.”
“My mother is allergic to this.”
“I have a sensitive stomach.”

Guest: “Everyone tells me what a great doctor you are, so I know you can help.”
This guest is preparing to ask for something I don’t want to give.

Sunday, September 11, 2011

Popular requests

Long ago a man phoned to inform me that he was on his honeymoon and would like a shot of testosterone. I explained that this was unlikely to solve his problem. Then I gave advice.

He did not want to leave any stone unturned, and I’m happy to make a housecall to deliver a harmless injection, but I couldn’t in this case because I didn’t carry testosterone. I bought some on my next drug order. Sadly, I never received another request. I discarded the vial after it expired and never replaced it.

Also long ago, a woman whose hot flashes were acting up asked for an estrogen injection. I explained that pills work as well, but she was willing to pay for an injection which I couldn’t provide. I ordered estrogen, but no one has asked for it since.

I carry two sorts of medication: those guests need and those they ask for. The second category is tricky as these examples illustrate. Another: bereaved guests or those in great emotional distress often beg for a shot to “put them out.” Unfortunately, although movie doctors use it regularly, there is no injection that makes you go to sleep. Given intravenously, a general anesthetic works, but it’s a bad idea to do this outside of a medical facility. Michael Jackson’s doctor disagreed, and it turned out badly.

B12 remains a hotel doctor’s only reliable moneymaking placebo. I’ve never encountered an illness that required it, but requests arrive several times a year. Celebrities often ask for an injection before a performance, always a thrill.

Friday, September 9, 2011

Sorry for the Mess

This is the most common phrase a hotel doctor hears. Sometimes I hear it as I step into the room, more often when I look for a place to set down my paperwork because all surfaces are piled with discarded clothes, toilet articles, food wrappers, luggage.

A messy room does not greatly embarrass guests. This is not the case when, after putting a thermometer in a guest’s mouth,I announce that I will wash my hands. That produces a minor panic as someone hurries into the bathroom to clear away another mess and search, sometimes in vain, for a clean towel.

A final ritual is collecting my fee. Technology makes accepting credit cards easy although the company takes about five percent for the convenience. Using a phone, I dial a computer whose automated voice instructs me to enter half a dozen codes (my bank number, my merchant number, the credit card number…). In the past I used the room phone until I noticed guests looking uneasy and remembered that hotels charge for calls. Now I use my cell phone, an awkward alternative because the small keypad encourages mistakes. At the end, the computer announces its approval and recites an authorization code which I dutifully copy. Occasionally, in an ominous tone, it denies approval, and I laboriously re-enter everything. If this doesn’t work, there is a scramble as guests search for another card or their wallets.

Cash-paying foreign guests take time counting out my fee because all American bills look alike. Around the world, denominations vary by color, so a quick glance tells a native its value. I think America is the only nation with monochromatic money.

When guests mention their difficulty, I joke that Americans find colored bills frivolous, like Monopoly money. Real money is green.

Friday, September 2, 2011

Mid-level chains (Hilton, Hyatt, Holiday Inn, Sheraton) provide most of my business. I love luxury hotels, but these have traditionally been the bread-and-butter of hotel doctoring, so my competitors, all more entrepreneurial than I, love them more. The result is that when one of them notices an iconic Los Angeles hotel (Bel Air, Beverly Hills Hotel, Sofitel, Four Seasons) calling me too often, he steps in and points out the error of their ways.

My colleagues don’t care to travel, so I’m the doctor for the most opulent hotel in the county: the Langham (formerly Ritz-Carlton) in Pasadena 25 miles away. It sits on twenty acres that includes a beautiful Italianate-style main building, luxurious Spanish Revival-style cottages, and a historic garden.

Last week the Langham concierge asked me to speak to a guest. As soon as she came on the line, I knew she felt terrible. She sounded weary and hoarse after vomiting for several hours. She was in good health, so odds favored the usual stomach virus, miserable but rarely life-threatening. Most vomiters want quick relief, but she preferred to wait it out. I gave the usual advice (don’t eat, don’t drink, suck on a piece of ice) and left my number. Fifteen minutes later the concierge connected me to another vomiting guest who also declined a visit.

This would have been a rare treat Рtwo patients at the same hotel. Sadly, both were American. Since Pasadena lacks the tourist cach̩ of Los Angeles, Langham guests include more Americans who are less inclined to pay for a housecall than foreigners who accept their helplessness in the hands of a rapacious medical system.

When I phoned later that day, both had recovered. They were grateful for my concern, but they would have been more grateful if I’d cared for them. Although you might not think so, I consider vomiting a good visit. It usually doesn’t last long, and the doctor gets the credit when it stops.