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Monday, July 23, 2012

No Income Today

A lady at the Westin wanted a housecall for her cough and fever. This seemed reasonable until I learned she was under treatment for multiple myeloma, a serious blood disease. It affects the immune system, so any sign of infection is a red flag.

I explained that she needed more than I could provide in a hotel room and gave directions to the nearest emergency room.
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Two hours later I spoke to a guest at the Airport Holiday Inn who was experiencing sharp chest pains. Chest pain is worrisome, but significant chest pain lingers. Fleeting pain in an otherwise healthy person is almost never a serious sign. I looked forward to the visit when, after my exam, I would deliver the gratifying news that I had found nothing wrong. That anticipation disappeared when the guest mentioned that he had suffered blood clots in his lung and was taking blood thinners. He hastily added that these chest pains were nothing like those when he was having blood clots.

Different or not, it was a bad idea to assume that these were trivial. I sent him to a facility that could perform tests.
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Coris-USA asked me to see a hotel guest in Encinitas.

“That’s near San Diego,” I pointed out. “It’s a hundred miles.”

The dispatcher explained that no one in San Diego was willing to make the visit.

I’ve traveled that far in the past and charged accordingly, but I didn’t want to quote a fee and risk having it accepted because I wasn’t in a mood for the grueling drive. I referred her to the internet for local urgent care clinics. 
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“I’m a physician in the U.K., and my wife has conjunctivitis in both eyes. I went to the chemist for antibiotic drops, but apparently I have to see an American doctor.”

“It’s unusual to have bacterial conjunctivitis in both eyes at the same time,” I pointed out. “But if you’re certain, you can ask the pharmacist to phone, and I’ll approve the prescription.”

He thanked me and hung up. Later the pharmacist phoned. When it comes to their own illness or that of their family, doctors are no more accurate than laymen, but they have no interest in my opinion. 

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