Thursday, May 31, 2012

A Hotel Doctor's Database: Part 2

Now and then I consult my database for business purposes: for example, to check on a guest who claims to have seen me before. Mostly, I use it satisfy my curiosity.

Men travel more than women but are less likely to ask for a doctor so women outnumber them 8834 to 7800. I’ve cared for 110 patients under age one and thirteen over 90, the oldest 97. The smallest of the small hours are not silent. I’ve made 634 housecalls between midnight and 5 a.m.

My leading diagnosis is the same as that of any family doctor: respiratory infections, 4219 visits. In second place are upset stomachs with vomiting and diarrhea: 2346.

I’ve been around long enough to see 76 patients with chicken pox, another 76 with gout, 12 with mumps, 53 with herpes, 29 with poison ivy, and 149 suffering a kidney stone. Victims of kidney stones rarely delay calling a doctor, and since they are rarely emergencies I visit a fair number.  I’ve seen 79 guests with chest pain and sent ten to the hospital. Far more of my 30,000 callers complained of chest pain, but I work hard weed out emergencies over the phone. Those ten were mistakes.

My most numerous foreign patients are, as you’d expect, the British:  1,711. You won’t guess number two: Argentineans with 1,686. That’s the home base of Latin American travel insurers, but they have prospered and spread; since 2000 I receive more calls from the largest country in the hemisphere, Brazil which will eventually overtake Argentina. 

I’ve cared for guests from Tonga, Malta, New Caledonia, and Curacao but not from Latvia, Estonia, Yemen, and half a dozen African nations. Russians didn’t travel until the fall of the Soviet Union. I saw my first in 1991. The Chinese don’t appear until 1998. So far Cuba has sent one.

Six guests died – fortunately none in the room after my visit. One was dead when I arrived. Four died soon after I sent them to the hospital, and another died after the ER doctor (mistakenly) sent her back. I called the paramedics after examining sixteen guests. Many more needed attention but weren’t urgent. To leave after accepting their promise to go to an emergency room guarantees intense worry on my part. If the guest decides to wait, and something dreadful happens, I’m the last doctor he or she saw, a situation that brings joy to the heart of malpractice lawyers. When a guest needs an emergency room, I stay until they head off. I’ve done this 51 times.

37 guests asked for a visit but weren’t in the room when I arrived. 58 refused to pay. 18 paid with a bad check. I don’t record guests who get a discount but 1331 paid between $5 and $50. 102 guests paid nothing. I will not deny that I have a category for “celebrity.” It has 90 entries although that includes their wives and children. I try to head off drug abusers over the phone but 77 slipped through. The diagnosis on four was “drunk,” but that’s certainly too few.

Friday, May 25, 2012

A Hotel Doctor's Database

At the end of every month I enter my data into the computer. It takes an hour during which the past flashes before my eyes. I re-experience its pleasures: calls from new hotels, dramatic cures, wee-hour or distant visits (extra money with the tedium a distant memory), and gratitude but also the pain: visits that didn’t turn out well, regular hotels that should have called but didn’t. At the end I punch F10 and the screen displays the month’s events: total calls, total visits, and income.

Few things besides wine and cheese improve with time, but a database is among them. Since 1984 I’ve answered the phone over 30,000 times and made 16,634 visits.

Of those visits, nearly 12,000 requests came directly from a hotel, but hotels are only the first of five sources of calls.

My second source is agencies that insure travelers visiting America: 2958 visits. Sick guests phone the agency’s US office; the agency phones me; I make the housecall and send my bill to the agency. I like these calls. Foreigners defer to doctors more than Americans, and patients who do not pay directly are less demanding. Sadly, some insurers are adopting the American system of requiring elaborate forms, itemization, and codes for every procedure. Others pay very slowly and only after many reminders. When my patience runs out, I ask for a credit card number so I can pay myself. If they refuse, I stop accepting their calls.

This doesn’t mean I stop seeing their clients because they switch their business to the third source that I call “competitors:” 1213 visits. These are national housecall services with names like Expressdoc, AMPM Housecalls, Hoteldoc, Housecall MD. If you live in a large city, they’re available, but their fees may take your breath away. All claim to provide a prompt housecall, but this is hype. None employ doctors, so when a request arrives, the dispatcher consults a list of local practitioners and begins calling. Finding a doctor willing to make a housecall at a moment’s notice is hard except in Los Angeles. Since I collect my usual fee, I don’t care if a travel insurer calls directly or calls a housecall service.

Category four is foreign airline crew: 655 visits. American airlines have no interest in what happens to crew when laying over. They have medical insurance, but with no transportation or knowledge of facilities in a strange city, they are out of luck. Occasionally I deal with their pitiful calls and treat them as charity cases. As with American insurance carriers, billing an American airline for a housecall is hopeless. 

A minor fifth category is what I call “private-parties:” 55 visits. These are people who learn about me from another source. That includes locals as well as former patients who return to the city and call me directly.

In a few days, I’ll extract some interesting statistics from the database.

Thursday, May 17, 2012

Everything Feels Worse in the Middle of the Night

That’s my mantra during a wee-hour visit.

I’ve made a thousand housecalls that got me out of bed. Patients are often suicidally reluctant to wake a doctor, but I don’t object. Freeway traffic is light, parking is easy, and since I have no office, I can sleep late.

What happens in a hotel room when the lights go out? Mostly, guests stub their toes and bump into furniture. I bring a flashlight when I go on vacation.

Many callers have awakened in the dark certain something terrible is about to happen. Now and then life seems overwhelming, and everything feels worse in the middle of the night. I try to handle anxiety attacks over the phone using sympathy and calm reassurance. Logic is useless; I never point out that nothing terrible will happen because guests know that; it’s one reason they’re upset. I explain that no one is perfect; sometimes our brains go haywire, but it never lasts long. If I can keep the guest on the line, this almost always works. Making a housecall is risky because guests often begin to feel better and cancel before I arrive, or they feel worse and call paramedics.

Unlike many doctors, hotel doctors included, who use the paramedics as a substitute for getting out of bed, I reserve them for emergencies. Mostly, these are obvious. Heart attacks can rouse victims from sleep, but they are not subtle. Niggling chest discomfort doesn’t qualify, and severe pain in a young person is probably something else. 

I see a cross-section of ailments, but guests with an upset stomach seem overrepresented. I consider a wee-hour visit for vomiting a good call (i.e. not life-threatening; I can help; patients are especially grateful). The latest antivomiting drug, ondansetron, is superior to Compazine, the choice for the past fifty years. Ondansetron was once wildly expensive and used only for vomiting after cancer chemotherapy, but its patent expired a few years ago, and the price has plummeted, so I can afford it.

Most violent upset stomachs don’t last long. I assure guests they’ll probably feel better when the sun rises , and (a perk of being a doctor) when that happens, guests are convinced I’ve cured them.

Tuesday, May 8, 2012

You Can't Make a Diagnosis Over the Phone

“Of course, you can’t make a diagnosis over the phone,” guests tell me.

But I can. Doctors do it all the time. I’d estimate my accuracy at ninety percent. It may be one hundred percent for some problems: respiratory infections, urine infections, backaches, many rashes, injuries, anxiety attacks. Driving to the hotel, it’s relaxing to know in advance that the guest has chicken pox, gout, herpes, a bladder infection, an acid stomach, or the flu. I can deliver my diagnosis, advice, and medication, collect my money and thanks, and drive home. What an easy job!

Jumping to conclusions is a major reason doctors get into trouble, but this is less of a problem when I make a housecall. A guest may announce that he’s having an allergic reaction and then describe symptoms that don’t quite fit. An examination will provide better information. 

Phone consultations require caution. If a fifty year-old describes chest pain that doesn’t sound like a heart attack, it’s unlikely I’ll tell him that it’s OK to wait. It’s also unlikely that I’ll make a housecall because an examination rarely helps, and I hate collecting a fee and then telling a guest to go somewhere else and pay another fee. On the other hand, chest pain in a twenty year-old is almost never a serious matter.

Abdominal pain is tricky at any age. Guests suggest gas, indigestion, and constipation. I worry about a dozen conditions that require a surgeon’s urgent attention. Oddly, it’s reassuring when vomiting or diarrhea accompanies the pain. Provided the guest is in good health, it’s usually a short-lived stomach virus, among my most frequent reasons for a housecall. Without vomiting or diarrhea, I’m likely to suggest a clinic visit where a doctor can get more information than a housecall provides.

"I know it's not broken because...." You don't know. Neither do I.