Tuesday, June 26, 2012

Special Treatment

“Our general manager’s husband has an eye problem. Could you see him this morning?”

“I could.”

“She’s wondering how much you’d charge?”

“There will be no charge.”

The concierge sounded delighted. I was also pleased. She worked at a large West Hollywood hotel that doesn’t call often. The list of doctors at the concierge desk contains several names, but mine is not at the top. Given a list, most people call the first name first.

I don’t charge hotel staff, but caring for them delivers priceless public relations. A lower level employee will certainly talk about the experience. This is important because, even at hotels that call regularly, many employees don't know that I exist, and guests who ask for help usually ask only once.

Hotel managers, of course, have the power to make important decisions.

I’ve never been asked to see a general manager’s spouse, but it seemed wise to give him special treatment. He was staying in the penthouse. The eye problem presented no difficulty; I informed him that no treatment was necessary and symptoms should vanish once he began wearing goggles when riding his motorcycle.

On my way out, the general manager expressed gratitude. I nodded modestly and kept my hopes to myself.

Thursday, June 21, 2012

Waiting for the Second Call

“This is the Shore hotel.”

This sounds routine, but it brought joy to my heart. It was a first call!... I almost never acquire new hotels, and the Shore, an upscale, boutique on the Santa Monica beach, opened last October.

I and my rivals keep an eye on new construction. As the opening nears, more aggressive hotel doctors approach the general manager or visit the lobby to extol their virtues to the staff. I send a dignified letter of introduction to the GM. This rarely works, but after more letters and the passage of time – years or perhaps a decade or two – calls materialize.

Before leaving the Shore, I stopped at the front desk to introduce myself, give thanks for the referral, and pass out business cards. The clerks responded with enthusiasm, accepted my cards, and promised to keep me in mind, but it was clear they had no idea who I was. When asked who had contacted me, they scratched their heads, consulted colleagues, and admitted they had no idea.

This reminded me that, over thirty years, every Los Angeles hotel has called for the first time. These always excite me, but it’s surprising how often they never call again. A hotel’s first call means little; if I get a second, more follow.  

After two weeks, it’s too early to give up on the Shore, but the tension is rising.

Friday, June 15, 2012

Fatal Diarrhea

Coris USA, a travel insurer, sent me to see a 35 year-old Argentinean lady with diarrhea at the Beverly Hills Hotel.

When a hotel calls, I always speak to the guest. This allows me to take care of trivia without a visit and intercept problems which a housecall can’t help.

When a travel insurer calls, I never speak to the guest. This has the advantage of earning me money for tasks like replacing forgotten prescriptions, but there’s a downside. I insist on more information if the insurance dispatcher mentions symptoms such as chest pain or paralysis, but diarrhea seemed a no-brainer.

Arriving, I learned that her illness was entering its sixth day: too long to be the ordinary stomach virus. The diarrhea was profuse, and she felt weak and feverish. She had recently taken antibiotics, so I wondered this was Clostridium difficile colitis, a rare consequence of the avalanche of unnecessary antibiotics consumed by humans everywhere including readers of this blog.

Every antibiotic you swallow kills trillions of germs living in your bowel, most of whom are doing no harm. They are immediately replaced by other germs that can grow in the presence of that antibiotic (why would you want that?....). Most bowels don’t harbor C. difficile, but if yours does, antibiotics may convert a small population into a large one, and it produces an irritating toxin that causes diarrhea that can be fatal in debilitated hospital patients. 

Diagnosing Clostridium requires more than suspicion, and there were other obscure possibilities. She needed a thorough evaluation.

Fortunately, Coris USA is a good travel insurer: meaning that it (a) pays me promptly and (b) takes my advice. These sound like unrelated qualities, but I’ve found that good travel insurers do both, bad ones do neither.

I phoned Coris’s Miami office with the news and the name of the doctor I recommended. The dispatcher contacted the main office in Buenos Aires for authorization; it appeared within the hour, and the patient went off. If I were dealing with a bad insurer, authorization would be denied or simply vanish into the void. I might phone back several times to hear that authorization was still pending, and I often sent patients off, warning that they would have to pay up front and try for reimbursement later.

Tests turned up Clostridium difficile, and she began improving after a few days of treatment.

Monday, June 11, 2012

Free Enterprise in Action

Visiting Disneyland last week, a couple’s two year-old twins fell ill. The parents consulted the concierge, and a doctor who wasn’t me duly arrived.

The family then traveled to Hollywood to spend a few days before flying home to Australia.

A delightful perk of hotel doctoring is the “clearance to travel” visit. Few conditions make flying dangerous for otherwise healthy people. I usually tell guests to travel if they feel up to it, but some insurers demand an exam and written permission. That’s where I came on the scene.

The children had recovered, and I dutifully wrote my consent. From the parents’ description, they had suffered viral upper respiratory infections with cough, fever, congestion, and general miseries. The hotel doctor had diagnosed: “otitis, tonsillitis, bronchitis, and mild pneumonia.” He had given injections, handed over medication, and written prescriptions for antibiotics, cough medicine, and eardrops.

The parents showed me his invoices. The fee for one child totaled $495, for the other $390. The prescriptions came to over $100, so they paid nearly a thousand dollars for a single visit.

I occasionally see guests after they’ve seen another hotel doctor, and the resulting bills often contain a string of itemized charges and a spectacular total.

Nothing I do in a hotel room costs much. That doctor billed $30 apiece for his injections; those I carry for common problems (vomiting, pain, allergy) cost less than a dollar a dose. A syringe costs a dime. He handed over several small packets of pills, charging $20 apiece. I carry about twenty similar packets containing from three to eight pills. Each pill costs between a nickel and a quarter. A bottle of cough medicine costs $1.50. A week’s supply of antibiotics is usually less than $5.00. I pay about $3.00 for a bottle of antibiotic eye drops. Perhaps my most expensive drug is antibiotic ear drops at $8.00. Doctors charge $30 for a urinalysis, but the dipsticks they dunk in your urine come in bottles of 100 at $40.00. That’s 40 cents a dipstick.

Medicine is a noble profession, and while I’m in favor of doctors earning a large income, it’s beneath their dignity to pay obsessive attention to it. This might not be a majority opinion. Doctors with an office practice often insist that they are businessmen operating in a free market. As such, it’s reasonable to charge for every service they provide; sensible patients will understand. Many of these doctors yearn to charge for phone calls.

You can read more about how doctors and money interact on my blog for February 12, 2010. It’s a depressing story.

Wednesday, June 6, 2012

A Second Opinion

“I need a second opinion about something personal,” said an elderly man at a West Hollywood hotel.

It’s always pleasure to visit a patient who isn’t sick, although this seemed an odd situation. But first, since he was American and over 65, I explained that I wasn’t a Medicare doctor, so Medicare wouldn’t pay for this visit.

“That’s OK. I need to see you.”

I drove to the hotel and listened as he explained that his scrotum hung too low. His family doctor hadn’t taken it seriously, so he wanted my advice.

On examination, his scrotum appeared normal although perhaps a bit long. I asked how this caused a problem.

“When I sit on the toilet, it dips into the water,” he said.

I scratched my head.

“A urologist could probably do surgery to shorten it, but I’m not sure Medicare would pay.... Why don’t you lower the water in the toilet bowl?”

Tuesday, June 5, 2012

You Win Some....

I was awake at 7 a.m. writing this blog when a woman from an airport hotel called with symptoms of a bladder infection.

Being American, her first question before agreeing to a visit was: do I accept her insurance. I explained that I didn’t, adding that there was an urgent care clinic a mile away that would.

“I’d probably have to wait forever,” she said. “I have meetings this morning.”

“I’m definitely convenient,” I said.

“Do you bring the medicine?”

“I do.”

I wanted to finish writing and eat breakfast, so I told her I’d arrive at 9 a.m., thereby demonstrating that, despite my age, wisdom, and vast experience, I do stupid things.

It’s a rule of hotel doctoring to go as soon as possible. After waiting a few hours, guests often reconsider, so I knew what to expect when the hotel’s number popped up on my caller ID at 8:30.

“I’m feeling better,” she lied. “I won’t need to see a doctor after all.”

“You won’t save much at the clinic,” I suggested. “They’ll charge extra for the urine test and extra for the culture, and you’ll have to find a pharmacy and pay for the prescription.”

“Oh, no! I’m feeling fine,” she insisted. “Thank you for your help.” She hung up.

When patients cancel, I often console myself if the illness seems likely to produce an unsatisfying encounter; for example guests are often disappointed when I can’t cure their respiratory infection. But urine infections are easy to treat and produce dramatic improvement, so I hate to miss one.