Followers

Sunday, October 30, 2011

It's Still a Good Job

“How quickly can you get here?”

That may be the most common phrase I hear after a concierge identifies herself.

“Pretty quick, but I like to talk to the guest first. Would you connect me?”

I didn’t assume this was an emergency; guests who make urgent request are more often impatient than sick.

“When can you get here?” asked the guest impatiently.

“Pretty quick. What’s going on?”

“It’s my assistant. He’s got the flu.”

“Could you tell me what’s bothering him?”

“I’m not a doctor. That’s why I called you.”

I suppressed a surge of annoyance. “People mean different things when they say ‘the flu.’ Is he vomiting?”

“No.”

“Is he feverish?”

“Yes. Listen! I have a dinner reservation at 6:15. Can you make it?”

It was 5:30. Unless guests feel truly miserable (vomiting, pain) they are usually willing to wait a few hours, so I often delay dinnertime calls until rush hour traffic dwindles. But hotel doctoring is a service as well as a dog-eat-dog business, and if I disappointed this demanding caller, he might ask the concierge to suggest someone else.

Creeping 1½ miles to the freeway onramp took fifteen minutes, but then traffic moved slowly but steadily, and I arrived on time. As is often true in my business, delivering medical care is the easiest part. The patient suffered a bad cold and didn’t consider it a serious problem. In person, his boss seemed congenial.

On my drive back, the freeway stopped cold. I took an exit three miles from home. Despite this, traffic crawled so slowly I was expecting a blocked lane ahead, but it was just the rush hour. It took an hour. On the bright side, I had finished half my dinner when the call arrived,, so I wasn’t hungry. And in hotel doctoring, when you finish seeing one patient, you go home.

Wednesday, October 26, 2011

Too Many Cooks

As I was preparing for bed, a call arrived from one of my favorite hotels, the Palomar. I like it because it’s large and upscale but mostly because it’s only a short drive. The caller explained that his nine year-old son had been coughing for three days.

“I started him on phenoxymethy penicillin,” he added.

“Does he have a bad sore throat?” I asked. Penicillin treats strep throat and no other common childhood illness, but the presence of coughing makes strep unlikely.

“No. I thought it might help… My brother is a pediatric consultant in London. He gave me a Ventolin inhaler.”

“Did that help?”

“A little.” That means “no,” but it was a good idea. Asthma inhalers often relieve a cough even in patients without asthma.

“I’m a doctor who comes to hotels. Would you like me to see him?” I asked.

“My wife wonders if I should take him to a clinic for a chest x-ray and blood tests.”

“Unless he’s very sick, that’s not necessary.”

“He’s doing better today. Maybe you should come. Can you give him cortisone?”

“I carry cortisone….”

“So you could give him an injection?”

“I would have to examine him first.”

After consulting with his wife, he said “We will wait for you.”

I exchanged my pajamas for a suit, filled out my encounter form, and was about to leave when the phone rang. It was the Palomar again, and I knew what that meant. Guests don’t like to cancel in person, so a hotel employee delivered the message.

“The gentleman says he’s decided to take the child to an urgent care clinic.”

“There’s no urgent care clinic in this area open so late. He’ll have to go to the UCLA emergency room.”

“Thanks for the information. I’ll tell him.”

I reverted to my pajamas and went to bed where I passed an uneventful night. The Palomar guest probably passed it in the emergency room.

Friday, October 21, 2011

Hitting the Jackpot

Two miles from the airport, the Adventure resembles a youth hostel: a mixture 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 one called at 8:30 as I was preparing breakfast. I told her I’d arrive between 9:30 and 10. During breakfast, 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 almost all paying visits, so I answered in a happy frame of mind, certain that I could skip my daily workout. 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 healthy, 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. It was the Adventure. Two visits at the same hotel, a rare treat!

A downside was that both patients seemed to be suffering my least favorite illness: a respiratory infection. Almost all are viral, but prescribing antibiotics is so common that even good doctors do it, so patients are often puzzled and disappointed when I don’t. Doctors love their patients’ gratitude, but prescribing Tylenol and cough medicine get them very little.

Having gotten this off my chest, I’ll admit that neither of those patients had a virus. The first had a severe cough and high fever, probably pneumonia because listening to her left lung revealed abnormal noises. In an otherwise healthy person, pneumonia is the only common chest infection that medical science can cure. So I cured her.

Walking upstairs, I examined the Coris patient, a middle-aged man from Brazil who explained that he had bronchiectasis. This is an uncommon condition 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 staying at the same hotel was a delightful bonus, but there was a downside. With no travel between visits, I finished at 11 o’clock, too early to skip the gym without guilt.

Friday, October 14, 2011

“Can you make a housecall in Larkspur?”

I’d never heard of it. Google Maps revealed that it’s four hundred miles away, north of San Francisco. The dispatcher seemed disappointed at the news.

Half a dozen travel insurance agencies serving clients from Latin America have US offices in Miami, and it’s natural that they’re unfamiliar with California geography. Looking up cities is easy, but it’s even easier to call me. I'm sure you've phoned your family doctor, wading through voicemail, answering services, receptionists, and leaving messages. Hours may pass, but eventually the doctor calls except when he doesn’t.

Pity these poor dispatchers. Once a sick client phones, the dispatcher retrieves a list of doctors from that city and begins calling. Even after she finds one willing to make a housecall, her task is not finished because everyone knows doctors are terribly busy. I can confirm from my own experience that a colleague who agrees to help might not give this a high priority. Early in my career my requests were invariably followed, a few hours later, by a call from the hotel informing me that the guest was still waiting. Now I extract a promise that he will go quickly and then phone later to make sure he does.

I’ve never had an office. My number reaches my cell phone; I always answer in person, and I try not to decline visits within reasonable driving distance. Without being asked, I always tell the caller when I’ll arrive.

This turns out to be good for business. Tracking down a doctor remains a tedious process in other cities but requires a single call in Los Angeles, so dispatchers find it easiest to call me. Some phone whenever a California client calls, so I often deliver the bad news that they must begin working down the list for San Francisco, Sacramento, or San Diego.

Saturday, October 8, 2011

Clever I-Phone features

My wife wanted to visit the Riverside photography museum, seventy miles away. On these trips, she drives, and I read aloud to her (on this occasion, Freedom by Jonathan Franzen… terrific!).

During any four hour period, there’s an even chance of a call, but only half require a visit. Our luck didn’t hold, and my phone rang after forty miles; someone was vomiting, not a visit I can stall. When we looked up the address on her I-phone GPS, it claimed no such location existed. Since this was an insurance call, the patient was foreign. She had phoned the insurance office whose dispatcher (also foreign) phoned me, so addresses often become garbled. I called the patient’s number and heard a busy signal, always a bad sign on today’s phones. I was forced to call the insurance number, spending a few minutes on hold before reaching a different dispatcher who spent several minutes researching before turning up the correct address.

Then the I-phone GPS worked its magic, laying out a detailed route to an obscure area near Long Beach thirty miles away. While I took care of the patient, she looked up a nearby restaurant on an I-phone Ap (Urban Spoon). We ate lunch and returned home.

Two days later we repeated the drive, this time successfully. Most photography museums are simply art galleries, but Riverside’s is part of the University of California, so it delivers large dose of interesting history with quantities of old cameras and old photographs. Afterward, she looked up a restaurant near the museum. Driving home with the rush hour approaching, I kept an eye on her I-phone GPS, marveling at its accuracy at predicting freeway jams.

My wife urges me to buy an I-phone. She loves it except when she hates it, and I observe her cursing, poking in vain at the touch-screen. So far my three year-old unsmart phone sends and receives calls without fail; no clever feature can match that.

Sunday, October 2, 2011

Why I Discourage Appointments

“The guest will be in the room at six o’clock and would like to see you then,” announced the concierge at two o’clock.

Tactfully, I suggested that she not make appointments without consulting me. The Torrance Marriott is eighteen miles away, and I didn't want to drive across town during the rush hour to see someone who wasn’t sick enough to leave work. I phoned to tell the guest that I could come immediately or around nine p.m. She chose nine.

Arriving ten minutes early, I knocked, and no one responded. Reached by cell phone, the guest reminded me that the visit was scheduled for nine. She was dining nearby, she added, and would hurry back. Twenty minutes passed before she arrived, but during that time another hotel phoned with a visit on my way home, so it looked like a good evening.

The guest arrived, apologized, and described her problem, a minor eye irritation. After I’d finished she mentioned that her husband felt under the weather. This is usually pleasant news because this couple had travel insurance. My routine is to ask the patient to phone the insurance to obtain its approval, so I could care for him and be paid. But obtaining authorization takes time. It was late, and I was anxious to see the next patient who seemed genuinely ill, so I treated the husband’s cold gratis and hurried off.