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Friday, July 27, 2012

24 Hour Call

As a hotel doctor, I’m on duty 24 hours a day. This sounds oppressive until you realize that even a busy week – say twenty visits – requires about thirty hours of actual work. A downside is that calls can arrive at precisely the wrong time.

This one came one hour and twenty minutes before a dinner reservation with friends. I calculated furiously and decided I could make it. As always, time constraints were driving and parking. My destination, the Mondrian, was on the Sunset Strip, six miles away. It was Sunday, so traffic was tolerable, but street parking on the Strip is difficult. The Mondrian is not one of my regulars, so parking attendants would probably not accommodate me. The hotel possesses only a skimpy open space around the entrance, so the valets might drive my car deep into the garage where it might take ten minutes to retrieve. Worse, there was a chance they would charge for parking.

Making a snap decision, I drove past, but no street parking materialized. I turned down a side street but no luck, so I returned to the hotel, handed over my keys, and announced (incorrectly) that I was the hotel’s doctor.

I arrived at the room and introduced myself only to hear the discouraging question: “Spik Spanish?”

I shook my head regretfully and began asking questions in English. This usually works because most Latin American male guests speak enough English to get along (women don’t do so well). Sadly, he proceeded to perform the Zero-English pantomime: pointing to his throat, pointing to his head, making coughing noises.

No problem. American hotels could not survive without Hispanic employees, and I doubt if naturalized citizens make up a majority. Peering outside the door, I appealed to a group of maids on their cleaning rounds, but they were recent arrivals and spoke no English. Luckily, a bellman pushing a food cart was bilingual.

Delivering medical care was, as always, the easiest part. To my delight, the valets had held my car, and I arrived at the restaurant not excessively late.

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. 

Saturday, July 14, 2012

Unexpected Symptoms

Universal Assistance asked me to see a young woman with abdominal pain at the Airport Marriott. According to the dispatcher, she had no other symptoms.

As I’ve mentioned, I prefer abdominal pain accompanied by vomiting or diarrhea. This is usually a stomach virus and easy to treat. Abdominal pain alone is trickier. Talking to the guest beforehand, I often conclude that he or she requires more than I can provide in a hotel room.

I never talk to guests when travel insurers call, so I sometimes encounter an urgent problem. A big advantage of dealing with an urgent problem through travel insurers is that I send them a bill and get paid. When guests call directly, I always discuss my fee, but in the distress of hearing upsetting news during the visit, dealing with paramedics, or hurrying off to an emergency room, they sometimes forget to pay, and I’m reluctant to remind them.

Arriving in the room, I learned things the insurance dispatcher hadn’t mentioned. The woman was three months pregnant and had noticed vaginal bleeding. That meant she had to go to an emergency room. It’s surprising how often doctors know the diagnosis as soon they set foot in the room, but it looks bad to blurt it out, so I asked questions, performed an exam, delivered my conclusions, and then phoned the insurance office with the news.

The following afternoon, the lady’s husband called. They were back in the hotel. The emergency room doctor had diagnosed a miscarriage, he explained. That was also my diagnosis.

The doctor had discharged his wife, he added. But she was still bleeding. Was that normal?...

Bleeding stops when a miscarriage is complete; if it continues, a doctor performs a D&C to remove remaining tissue. I have no explanation of why she was sent out still bleeding. I told the husband that, sadly, he would have to take her back. The second time she received her D&C.   

Monday, July 2, 2012

A Quick Look

“My other son is coming down with something. Do you mind taking a quick look?”

If you wonder if it annoys doctors to see an extra patient at the last minute, it does. They grumble regularly on physician internet forums which, like forums in general, are full of petty complaints.

In an office, that second patient generates a second bill, but I rarely charge double in a hotel. Driving takes up 80 percent of my housecall time, so an extra consultation doesn’t add much. I’m also aware of one rule of medicine that may come as a surprise.

Rule:  If one member of a family is ill, it might be serious. When two members are ill, it’s never serious.

A guest with chest pain, vertigo, or difficulty breathing is probably the only one in the room suffering. When two people are sick, it’s a respiratory infection: cough, congestion, fever, sore throat… These are not serious.

No medical rule is one hundred percent accurate, but I’d rate this near 99. In an otherwise healthy person, the only common, serious, and curable respiratory infection is bacterial pneumonia. Since pneumonia is not generally contagious, I’ve never seen two cases in the same room.